" " ;DIANAHEALTH ;;"SEARCH CRITERIA" ;;"Initiative: "; ;;"Speciality: "; ;;"Intervention type:"; ;;"Publication Year:";; ;;"Recomendation type:"; ;;"Search Terms:"; ;;; Id;Initiative;"Initiative Name";Institution;Language;Title;Description;"Publication Year";Speciality;Intervention;"Recommendation Type";Keywords;Source 6969;1;"NICE ";NICE;English;"Induction of therapeutic hypothermia is not recommended to prevent fever and improve neurological outcomes after cardiac arrest";"Cardiac arrest occurs when normal blood circulation suddenly stops because the heart is not contracting effectively. The underlying abnormal heart rhythms most commonly associated with cardiac arrest are: ventricular fibrillation (VF), asystole, pulseless electrical activity, and pulseless ventricular tachycardia (VT). Cardiac arrest causes loss of consciousness, respiratory failure, and ultimately death. Treatment of cardiac arrest includes immediate cardiopulmonary resuscitation to restore circulation and prevent further brain injury. Standard care may also include mechanical ventilation and medications such as epinephrine and amiodarone. After cardiac arrest, comatose people who have return of spontaneous circulation (ROSC) can actively control their core body temperature. This is done to: prevent fever (maintaining a core temperature between 36.5�C and 37.5�C), or induce therapeutic hypothermia (cooling to a core temperature typically between 32�C and 36�C). The goal is to reduce brain injuries and improve neurological outcomes. To see the quality of the evidence for the induction of hypothermia to prevent neurological injuries after cardiac arrest, an exhaustive search of the literature and a detailed review of the evidence from 9 sources was performed. The evidence included 8 systematic reviews and meta-analyses and 1 randomized controlled trial (RCT). As adverse effects, it was seen that the use of large volumes of intravenous saline solution to induce therapeutic hypothermia before hospital admission can cause side effects such as pulmonary edema.";2024;;;Uncertain;-;"Temperature Control to Improve Neurological Outcomes After Cardiac Arrest" 6971;1;"NICE ";NICE;English;"Pharyngeal electrical stimulation is recommended in people with neurogenic dysphagia undergoing tracheostomy after stroke";"Difficulty swallowing (dysphagia) is caused by neurological impairment. It can occur due to several conditions. Dysphagia can lead to malnutrition, dehydration, aspiration pneumonia, and death. Current treatment includes: dietary modification (including liquids and thicker foods); in moderate or severe dysphagia, nasogastric tubes, percutaneous endoscopic gastrostomy tubes, or jejunostomy tubes may be used to provide nutritional support; rehabilitation through swallowing therapy; for some people, transcutaneous neuromuscular stimulation. In electrical stimulation, a catheter with 2 electrodes on the outside is passed through the nose to the pharynx. Focused stimulation aims to increase brain activity in the swallowing control center and restore neurological control of swallowing function. The evidence is based on a rapid review of the published literature on the effectiveness and safety of this procedure. This involved a comprehensive literature search and a detailed review of evidence from 8 sources. The evidence included 2 systematic reviews and meta-analyses, 3 randomized controlled trials (RCTs), 1 registry analysis, and 2 pilot RCTs. For people with neurogenic dysphagia after stroke who do not have a tracheostomy and people with other causes of neurogenic dysphagia, more research is needed on pharyngeal electrical stimulation.";2024;;;"High value";-;"Pharyngeal electrical stimulation for neurogenic dysphagia" 6972;1;"NICE ";NICE;English;"Intravascular lithotripsy is recommended to treat peripheral vascular disease in patients with femoroplopitis, iliac lesions, and chronic limb ischemia.";"Peripheral arterial disease consists of the accumulation of plaques in the arteries, restricting the blood that reaches the extremities, causing symptoms at rest or gangrene. It is characteristic in DM or chronic kidney disease. Lithotripsy is the procedure through which, through an angioplasty balloon with wave emission, the vessel is expanded by fracturing the calcium in the arterial wall. It can be used as an alternative to standard angioplasty, although sometimes the application of a stent will also be required to keep the vessel patent. The amputation of limbs that do not receive sufficient flow is prevented. The evidence is summarized in an exhaustive search for detailed information from 10 sources discussed in committee.";2024;;;"High value";-;"Intravascular Lithotripsy for Calcified Arteries in Peripheral Arterial Disease" 6973;1;"NICE ";NICE;English;"There is uncertainty in using the Software derived from artificial intelligence to assist in clinical decision making in the event of stroke";"Stroke negatively affects the quality of life of many people who survive it. Greater and faster access to treatment could improve clinical outcomes and therefore quality of life after stroke. AI-derived software used in conjunction with healthcare professionals' interpretation of brain CT scan images could guide and facilitate stroke decision-making, for example, decisions about thrombolysis and thrombectomy treatment. AI-derived software uses fixed (or static) algorithms in clinical practice, and AI is used to derive new versions of the algorithm. Clinical evidence on the software is of limited quality. There is no evidence on their diagnostic accuracy when used in conjunction with review by healthcare professionals who met the review inclusion criteria. Some studies of two technologies (e-Stroke and RapidAI) in clinical practice suggest that people had greater or faster access to treatment after using the software, but it is unclear to what extent this is an effect of the software. In the economic model, a small increase in the number of people undergoing thrombectomies due to AI-derived software would likely make the software profitable. The software is already widely used in the British National Health Service and should always be used with the review of a healthcare professional. Because a potentially important benefit of the technologies is improving image sharing between centers to assist with urgent decision making, centers should ensure that shared images are of sufficient quality to allow remote image review.";2024;;;Uncertain;"Diagnosis (image)";"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6974;1;"NICE ";NICE;English;"The use of antibiotics to prevent or treat COVID-19 is not recommended unless there is clinical suspicion of additional bacterial co-infection in general population ";"Do not offer an antibiotic to prevent or treat pneumonia if the cause is likely to be SARS-CoV-2, another virus, or a fungal infection. Antibiotics do not work against viruses, and inappropriate use of antibiotics can reduce their availability. Additionally, inappropriate use can lead to Clostridioides difficile infection and antimicrobial resistance, particularly with broad-spectrum antibiotics. Evidence suggests that antibiotics such as azithromycin are no better than standard care for reducing the risk of death in people hospitalized with COVID-19. Limited evidence also suggests that azithromycin does not reduce the risk of hospitalization or death in people with COVID-19 in the community. There is no evidence of the use of azithromycin for the treatment of COVID-19 in children. The panel did not think there was reason to expect different results in this group, so they agreed that the recommendation applies to all age groups. They also noted the risk of antimicrobial resistance with azithromycin.";2024;;;"Low value";"Covid-19 treatment";"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6975;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is not recommended to treat adults with mild depressive episodes with antidepressants as a first therapeutic option.";"A depressive episode is considered to be mild when the depressive symptoms have a limited impact on the person's daily life. Operationally, depression can be considered mild when the score on the Patient Health Questionnaire (PHQ-9) is less than 15 points. The efficacy of antidepressants is low in mild cases, most of the evidence has been generated in people with moderate or severe depression and, in general, the more severe the depressive symptoms, the more beneficial the pharmacological treatment. In contrast, adverse events are well known, including gastrointestinal symptoms such as nausea, dry mouth or diarrhea, sexual dysfunction, sleep disturbances, weight gain, anxiety, tremor, overstimulation, agitation and cardiovascular risk. For these reasons, antidepressants are not currently recommended as the first therapeutic option, but rather interventions related to support, guided self-help, psychoeducation, structured physical exercise or social prescription should be prioritized. This evidence derives from a recent network meta-analysis of interventions in mild depression, based on 142 randomized clinical trials with a total of 20,663 participants, where interventions such as exercise, self-help, a wide range of psychological therapies and antidepressants have been compared.";2024;;;"Low value";Treatment;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6977;15;"U.S. Preventive Services Task Force A and B recommendations";USPSTF;English;"There is uncertainty in the detection of speech and language retardation and disorders in children under 5 years of age.";"Delays and disorders of speech and language can pose significant problems for children and their families. Evidence suggests that school-age children with speech or language delays may be at increased risk for learning and literacy disabilities, including reading and writing difficulties. Observational cohort studies suggest that children with these conditions may also be at increased risk for social and behavioral problems as well as learning problems, some of which may persist into adulthood. It is concluded that the evidence is insufficient to evaluate the balance of benefits and harms of the detection of speech and language delay and disorders in children who do not present signs or symptoms or concerns of parents/caregivers. This is not a recommendation for or against screening, and the USPSTF is calling for more research into the benefits and harms of screening.";2024;;;Uncertain;Diagnosis;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6978;1;"NICE ";NICE;English;"There is uncertainty regarding Sebelipase alfa therapy in infants and children under 2 years of age as a long-term treatment for Wolman's disease.";"Evidence from clinical trials suggests that sebelipase alfa increases the life expectancy of patients with Wolman's disease (rapidly progressive lysosomal acid lipase deficiency), a rare genetic condition that occurs in infants and children under 2 years of age. It causes a buildup of fat in the cells of the liver, heart, blood vessels and digestive system. Without treatment, the infant or child will not survive. With sebelipase alfa treatment, it is unclear how much longer these patients will live and how their long-term quality of life compares to that of people without this condition. Because of clinical uncertainties, including those related to how sebelipase alfa is used in the treatment pathway for people with Wolman disease. Enzyme replacement therapy with sebelipase alfa has cost-effectiveness estimates are also uncertain. When considering that this is a very serious condition and the effect of sebelipase alfa on quality of life and length of life, the most likely cost-effectiveness estimates are within the range that NICE considers an acceptable use of NHS resources. Therefore, sebelipase alfa is recommended. ";2024;;;Uncertain;Treatment;"Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6979;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"There is uncertainty about the use of digoxin in the treatment of arrhythmias.";"Single case study that describes the situation of a woman with adverse effects from taking digoxin. Symptoms and signs were chest pain, nausea, anorexia and fatigue.";2024;;;Uncertain;-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6990;1;"NICE ";NICE;English;"It is recommended that a physician with basic competencies in acute illness evaluate the patient, as well as perform blood tests and give antibiotics for suspected sepsis in acute hospital settings in patients over 16 years of age at risk of severe illness or death from sepsis.";"In the management of suspected sepsis in acute hospital settings in patients over 16 years of age at risk of severe illness or death, it is recommended that a physician with basic competencies in acute illness evaluate the patient, as well as perform a blood test. which includes: blood gases, including measurement of glucose and lactate, blood culture, complete blood count, C-reactive protein, urea and electrolytes, creatinine, liver function tests and a coagulation study. It is also recommended to administer antibiotics in line with the recommendation of choosing antibiotic therapy in people with suspected sepsis.";2024;;;"High value";-;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6997;1;"NICE ";NICE;English;"Endoscopic sleeve gastroplasty is recommended as an option to treat obesity in adults.";"Endoscopic sleeve gastroplasty is a minimally invasive transoral endoscopic procedure that reduces the volume of the stomach and may delay gastric emptying. It creates a sensation of fullness and reduces the amount of food that can be eaten at one time. Evidence on safety shows this procedure is safe in the short and long term. Evidence on efficacy shows that, when combined with lifestyle changes, people with a body mass index (BMI) over 30 kg/m2 who have the procedure lose weight. So, it can be used with standard arrangements. The recommendation is based on a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 8 sources, which was discussed by the committee. The evidence included 1 randomised controlled trial, 4 systematic reviews and meta-analyses, 2 cohort studies and 1 propensity score matched study. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in the appendix of the overview. ";2024;;;"High value";-;"Link to the recommendation on the website of the initiative" 6999;6;"Less Is More Collection - JAMA Network";"JAMA Network";Spanish;"There are limited benefits of routine viral testing in EDs for adult patients with acute respiratory infection (ARI). ";"In this systematic review and meta-analysis of 11 randomized clinical trials, rapid viral testing was not associated with reduced antibiotic use, ED length of stay, and the rate of ED return visits or of hospitalization. However, rapid viral testing was associated with moderately increased influenza antiviral use (absolute risk difference 1%) and decreased use of chest radiography and blood tests (absolute risk difference, 3%-4% each). Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Two independent reviewers (T.S. and K.W.) extracted data and assessed risk of bias using the Cochrane Risk of Bias, version 2.0. Estimates were pooled using random-effects models. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.";2024;;;Uncertain;-;"Link to recommendation at the initiative's website" 7000;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is recommended to carry out a thorough examination of the person with intellectual and developmental disabilities who present a behavioral alteration or discomfort to avoid diagnostic overshadowing.";"Diagnostic overshadowing or diagnostic masking is a phenomenon by which health professionals attribute a physical or behavioral symptom to intellectual and developmental disability, without considering other factors. Although the concept was originally applied to people with intellectual and developmental disabilities, this bias affects other groups, to which the use of the term is being extended. To prevent diagnostic masking from occurring, the guidelines recommend that the health professional who cares for a person with intellectual and developmental disabilities and manifestations of disruptive behavior, restlessness and/or emotional distress, make a systematic and hierarchical assessment of possible triggers for behavior change. Other guides do not talk so much about a graded assessment as much as a comprehensive evaluation of the biopsychosocial problems that arise: clinical, family, psychosocial and treatment histories; with observational data from the patient, family and all agents who provide assistance.";2024;;;"High value";-;"Link to recommendation at the initiative's website" 7002;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely: Things we do for no reason";Spanish;"Continuous monitoring and further laboratory testing is recommended instead of ECG in patients with mild hyperkalemia at risk for rapid potassium increases or dangerous arrhythmias. ";" Hyperkalemia in this context is associated with increased all-cause mortality Cardiac toxicity and arrhythmia are feared complications of hyperkalemia and a retrospective study from 2017 showed that ECG changes in patients with potassium >6.5?mmol/L predict the risk of short-term adverse cardiac events. Hyperkalemia in this context is associated with increased all-cause mortality. Pseudohyperkalemia, a false elevation in measured potassium levels most frequently caused by cellular lysis during sample collection or processing, is also common in hospitalized patients and may be challenging to distinguish from true hyperkalemia.";2024;;;"High value";-;"?Link to the recommendation on the website of the initiative" 7003;1;"NICE ";NICE;English;"The diagnostic and treatment of vitamin B12 deficiency is not recommended in adults over 16 years of age.";"Vitamin B12 deficiency is caused by a lack of the vitamin in the diet or problems with absorption in the gastrointestinal tract (for example, due to autoimmune gastritis or major gastric resection). Vitamin B12 deficiency is usually diagnosed and treated in primary care. A blood test is usually done when people have symptoms such as unexplained fatigue, which can be common in many conditions, or when there are abnormal results on other blood tests. Testing is also performed when investigating conditions such as anemia, macrocytosis, and neuropsychiatric or neurodegenerative symptoms or signs. Treatment for vitamin B12 deficiency depends on the cause, but the goal is to replace vitamin B12 and improve the person's symptoms. The most common treatments are oral vitamin B12 replacement or intramuscular injections administered by a healthcare professional. Low quality evidence. This evidence was downgraded due to methodological problems. Limitations due to the specific recruitment of patients from charities and social networks, support groups and an unclear relationship between the researcher and participants. The evidence was also downgraded due to concerns regarding adequacy, as the findings were based on an individual study with a small number of participants. The committee considered that some symptoms and signs of vitamin B12 deficiency are common, may not affect daily life in isolation and may overlap with other conditions, and therefore the person will not be able to attribute them to their deficiency.";2024;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7005;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"Co-administration of furosemide-albumin is not recommended in patients with resistance to diuretics.";"Diuretic resistance is defined as urine output of <100?150 mL/h during the first 6 h after loop diuretic administration. Two proposed mechanisms explain why albumin infusion preceding furosemide (hereon referred to as ?coadministration?) might facilitate diuresis and/or overcome resistance. The first mechanism, based onpharmacokinetics, postulates that albumin binds furosemide so tightly that it prevents filtration in the glomerulus. Instead, the nephron actively secretes furosemide into the proximal tubule, where it inhibits the Na/K/Cl transporter. Decreased albumin results in decreased binding of furosemide, which allows furosemide to get filtered through the glomerulus rather than delivered to its site of action, resulting in decreased activity. Finally, the authors concluded that the analysis cannot determine the effect of coadministration on edema resolution, as they used urine output as a surrogate and the articles included in their study did not report weight reduction. A 2014 metaanalysis of 10 randomized controlled trials, updated meta?analysis in 2021, which included four new studies and all but one of the studies in the original meta?analysis and three other studies, that showed no significant differences in their primary outcomes, show high quality of evidence. Specific patient populations predisposed to hypoalbuminemiamay benefit from coadministration. Patients with nephrotic syndrome or cirrhosis for example. In the 2021 updated meta?analysis, patients with serum albuminlevels of less than 2.5 g/dL most benefited from coadministration.";2024;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7007;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"An electrocardiogram is not recommended in the management of mild hyperkalemia in hospitalized adults.";"Potassium is a highly regulated intracellular cation with serum concentrations maintained between 3.5 and 5.0?mmol/L.1 Deviations from this range impact cardiac function by altering physiologic membrane potential. Hyperkalemia (concentration >5.0?mmol/L) has depolarizing effects on myocytes, increasing the risk of cardiac arrhythmia. With increasing potassium levels, there is loss of P waves, development of sine-wave pattern conduction, atrioventricular (AV) junction delay, and ultimately cardiac arrest from ventricular fibrillation or asystole. While the definitions of hyperkalemia severity vary in the literature, potassium levels between 5.0 and 6.0?mmol/L are generally termed mild hyperkalemia. Rather than routinely obtain ECGs for patients with laboratory-confirmed hyperkalemia <6.0?mmol/L, we recommend physicians rely on serum measurements to guide management. Use continuous cardiac monitoring and increased frequency of laboratory testing, rather than ECGs, for patients with mild hyperkalemia at risk for rapid increases in potassium or dangerous arrhythmias. There are no published studies demonstrating that ECGs improve diagnostic accuracy, time to treatment, or outcomes in hospitalized patients with mild hyperkalemia. A retrospective analysis of 305 admitted patients showed that those with moderate hyperkalemia (6.0?7.0?mmol/L) had similar rates of ECG changes as their normokalemic controls.";2024;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7015;1;"NICE ";NICE;English;"It is recommended not to delay transfer to the hospital to administer antibiotics to people with suspected or strongly suspected bacterial meningitis or meningococcal disease.";"Bacterial meningitis is an inflammation of the membranes surrounding the brain and spinal cord, caused by a bacterial infection. We use the term ""meningococcal disease"" to refer to disease caused by invasive meningococcal infection (including bloodstream infection and meningitis). The main bacteria that cause meningitis in adults, children, and babies older than 3 months are Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae (pneumococcus). Group B streptococci, Escherichia coli and other coliforms are common in babies under 3 months old. Listeria monocytogenes is very rare, but occasionally causes meningitis in older people, very young children, and in people with other risk factors. Strongly suspect bacterial meningitis in people with all of the red flag combination symptoms: fever, headache, neck stiffness, and altered level of consciousness or cognition (including confusion or delirium).";2024;;;"High value";"diagn�stico ";"link to the recomendation on the website of the initiative /enlace a la recomendaci�n en la pagina web de la iniciativa. " 7024;1;"NICE ";NICE;English;"It is no recommended to perform lumbar puncture if there is extensive or rapidly spreading purpura, infection at the lumbar puncture site, risk factors for an evolving space-occupying lesion or any symptom or sign, which might indicate raised intracranial pressure.";"Lumbar puncture is the only test that can directly confirm a diagnosis of bacterial meningitis. Antibiotics can affect the results of cerebrospinal fluid tests, so lumbar puncture needs to be performed before antibiotics when possible. The committee did not recommend a specific timeframe for performing lumbar puncture because they were concerned that it would be interpreted as a hard cutoff. The committee used their experience to highlight situations that need treating or stabilising before a lumbar puncture, because these are potentially life-threatening and present a greater risk than delayed meningitis investigations.";2024;;;"Low value";Diagnostico;"Link to recommendation on the website of the initiative/ Enlace en la p�gina web de la iniciativa" 7026;1;"NICE ";NICE;Spanish;"It is recommended to perform a lumbar puncture to obtain a sample of cerebrospinal fluid if there is clinical suspicion of neonatal infection. It is also recommended, if possible, to perform it before administering antibiotics. In addition, it is recommended to previously stabilize babies with suspected early-onset neonatal infection.";"A lumbar puncture to obtain a cerebrospinal fluid sample is recommended when there is a strong clinical suspicion of early-onset neonatal infection or there are clinical symptoms or signs suggestive of meningitis. Lumbar puncture is the only test that can directly confirm the diagnosis of bacterial meningitis. Before performing a lumbar puncture, it is recommended to treat unprotected airway, respiratory compromise, septic shock, uncontrolled seizures, and risk of hemorrhage. Antibiotics can affect the results of cerebrospinal fluid tests, so when possible, a lumbar puncture should be performed before antibiotics. The committee did not recommend a specific time frame for performing the lumbar puncture because it was concerned that it would be interpreted as a strict limit. The key period is the 1-hour period for administering antibiotics, but clinical judgment is needed to make decisions about how to adapt lumbar puncture to this period.";2024;;;"High value";"Lumbar puncture for the diagnosis of early-onset neonatal infection";"Link to the recommendation on the initiative website/Enlace a la recomendaci�n en la web de la iniciativa" 7027;1;"NICE ";NICE;Spanish;"Lumbar puncture is not recommended for infants with suspected early-onset infection if there is extensive purpura or infection at the puncture site. It is also not recommended to perform it in the presence of symptoms or signs that may indicate the presence of a space-occupying lesion or an increase in intracranial pressure.";"Lumbar puncture is not recommended if there is extensive or rapidly spreading purpura, infection at the lumbar puncture site, or risk factors for an evolving space-occupying lesion. It is also not recommended in the presence of any of these symptoms or signs, which could indicate increased intracranial pressure: new focal neurological characteristics (including seizures or posturing), abnormal pupillary reactions, a progressive and sustained drop in level of consciousness.";2024;;;"Low value";"Diagnosis of neonatal infection by lumbar puncture";"Link to the recommendation on the initiative website/Enlace a la recomendaci�n en la web de la iniciativa" 7028;1;"NICE ";NICE;English;"The recommendation of combined oral contraceptives as preventive medicine in women, trans men, or people born with any female reproductive organ at risk for epithelial ovarian c�ncer must be individualized according to the case.";"The use of combined oral contraceptives is only recommended if the risk of developing ovarian cancer exceeds the risk of developing breast cancer, after taking into account any risk-reducing surgery (mastectomy or salpingo-oophorectomy), procedures not indicated in high age or planned pregnacy cases. Several observational studies are used to conclude the evidence.";2024;;;"High value";Preventive;"Link to the recommendation on the website of the initiative" 7030;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";GenCat;Spanish;"Fosfomycin trometamol is recommended in acute uncomplicated cystitis in healthy women";"Acute uncomplicated cystitis is the most common form of urinary tract infection and manifests with voiding symptoms; acute onset dysuria, urinary urgency, polyaciuria, suprapubic pain or hemat�ria) It is important to carefully select the antibiotic to fight resistance. Clinical practice guidelines (European Association of Urology and Spanish Association of Urology) recommend single-dose treatment.";2024;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 7031;1;"NICE ";NICE;English;"There is uncertainty regarding treatment with epidermal radiotherapy using rhenium-188 paste in patients with non-melanoma skin cancer.";"Non-melanoma skin cancer is the most common type of cancer. It affects the cells in the top layers of the skin. The most common types of non-melanoma skin cancer are basal cell carcinoma and squamous cell carcinoma. The main symptom is the appearance of lesions (lumps or discoloured patches) on the skin. The lesions are mostly found on skin that is regularly exposed to the sun. The procedure is done without the need for anaesthesia or inpatient admission. It uses a beta-emitter radioisotope, rhenium 188, which can penetrate human tissue up to 3 mm deep. Rhenium 188 is bound to a matrix to form a paste. The evidence shows there are no major safety concerns with this procedure, and evidence on efficacy is promising. But the evidence is limited because most of the studies are retrospective and are small. Also, the calculation of how much rhenium 188 paste to use and the treatment margin around the tumour to use are not standardised for this procedure. So more research is needed. The procedure cannot be used safely on the upper eyelid because of potential damage to the cornea. ";2024;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 7032;1;"NICE ";NICE;English;"It is not recommended risk-reducing total hysterectomy in people with pathogenic variants other than MLH1, MSH2, MSH6 and PMS2, unless a personalised risk assessment shows a high risk of endometrial cancer that would necessitate hysterectomy or there is another gynaecological indication for hysterectomy.";"The genetic variants associated with ovarian cancer are the following: variants in BRCA1, BRCA2, RAD51C, RAD51D, BRIP1, PALB2, MLH1, MSH2 and MSH6 genes. Most of the people who carry a pathogenic variant for ovarian cancer do not have a family history suggestive of a genetic risk. This means many people have not sought testing for high-risk ovarian cancer pathogenic variants. Current best estimates are that only 3% of people with a pathogenic variant know that they are carriers. This proportion will increase with improved availability of genetic testing. Familial ovarian cancer affects people born with female reproductive organs (ovaries, fallopian tubes and/or a uterus). The committee based the recommendations on the evidence and their knowledge and experience. Twenty-five qualitative studies were included in this review. Risk-reducing surgery is already current practice, but the timing of when it is offered varies. There is currently no specific consideration for the timing related to specific pathogenic variants other than BRCA1 and BRCA2, and the committee noted that the recommendations will standardise this. The recommended ages for risk-reducing surgery correspond with increasing cancer incidence and offer the greatest potential for cancer reduction and associated healthcare cost savings. ";2024;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7034;15;"U.S. Preventive Services Task Force A and B recommendations";USPSTF;Spanish;"There is uncertainty regarding the balance of benefits and harms of primary care interventions to prevent child maltreatment.";"Child maltreatment, including child abuse and neglect, can have profound effects on health, development, survival, and well-being throughout childhood and adulthood. Because of the recommended schedule of regular health assessments and relationships with families, primary care physicians are uniquely positioned to identify child maltreatment. Evaluation of possible physical abuse may include a complete medical and event history, a physical examination, and additional diagnostic studies (e.g., imaging or laboratory tests) as needed. Multiple interventions have been studied to prevent child maltreatment, including primary care programs designed to identify youth at highest risk for maltreatment who may benefit from parent education, referral to community resources, approaches to increase use of strategies . of positive discipline and psychotherapy to improve the capacity of caregivers. Coping skills and strategies to strengthen the relationship between parents and children. Risk assessment instruments are designed to help identify youth for whom preventive interventions may be indicated. However, the USPSTF found limited and inconsistent evidence on the validity and reliability of risk assessment instruments. There is no gold standard for these instruments; The measures to validate the instruments are imprecise and probably over- or under-report true child abuse. Thus, limited evidence was found on the harms associated with interventions to prevent child maltreatment. Given widespread racial and ethnic disparities in the reporting, investigation, and placement of child maltreatment in the child welfare system, biases in the identification of child maltreatment may disproportionately harm Black, Hispanic, and American Indian/Alaska Native families. Other potential harms of preventive interventions include social stigma and effects on family functioning and dynamics.";2024;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 6912;1;"NICE ";NICE;English;"Lumasiran is recommended for the treatment of primary hyperoxaluria type 1 in people of all ages.";"Primary hyperoxaluria type 1 is a rare inherited disease that can significantly affect the quality of life of people who suffer from it, their families and caregivers. In primary hyperoxaluria type 1, the liver produces excess oxalate that combines with calcium in the tissues to form toxic crystals. These crystals can cause recurrent kidney stones, kidney damage, and in severe cases, kidney failure and multi-organ damage. Standard care includes supportive measures, dialysis, and a liver and kidney transplant, depending on the person's kidney function. Evidence from clinical trials suggests that, after 6 months of treatment, lumasiran plus standard care reduces a person's oxalate levels compared to standard care alone.";2023;;;"High value";Tratamiento;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6913;1;"NICE ";NICE;English;"Maximal cytoreductive surgery is recommended as an option for advanced ovarian cancer in selected adults.";"The aim of maximal cytoreductive surgery for advanced ovarian cancer is to safely remove all identifiable disease, to improve survival, compared with surgery that leaves residual disease. It is a development and extension of standard surgery for ovarian cancer. Evidence on the safety and efficacy of maximal cytoreductive surgery for advanced ovarian cancer is adequate to support using this procedure";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6914;1;"NICE ";NICE;English;"Onasemnogene abeparvovec is recommended as a treatment for presymptomatic spinal muscular atrophy 5q with biallelic mutation in the motor neuron survival gene 1 and up to 3 copies of the motor neuron survival gene 2 in infants 12 months or younger.";"Spinal muscular atrophy a rare genetic condition. Some children are diagnosed with spinal muscular atrophy through genetic testing before symptoms appear if a sibling has been diagnosed with the condition. If left untreated, presymptomatic spinal muscular atrophy will become one of several types of spinal muscular atrophy of varying severity and symptoms. There are no routinely commissioned treatments for presymptomatic spinal muscular atrophy for use in the National Health Service. If presymptomatic spinal muscular atrophy develops into spinal muscular atrophy type 1, onasemnogene abeparvovec is an available treatment option in certain situations. Evidence from a clinical trial suggests that onasemnogene abeparvovec is effective for presymptomatic spinal muscular atrophy in infants. But it is difficult to estimate how well onasemnogene abeparvovec works, mainly because the trial only included babies aged 6 weeks or younger, and treatment before this time is not always possible in National Health Service clinical practice. Furthermore, long-term evidence on onasemnogene abeparvovec in presymptomatic spinal muscular atrophy is lacking.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6915;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"It is recommended the screening for depression in the adult population, including pregnant and postpartum persons, as well as older adults.";"Major depressive disorder, is a common mental disorder, that can have a substantial impact on the lives of affected individuals.If left untreated, MDD can interfere with daily functioning and can be associated with an increased risk of cardiovascular events, exacerbation of comorbid conditions, or increased mortality. Although screening for depression is recommended (grade B), it is concluded that the current evidence is insufficient on the benefit and harms of screening for suicide risk in adults, including pregnant and postpartum persons, as well as older adults. The evidence is from a systematic review.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6916;1;"NICE ";NICE;English;"Limited recommendation for the use of focal therapy using high-intensity focused ultrasound for localized prostate cancer in adults";"The therapy involves using high-intensity focused ultrasound to heat up and destroy only the areas of the prostate with cancer (focal therapy). The aim is to destroy the cancer while reducing damage to healthy prostate tissue. This procedure differs from standard whole-gland high-intensity focused ultrasound in that only some of the prostate is treated. Evidence on the safety of focal therapy using high-intensity focused ultrasound for localised prostate cancer is adequate, but evidence on its efficacy is limited. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";2023;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6917;1;"NICE ";NICE;English;"It is recommended the endoscopic ultrasound-guided biliary drainage for biliary obstruction caused by distal malignant disease.";"Biliary obstruction involves blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine. It may have benign or malignant causes, and can lead to symptoms including jaundice, nausea and abdominal pain, itching, pale stools and dark urine. Current standard management of biliary obstruction usually includes stenting using endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage. For malignant obstruction, treatment may also include chemotherapy, biological therapy, photodynamic therapy and radiofrequency ablation. The evidence comes from a review of the published literature on the efficacy and safety of this procedure. It included 1 systematic review and meta-analysis, 2 randomised controlled trials, 1 non-randomised comparative study, 5 case series and 1 case report. The evidence is adequate to support using this procedure. Although it is recommended using endoscopic ultrasound-guided biliary drainage (EUS?BD) for biliary obstruction caused by distal malignant disease. There is inadequate evidence on the safety and efficacy of using EUS?BD in biliary obstruction caused by malignant hilar or benign disease.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6918;1;"NICE ";NICE;English;"Limited recomendation for percutaneous thoracic duct embolisation procedure for persistent chyle leak in selected adults";"In this procedure, under general anaesthesia, ultrasound and X-rays are used to create an image of the thoracic duct and find the leak. Then, using a needle, a tube is inserted through the abdominal wall (percutaneous) and guided into the thoracic duct. Small metal coils and medical glue are inserted through the tube and used to plug the leak (embolisation). The aim is to stop the leak. Evidence on the safety and efficacy of percutaneous thoracic duct embolisation for persistent chyle leak is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";2023;;;"Low value";"Treatment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6919;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"Screening for anxiety disorders is recommended for adults aged 64 or younger, including pregnant and postpartum individuals.";"Anxiety disorders are commonly occurring mental health conditions. Anxiety disorders include generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder, phobias, selective mutism, and anxiety not otherwise specified. Anxiety disorders often go unrecognized in primary care settings, resulting in delays of years in the initiation of treatment. Anxiety can be a chronic condition characterized by periods of remission and recurrence. However, a complete recovery can occur. The US Preventive Services Task Force concludes with moderate certainty that anxiety screening in adults, including pregnant and postpartum people, has a moderate net benefit. The United States Preventive Services Task Force concludes that the evidence is insufficient on the detection of anxiety disorders in older adults, defined as 65 years or older.";2023;;;"High value";Diagnosis;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6920;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"Screening for latent tuberculosis infection is recommended for asymptomatic adults 18 years or older at higher risk";"Latent tuberculosis infection or latent tuberculosis infection is an infection with M. tuberculosis in which the bacteria are alive but contained by the immune system. Persons with latent tuberculosis infection have no apparent symptoms, do not feel sick, cannot spread tuberculosis to others, and usually have a positive tuberculosis skin test result or positive tuberculosis blood test reaction. Persons with latent tuberculosis infection may develop tuberculosis disease if they do not receive treatment for latent tuberculosis infection. Active tuberculosis or tuberculosis disease is an illness in which tuberculosis bacteria are multiplying and attacking a part of the body, usually the lungs. Tuberculosis disease may be symptomatic. A person with tuberculosis disease may be infectious and spread tuberculosis bacteria to others. It has been concluded with moderate certainty that there is a moderate net benefit in preventing active tuberculosis disease by screening for latent tuberculosis infection in persons at increased risk for tuberculosis infection.";2023;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6921;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea";Spanish;"Appropriate dosage of platelet transfusion";"Do not transfuse platelets prophylactically in adults and children over one year of age who have a platelet count >10 x 109/L unless there are signs, symptoms or risk factors for active bleeding or they are undergoing an invasive procedure.

Use a low dose of platelets (1/2 apheresis/pool of platelets in adults) for prophylactic transfusion (especially in patients weighing <50 kg) or at most intermediate doses (1 apheresis/pool in adults). It is not recommended to use double amounts of platelets. In pediatric patients, it will be transfused at the equivalent dose.

It is not recommended to transfuse platelets prophylactically more than once a day.

Post-transfusion platelet count monitoring is not recommended, except in cases of suspected refractoriness.";2023;;;"Low value";"platelet transfusion";"Appropriate dosage of platelet transfusion. MAPAC Navarra. 2023;4(4). ISSN: 2695-9135. Available at: https://n9.cl/5injz" 6922;1;"NICE ";NICE;English;"Transperineal biopsy for diagnosing prostate cancer";"It's recommended to use local anaesthetic transperineal (LATP) prostate biopsy using the freehand needle positioning device PrecisionPoint as an option for diagnosing prostate cancer.The current standard prostate biopsy is mpMRI-influenced local anaesthetic transrectal ultrasound (LA?TRUS) biopsy or mpMRI-influenced local anaesthetic transperineal (LATP) biopsy. Both routes use a transrectal ultrasound probe inserted into the anus to image the prostate. Both approaches are done in an outpatient setting. Although more research is needed to understand the cancer detection rates, adverse events and cost effectiveness; the most likely cost-effectiveness estimates for freehand needle positioning devices are within what NICE considers an acceptable use of NHS resources. The current standard prostate biopsy is mpMRI-influenced local anaesthetic transrectal ultrasound (LA?TRUS) biopsy or mpMRI-influenced local anaesthetic transperineal (LATP) biopsy. Both routes use a transrectal ultrasound probe inserted into the anus to image the prostate. Both approaches are done in an outpatient setting.";2023;;;"High value";Diagnostico;"Transperineal biopsy for diagnosing prostate cancer" 6923;1;"NICE ";NICE;English;"It is recommended botulinum toxin type A injections into the urethral sphincter only in special arrangements for clinical governance, consent, and audit or research for people with idiopathic chronic non-obstructive urinary retention caused by external urethral sphincter dysfunction";"Idiopathic non-obstructive urinary retention is the inability to completely empty the bladder when there is no physical obstruction (in the urethra or bladder neck) to normal urine flow. It can be caused by urethral sphincter dysfunction. This can be because of dysfunctional voiding, urethral sphincter hyperactivity or inadequate relaxation of the urethral sphincter (for example, Fowler's syndrome in younger women and people with female anatomy), or bladder functional problems (detrusor muscle underactivity, or detrusor hyperreflexia and inadequate contractility). Idiopathic non-obstructive urinary retention is often asymptomatic, but some people have lower abdominal discomfort and pain. Current treatments for non-obstructive urinary retention include urotherapy (that is, education and rehabilitation for bladder and bowel management), an alpha-adrenoreceptor blocker medicine, urethral dilatation or clean intermittent catheterisation. When the condition is refractory to these treatments, it may be treated with sacral nerve stimulation or urinary diversion procedures. External urethral sphincter dysfunction is rare, and evidence from observational studies suggests that the procedure may improve symptoms. But there are uncertainties about how well it works and how safe it is in the long term. So, it should only be used with special arrangements for external urethral dysfunction. Evidence on the safety and efficacy of botulinum toxin type A injections into the urethral sphincter for idiopathic chronic non-obstructive urinary retention from all other causes is inadequate in quality and quantity. So, it should only be used in research when there are other causes.";2023;;;"High value";treatment;"Enlace a la recomendaci�n en la pagina web de la iniciativa" 6924;1;"NICE ";NICE;English;"It is recommended that minimally invasive fusionless posterior-approach surgery to correct idiopathic scoliosis in children and young people should be used only in research.";"Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis in children and young people. It is progressive and the exact cause is unknown. Mild to moderate spinal curvature does not cause any health problems but can cause cosmetic concerns. Severe spinal curvature with secondary rib changes can also cause significant pain and lung problems. Treatment of AIS depends on several factors, including skeletal maturity, location of the spinal curve, speed of curve progression and size of the curve. Conservative treatments for mild to moderate AIS include routine surveillance (spinal imaging to monitor progression) and physical therapy. For severe AIS, interventions include casting or bracing (for curves of more than 25 degrees) or spinal fusion surgery (for curves of more than 40 degrees) with various instrumented metallic fixation techniques and grafting to fuse vertebrae. Minimally invasive growth modulating and fusionless surgical techniques to correct idiopathic scoliosis include vertebral body stapling, vertebral body tethering, magnetically controlled growing rods and sublaminar polyester bands. These are also used for AIS in some people. The aim is to correct the scoliosis, prevent progression, restore balance, and reduce pain and morbidity. Evidence from a rapid review indicates that minimally invasive fusionless posterior-approach surgery to correct idiopathic scoliosis in children and young people should be used only in research. ";2023;;;"High value";Treatment.;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6925;1;"NICE ";NICE;English;"Su recomendado s�lo debe utilizarse con acuerdos especiales de gobierno cl�nico, consentimiento y auditor�a o investigaci�n Estimulaci�n intramuscular del diafragma para la insuficiencia respiratoria cr�nica dependiente de ventilador por lesiones medulares altas.";"High spinal cord injuries can damage the nerves that control breathing and cause chronic respiratory failure. Standard care for managing chronic respiratory failure in people with high spinal cord injuries includes non-invasive forms of ventilation support (such as bi-level positive airway pressure). In advanced stages of respiratory failure, mechanical ventilation is done through a permanent tracheostomy. Phrenic nerve pacing is an alternative treatment for people who have intact phrenic nerves (the nerves that contract the diaphragm). The diaphragm is stimulated to contract by electrodes placed on the phrenic nerve in the neck or thorax. The aim of intramuscular diaphragm stimulation is to make the diaphragm contract, enabling a full or partial weaning from mechanical ventilation. This procedure needs intact phrenic nerve function. It avoids the need to access the phrenic nerve through the neck or thorax, as well as reducing the risk of phrenic nerve damage. The evidence for this procedure is limited because there is a lack of long-term data and no high-quality clinical trials. But the evidence does suggest that this procedure may improve quality of life and enable people to have some ventilator-free time each day. The evidence on safety includes reports of electrode insertion site infection and pneumonia, but it is not certain if pneumonia is directly caused by the procedure. More research will offer more evidence on safety and long-term outcomes. High spinal cord injury is severely disabling. For people who are dependent on mechanical ventilation, this procedure offers one of few options that could enable them to have some ventilator-free time. So, this procedure is recommended but only with special arrangements.";2023;;;"High value";treatment;"enlace a la recomendacion en la pagina web de la iniciativa" 6926;1;"NICE ";NICE;English;"It is not recommended the use of artificial intelligence ?derived computer-aided detection software alongside clinician review of computed tomography scan images for people having a chest computed tomography scan because of signs or symptoms that suggest lung cancer.";"Lung cancer is one of the most common types of cancer. It causes symptoms such as persistent cough, coughing up blood, and feeling short of breath. People in the early stages of the disease may not have symptoms, so lung cancer is often diagnosed late. Detecting lung nodules could help find lung cancer early. Lung nodules can be seen on a chest computed tomography scan. The scan may be done because of signs and symptoms that suggest lung cancer, or as part of targeted lung health checks. Computer-aided detection software with artificial intelligence ?derived algorithms can be used to automatically detect and measure lung nodules on chest computed tomography scan images. This could help radiologists or other healthcare professionals review scan images, and support clinical decisions about the need for computed tomography surveillance or further investigation. Although there is more evidence in targeted lung cancer screening, it is too limited to show which technologies are the most clinically and cost effective. But the model results suggest that using the software alongside clinician review has the potential to be cost effective. So, although there is not yet enough evidence to recommend the software, centres may use it as part of targeted lung cancer screening. But they should generate evidence to make sure the potential benefits of using the software are realised in practice and to allow comparisons of the different technologies. ";2023;;;"Low value";diagnosis;"Enlace a la recomendaci�n en la p�gina web de la iniciativa. " 6927;1;"NICE ";NICE;English;"Its not recommended Magnetic Resonance Imaging fusion biopsy systems for diagnosing prostate cancer";" Current care: Targeted biopsies, which take only a small number of tissue samples , are done for suspicious lesions identified by MRI. A systematic biopsy approach, in which multiple samples are taken from different regions of the left and right side of the prostate, can be done alongside a targeted biopsy. This can be done if radiologists are unsure if the lesion is malignant and clinical suspicion of cancer is high. Clinical experts explained that the biopsy approach depends on the information from the multiparametric MRI and individual clinician preference. Targeted biopsies are usually done using cognitive fusion, in which the previously captured MRI image is visually compared with the live transrectal ultrasound image to guide the biopsy needle. Because of the differences in positioning when a person has an MRI scan compared with when they have an ultrasound scan, the prostate shape differs on MRI and ultrasound images. This can make targeting the lesion difficult. The article assess the performance of MRI fusion biopsy systems Biopsies for suspected prostate cancer are done using previously taken MRI images and live ultrasound imaging to help the operator guide the biopsy needle (cognitive fusion). In MRI fusion biopsy systems, software overlays the MRI image onto the live ultrasound image (MRI fusion). This could mean fewer cases of prostate cancer are missed and could reduce the number of repeat biopsies. The cost-effectiveness estimates depend on how well MRI fusion biopsy systems detect higher-grade cancers compared with cognitive fusion. The estimates suggest that MRI fusion biopsy systems could be cost effective compared with cognitive fusion, but because the clinical evidence is uncertain, the cost-effectiveness estimates are very uncertain. MRI fusion biopsy systems show promise for better detection of prostate cancer and could help to standardise biopsy quality across the NHS, but more evidence is needed.";2023;;;"Low value";diagostic;"Enlace a la recomendacion de la pagina web de la iniciativa" 6928;1;"NICE ";NICE;Spanish;"There isn't enough evidence on the safety of intraoperative electron beam radiotherapy for locally advanced and locally recurrent colorectal cancer is adequate in adults.";"There are various treatments for colorectal cancer, including resection, chemotherapy and radiotherapy. Treatment choice depends on the type of cancer, location and staging. The radicality of resection is the most important prognostic factor for survival. About 5% to 20% of people with colorectal cancer have locally advanced disease, in which the cancer has invaded nearby tissues. After primary resection to remove the tumour, it returns in the same place in about 5% to 20% of people. Evidence on efficacy of this treatement of delivering intraoperative radiotherapy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Patient selection and the procedure should only be done in specialist centres by a multidisciplinary team experienced in managing colorectal cancer, including a colorectal surgeon, a clinical oncologist, a medical physicist, a radiographer and an anaesthetist. ";2023;;;"Low value";"Intraoperative electron beam radiotherapy for locally advanced and locally recurrent colorectal cancer";"Intraoperative electron beam radiotherapy for locally advanced and locally recurrent colorectal cancer" 6929;1;"NICE ";NICE;English;"Endoscopic ultrasound-guided gallbladder drainage is recommended for acute cholecystitis when surgery is not an option, if standard arrangements are in place for clinical governance, consent and audit.";"Acute cholecystitis is inflammation of the gallbladder. The most common cause of acute cholecystitis is gallstones (calculous cholecystitis) blocking the duct that drains the gallbladder (cystic duct). This means bile cannot drain from the gallbladder, causing pain, nausea, vomiting and fever. Acalculous cholecystitis is a less common, but usually more serious, cause of acute cholecystitis. It usually develops as a complication of a serious illness, infection or injury that damages the gallbladder. It can be caused by accidental damage to the gallbladder during major surgery, serious injuries or burns, sepsis, severe malnutrition, or HIV or AIDS. Initial treatment usually involves fasting, pain relief, and antibiotics if there is an infection. The gallbladder can be surgically removed (open or laparoscopic cholecystectomy) to prevent acute cholecystitis re-occurring, and to reduce the risk of developing complications, such as gangrenous cholecystitis and peritonitis. People who cannot have surgery may be able to have percutaneous cholecystostomy. This involves inserting a drainage catheter in the gallbladder through a small entry hole made in the abdominal wall. Endoscopic transpapillary gallbladder drainage is a less common alternative. It involves inserting a plastic stent through the ampulla and cystic duct into the gallbladder endoscopically. Evidence from a rapid review suggests that endoscopic ultrasound-guided gallbladder drainage can be effective for the drainage of the gallbladder, for the resolution of sepsis, and for the symptom relief, including reduction in pain and improvement in quality of life. But, it can cause pain, infection, damage to adjacent structures, bile leak and it could need further intervention.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6932;1;"NICE ";NICE;Spanish;"It is recommended Afamelanotide for treating erythropoietic protoporphyria in adults";"Erythropoietic protoporphyria is a condition in which exposure to light causes very painful and debilitating reactions in the body. There is no treatment and the only way to avoid reactions is to avoid light. There is some evidence from clinical trials that afamelanotide provides benefits to people with this disease. Despite this, the benefits of afamelanotide may not have been adequately captured in the formal analysis and therefore it is not possible to conclude that afamelanotide provides adequate value for money.";2023;;;"Low value";Treatment;"Enlace a la recomendaci�n en el sitio web de la iniciativa" 6933;1;"NICE ";NICE;English;"The use of automated arm-ankle pressure index measurement devices to detect peripheral arterial disease in people with leg ulcers is recommended only in research, not routinely.";"There is insufficient evidence to recommend routine adoption of automated ankle-brachial pressure index (ABPI) measurement devices to detect peripheral arterial disease in people with leg ulcers. They should only be used in the context of research in these people. Centers that already use automated ABPI measurement devices to detect peripheral arterial disease in people with leg ulcers may continue to use them only if: They collect data or conduct research to evaluate their value and how well they identify people with peripheral artery disease. The people who use the devices are experienced in evaluating peripheral arterial disease. People who use the devices are aware of their limitations, particularly diagnostic accuracy and the risk of missing peripheral arterial disease, and that there are differences between the devices. Additional evaluations using other methods, including manual Doppler, are available. Further research on automated ABPI measurement devices is recommended.";2023;;;"Low value";"Diagnostic test";"https://www.nice.org.uk/guidance/dg52" 6934;1;"NICE ";NICE;Spanish;"It is recommended aortic valve reconstruction with glutaraldehyde-treated autologous pericardium for aortic valve disease";"Hypertension is a major risk factor for cardiovascular disease and chronic kidney disease. Hypertension can be primary or secondary. Aortic valve disease (stenosis or regurgitation) is usually progressive and causes increased cardiac workload, left ventricular hypertrophy, and heart failure. Symptoms may include palpitations, fatigue, shortness of breath, syncope, and chest pain with exercise. The NICE guideline on hypertension in adults outlines the diagnosis and treatment of hypertension, including resistant hypertension. Evidence suggests that there are no major short-term safety concerns and complications, such as renal artery damage, are well recognized. Evidence shows that it reduces blood pressure in the short and medium term. In general, there are uncertainties about how well it works in the long term and whether there are long-term complications. Therefore, it should only be used with special arrangements.";2023;;;Uncertain;Treatmetns;"Link to te recommendation on the website of the initiation" 6935;1;"NICE ";NICE;English;"Se recomienda FibroScan para evaluar la fibrosis hep�tica y la cirrosis";"FibroScan is recommended to assess liver fibrosis and cirrhosis if each FibroScan device is expected to be used for at least 500 scans per year, this is likely to improve access to testing for underserved groups, used in accordance with guidelines national standards, a clear care pathway is set out locally with guidance for professionals, there is training for healthcare professionals on how to perform the test, and the company provides support materials to ensure that people using the test continue to use it correctly.";2023;;;"Low value";"Diagn�stic test";"FibroScan para evaluar la fibrosis hep�tica y la cirrosis fuera de la atenci�n secundaria y especializada" 6936;1;"NICE ";NICE;Spanish;"It is recommended radiofrequency denervation for osteoarthritic knee pain";"Osteoarthritis is characterized by localized loss of cartilage, remodeling of adjacent bone, and associated inflammation. The knees are one of the most affected joints, with pain being an important symptom. Radiofrequency denervation involves applying thermal energy (radiofrequency) to damage the nerves (denervation) that cause knee pain. There is good evidence that this procedure relieves pain in the short term.";2023;;;"High value";Treatment;"Enlace en la pagina web de la iniciativa" 6937;1;"NICE ";NICE;English;"It is recommended irreversible electroporation for treating prostate cancer";"Prostate cancer is the most common cancer in men in the UK. Most prostate cancers are localized or locally advanced at the time of diagnosis. Localized prostate cancer usually does not cause any symptoms, but some people may have urinary problems or erectile dysfunction. Prostate cancer is the most common cancer in men in the UK. Most prostate cancers are localized or locally advanced at the time of diagnosis. Localized prostate cancer usually does not cause any symptoms, but some people may have urinary problems or erectile dysfunction. There is enough evidence to suggest that the procedure works and does not pose any major safety concerns in the short to medium term. The procedure can have complications and it is not known how well it will work in the long term. It is also unclear who would benefit most from the procedure and at what stage of prostate cancer treatment it would be most effective. The evidence included 1 systematic review, 1 randomized controlled trial, 1 nonrandomized comparative study, 1 single-arm trial, and 7 case series. Therefore, it can be used with special arrangements and further data collection is needed.";2023;;;"High value";treatment;"Link to the recommendation on the website of the initiation" 6938;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya ";English;"It is recommended that everyone who plans or may become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid.";"The USPSTF recommends that everyone who plans or may become pregnant take a daily supplement containing 0.4 to 0.8 mg (400 to 800 mcg) of folic acid. To achieve benefits, people who plan or may become pregnant should begin taking daily folic acid supplements at least 1 month before expected conception and continue for the first 2 to 3 months of pregnancy. Neural tube defects are among the most common birth defects in the U.S., affecting an estimated 3,000 pregnancies each year. 1 Many of these neural tube defects are caused by low levels of folate in the pregnant person's body. Folate refers to vitamin B 9, a water-soluble B vitamin that occurs in many chemical forms, including naturally in foods such as leafy green vegetables, fruits, nuts, beans, peas, seafood, eggs, dairy products, meat and poultry. 10 Folic acid is the term applied to the synthetic form of folate found in supplements and added to fortified foods. Folic acid supplementation for people in the periconceptional period has been found to reduce the risk of neural tube defects in offspring. In 2017, the USPSTF reviewed the evidence on folic acid supplementation and issued an A recommendation. 12 The USPSTF has decided to use a reaffirmation deliberation process to update this recommendation. The USPSTF uses the reaffirmation process for current well-established, evidence-based standards of practice in primary care for which only a very high level of evidence would justify a change in the grade of the recommendation. In its deliberation about the evidence, the USPSTF considers whether the new evidence is of sufficient strength and quality to change its previous conclusions about the evidence.";2023;;;"High value";Prevention;"https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/folic-acid-for-the-prevention-of-neural-tube-defects-preventive-medication" 6939;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";Spanish;"Primary prophylaxis for HIV is recommended in people at higher risk of contracting it";"It is recommended that the following people be considered for PrEP: - Sexually active adults and adolescents weighing at least 35 kg who have had anal or vaginal intercourse in the last 6 months and present any of the following symptoms: 1. A sexual partner who has HIV (especially if the partner has an unknown or detectable viral load). 2. A bacterial sexually transmitted infection (STI) (syphilis, gonorrhea, or chlamydia for men who have sex with men and transgender women; gonorrhea and syphilis for heterosexual women and men) within the past 6 months. 3. A history of inconsistent or no condom use with sexual partners whose HIV status is unknown; assess risk in conversation with the patient and consider factors such as number of partners, specific sexual activities a person engages in, and whether their sexual partner or partners are in a group with a higher prevalence of HIV - People who inject drugs and share injection equipment or have a partner who injects drugs and has HIV.";2023;;;"High value";Prevenci�n;"Prevenci�n de la adquisici�n del VIH: profilaxis previa a la exposici�n" 6940;22;"The Canadian Task Force for Preventive Health Care Guidelines";"The Canadian Task Force for Preventive Health Care Guidelines";English;"Risk assessment through early detection to prevent fragility fractures in women aged ?65 years is recommended as follows";"Actual screening practice to prevent fragility fractures is often based solely on bone mineral density (BMD) testing, with the possible addition of risk assessment. Fracture risk assessment tools (eg, FRAX, CAROC) estimate the percentage risk or risk category of a fracture over a 5- to 10-year period. The evidence indicates that initial risk assessment probably reduces hip fractures and probably slightly reduces clinical fragility fractures (also called major osteoporotic fractures) among women ? 65 years (moderate-certainty evidence). However, for younger women (<65 years) and men ?40 years, the evidence was indirect or very uncertain and did not establish a benefit. Risk assessment through early detection to prevent fragility fractures in women aged ?65 years is recommended as follows (conditional recommendation, low-certainty evidence): FRAX: Apply the Canadian clinical risk assessment tool FRAX (without BMD). Use the 10-year absolute risk of MOFs to facilitate shared decision-making about the potential benefits and harms of preventive pharmacotherapy. BMD + FRAX: Following this discussion, if preventive pharmacotherapy is being considered, request BMD measurement by dual-energy X-ray absorptiometry of the femoral neck. Then, re-estimate fracture risk by adding the BMD T-score in FRAX.";2023;;;"High value";Prevention;"Link to the recommendation on the website of the initiative." 6941;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";Spanish;"It is recommended detection of hypertensive disorder in asymptomatic pregnant women.";"Hypertensive disorders of pregnancy include gestational hypertension, preeclampsia and eclampsia, and chronic hypertension with superimposed preeclampsia. In this update, the USPSTF found evidence related to 3 different screening approaches that did not reduce or increase diagnoses of hypertensive disorders of pregnancy.";2023;;;"High value";Prevention;"Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6942;1;"NICE ";NICE;English;"It is recommended quantitative faecal immunochemical testing using HM?JACKarc or OC?Sensor to guide referral for suspected colorectal cancer in adults with an abdominal mass, with a change in bowel habit, with iron-deficiency anaemia, aged 40 and over with unexplained weight loss and abdominal pain and aged under 50 with rectal bleeding, among others.";"FIT detects small amounts of blood in faeces, which is a sign of possible colorectal cancer. Evidence shows that offering the test in primary care can identify people who are most likely to have colorectal cancer. These people can then be prioritised for referral to secondary care, while people who are less likely to have colorectal cancer can avoid unnecessary investigations. There is a lack of evidence on using dual FIT in primary care, using FIT in people aged under 40, and using FIT in people who have conditions or medicines that increase the risk of gastrointestinal bleeding. So, further research is needed. All testing strategies using HM?JACKarc or OC?Sensor are cost effective compared with the previous recommendations on testing and referral in NICE's guideline on suspected cancer. ";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6943;1;"NICE ";NICE;English;"It is recommended Removal, preservation and reimplantation of ovarian tissue for restoring fertility after gonadotoxic treatment";"Some treatments for cancer or other medical conditions can damage the ovaries (gonadotoxic treatment). This can lead to early menopause and infertility. For people who are going to have treatments that may damage their ovaries, cryopreservation of oocytes or embryos before the treatment begins are options for preserving fertility. These both involve ovarian stimulation, which may lead to a delay in treatment. Embryo cryopreservation also requires sperm from a partner or donor. Before starting gonadotoxic treatments, ovarian tissue is removed surgically through laparoscopy, mini-laparotomy, or laparotomy. Usually, at least half of one ovary is removed and the other ovary is left in place to act as a site for future orthotopic autotransplantation. After histological examination of a portion to exclude malignancy, most of the excised ovarian tissue is frozen for future autotransplantation. When indicated, the frozen cortical ovarian tissue is thawed and transplanted back to the same person. It can be placed into pelvic sites such as the remaining ovary, ovarian fossa, or broad ligament (orthotopic autotransplantation) through laparoscopy or mini-laparotomy. Future pregnancies may require assisted reproduction technologies, although the procedure can offer the possibility of natural conception. Ovarian stimulation is not needed before removal of ovarian tissue for autotransplantation and gonadotoxic treatment can start immediately afterwards. It may be the only fertility preservation option suitable before puberty or for people with oestrogen-sensitive malignancies. Even though no clinical trial has been performed because of the ethical implications, we can consider it a high level of recomendation because it comes from an expert committe after having checked 4 sitematical reviews, 1 retrospective cohort study, 1 multicentre case series and 1 registry analysis ";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6944;1;"NICE ";NICE;English;"It is not recommended cryotherapy for chronic rhinitis in the general population.";"Cryotherapy is the use of extreme cold to freeze and remove abnormal tissue. The evidence for cryotherapy for chronic rhinitis is limited and includes people with different types of rhinitis. The evidence does not raise any major safety concerns, but the procedure can have complications. The short-term evidence is promising, but it is still uncertain how well the procedure works, particularly which group of patients will benefit most from the procedure and how long the effect of the treatment will last.";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6945;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"It is not recommended Screening and Preventive Interventions for Oral Health in Adults";"Oral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes. The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults.";2023;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 6946;1;"NICE ";NICE;English;"It is recommended transurethral water-jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH).";"Benign prostatic hyperplasia (BPH) is a common condition that affects older people with a prostate. Stromal and epithelial cells increase in number, causing the prostate to get bigger. It often happens in the periurethral region of the prostate, with large discrete nodules compressing the urethra. Symptoms include hesitancy during urination, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention. The evidence included 1 systematic review, 1 pooled analysis of 4 trials, 1 randomised controlled trial (described in 2 publications and also included in the pooled analysis), 1 prospective multicentre single-arm trial (described in 2 publications and also included in the pooled analysis), 1 retrospective cohort study, 1 retrospective non-randomised comparative study, 2 retrospective case series, and a report from the US Food and Drug Administration Manufacturer and User Facility Device Experience database.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6947;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"It is not recommended (with current evidence) routine screening for oral health conditions in children and adolescents aged 5 to 17 years.";"Oral health is essential for health and well-being throughout life. Oral health conditions affect the daily lives of school-aged children and adolescents. Untreated oral health conditions in children can lead to serious infections and affect growth, development and quality of life. Current evidence is insufficient to assess the balance between the benefits and harms of screening for oral diseases in asymptomatic children and adolescents aged 5 to 17 years. Current evidence is insufficient to assess the balance of benefits and harms of preventive oral health interventions in asymptomatic children and adolescents aged 5 to 17 years.";2023;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 6948;1;"NICE ";NICE;Spanish;"It is recommended birch bark extract as an option for treating partial thickness wounds associated with dystrophic and junctional epidermolysis bullosa in people aged 6 months and over.";"Epidermolysis bullosa (EB) is a condition caused by gene mutations that mean certain skin anchoring proteins are not expressed correctly or are disrupted. This results in very fragile skin that blisters and breaks frequently, particularly in response to minor trauma or friction. There are various types of EB, but birch bark extract is only indicated for dystrophic and junctional EB. The evidence is from the EASE trial, which was a phase 3 randomised double-blind trial.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6949;1;"NICE ";NICE;English;"It is recommended percutaneous deep venous arterialization for chronic limb-threatening ischemia in patients with limited treatment options.";"Chronic limb-threatening ischaemia of the lower extremities is caused by severely narrowed or blocked arteries. It is an advanced stage of peripheral arterial disease. The severely reduced blood supply causes ischaemic pain, ulceration, tissue loss and gangrene. Chronic limb-threatening ischaemia usually needs treatment to re-establish blood flow to the affected area and to prevent major amputation. The procedure uses an endovascular, minimally invasive approach. An arteriovenous fistula is created to allow venous arterialisation in the below-the-knee vasculature. The aim is to restore blood flow to the ischaemic foot. The evidence is limited in quality and quantity; in particular, long-term data and quality of life data are lacking. ";2023;;;"High value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 6950;1;"NICE ";NICE;English;"There is uncertainty about the efficacy and safety of endoscopic transluminal vaginal hysterectomy and adnexal surgery for benign gynecologic conditions, so their use is recommended only when special clinical governance, consent and audit or research agreements are in place. ";"Benign gynecological conditions are those non-neoplastic pathologies that affect the female reproductive system: chronic pelvic pain, uterine prolapse, fibroids and abnormal vaginal bleeding. If left untreated, they can cause intense and prolonged pain, infections and reduced quality of life. Currently there are different surgical approaches including hysterectomy, adnexectomy and myomectomy. Conventional hysterectomy (removal of the uterus) can be performed via laparotomy, laparoscopy or transvaginal approach. Vaginal transluminal endoscopic endoscopic hysterectomy is performed similarly to conventional vaginal hysterectomy, but uses endoscopic vision and laparoscopic instruments. 1) Physicians performing this procedure should inform their clinical managers, ensure that both the patient and family members understand the safety and efficacy of the procedure, and resolve any doubts or uncertainties. Always taking into account shared decision making. 2) The results of the intervention should be audited and reviewed. They should then be evaluated on an annual basis for reflection, learning and improvement, as well as to determine efficacy and safety for future inclusion in this guideline. 3) Healthcare organizations should ensure that systems are in place to help physicians collect and report data on the outcomes and safety of all individuals undergoing this procedure. 4) Patient selection should be performed by a multidisciplinary team that includes physicians with specific training in relation to the procedure. And it should be performed by an expert surgical team with the ability to convert to a conventional hysterectomy if necessary. 5) NICE encourages further research into endoscopic transluminal vaginal endoscopic hysterectomy and adnexal surgery for benign gynecologic conditions and may update the guidelines when more evidence is published. ";2023;;;Uncertain;"""Vaginal transluminal endoscopic endoscopic hysterectomy""";"Link to recomendation Link to the recommendation on the website of the initiative" 6962;1;"NICE ";NICE;Spanish;"The recommendation in neonatal jaundice is updated to highlight that skin pigmentation changes may be more difficult to see in darker skin, and it is advised that urine culture should only be considered if there is clinical suspicion of urinary tract infection.";"This guideline covers diagnosing and treating jaundice in newborn babies under 28 days, which is caused by increased levels of bilirubin in the blood It aims to help detect or prevent very high levels of bilirubin, which can be harmful if not treated.";2023;;;"Low value";-;"Link to see the recomendation" 6963;1;"NICE ";NICE;English;"Extracorporeal carbon dioxide removal is not recommended in people with acute hypoxic respiratory failure. Extracorporeal carbon dioxide removal is recommended only in the investigation of acute hypercapnic respiratory failure.";"Respiratory failure is a serious lung condition that causes the patient to feel short of breath because the lungs cannot deliver enough oxygen to the blood. Simultaneously, it can cause the accumulation of carbon dioxide that can damage tissues and organs. It is defined with PaO2 values less than 60 mmHg with or without hypercapnia (PaCO2 greater than 45 mmHg). The most common cause of hypercapnic respiratory failure is an acute exacerbation of chronic obstructive pulmonary disease. Its prevalence is 6% in the adult population and 19% in the population over 65 years of age. It incorporates the literature published since the last interventional procedure guideline on this procedure and a detailed review of the evidence from 9 sources. These are: two systematic reviews and meta-analyses, three randomized controlled trials (RCTs), a long-term follow-up analysis of one of the RCTs, two case series, and a secondary analysis of one of the case series. All of them do not lead to a HIGH quality of evidence. The guide presents a series of particularities. Among them we can highlight the difference in recommendation in the context of hypercapnia, the population to which it is directed (in the context of the disease) or the current treatment (treat the underlying cause and provide greater oxygen through invasive or non-invasive ventilation).";2023;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg776/chapter/2-The-condition-current-treatments-and-procedure" 6964;1;"NICE ";NICE;Spanish;"There is uncertainty about the efficacy and safety of endoscopic transluminal vaginal hysterectomy and adnexal surgery for benign gynecologic conditions, so their use is recommended only when special clinical governance, consent and audit or research agreements are in place.";"Benign gynecological conditions are those non-neoplastic pathologies that affect the female reproductive system: chronic pelvic pain, uterine prolapse, fibroids and abnormal vaginal bleeding. If left untreated, they can cause intense and prolonged pain, infections and reduced quality of life. Currently there are different surgical approaches including hysterectomy, adnexectomy and myomectomy. Conventional hysterectomy (removal of the uterus) can be performed via laparotomy, laparoscopy or transvaginal approach. Vaginal transluminal endoscopic endoscopic hysterectomy is performed similarly to conventional vaginal hysterectomy, but uses endoscopic vision and laparoscopic instruments. Different reviews and studies relevant to the intervention have been identified. 1) Physicians performing this procedure should inform their clinical managers, ensure that both the patient and family members understand the safety and efficacy of the procedure, and address any questions or uncertainties. Always taking into account shared decision making. 2) The results of the intervention should be audited and reviewed. They should then be evaluated on an annual basis for reflection, learning and improvement, as well as to determine efficacy and safety for future inclusion in this guideline. 3) Healthcare organizations should ensure that systems are in place to assist physicians in collecting and reporting data on the outcomes and safety of all individuals undergoing the procedure. 4) Patient selection should be performed by a multidisciplinary team that includes physicians with specific training in relation to the procedure. And it should be performed by an expert surgical team with the ability to convert to a conventional hysterectomy if necessary. 5) NICE encourages further research into endoscopic transluminal vaginal endoscopic hysterectomy and adnexal surgery for benign gynecologic conditions and may update the guidelines when more evidence is published. ";2023;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 6965;1;"NICE ";NICE;Spanish;"The recommendation in neonatal jaundice is updated to highlight that skin pigmentation changes may be more difficult to see in darker skin, and it is advised that urine culture should only be considered if there is clinical suspicion of urinary tract infection.";"This guideline covers diagnosing and treating jaundice in newborn babies under 28 days, which is caused by increased levels of bilirubin in the blood It aims to help detect or prevent very high levels of bilirubin, which can be harmful if not treated.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative" 6966;1;"NICE ";NICE;English;"Biodegradable subacromial spacer insertion is not recommended in patients with rotator cuff tears when debridement is an appropriate option.";"People who have rotator cuff tears may have shoulder pain and weakness, with reduced shoulder function, leading to a reduced quality of life. Rotator cuff tears can be caused by an injury or can develop gradually. They can be minor or serious depending on the degree of tendon damage. Minor rotator cuff tears are very common and may not cause any symptoms. Diagnosis is usually made by ultrasound or MRI. The guideline is based on a comprehensive literature search and a detailed review of evidence from 9 sources, which was discussed by the committee. The evidence included 2 randomized controlled trials (RCTs), 2 systematic reviews, 1 case-control study, 1 retrospective comparative study, and 3 case series. Which translates into a high quality of evidence. The guide discusses current treatment and discusses conservative treatment (physiotherapy, pharmacological treatments such as analgesics and nonsteroidal anti-inflammatory drugs, and corticosteroid injections). If the tear is severe or has not responded to other treatments, surgical interventions such as debridement, rotator cuff repair, subacromial planing, tendon transfer, or shoulder arthroplasty may be necessary.";2023;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg775/chapter/2-The-condition-current-treatments-and-procedure" 6967;1;"NICE ";NICE;English;"There is uncertainty regarding the benefit of percutaneous transarterial carotid artery stenting for extracranial carotid stenosis in asymptomatic adults versus classical carotid endarterectomy.";"The carotid arteries can become stenosed by fatty deposits favoring blood clots formation. Fragments can then detach and lodge in thinner arteries that supply blood to the brain. This can cause a stroke or transient ischemic attack. If the carotid stenosis is not causing any health problems it is asymptomatic. For people with asymptomatic extracranial carotid stenosis, management includes lifestyle modification (diet, exercise, and smoking cessation) and pharmacological therapy (antithrombotics, lipid-lowering agents, blood pressure Some people with severe stenosis may be offered revascularisation and the conventional surgical approach used is CEA. This technique is performed under local anesthesia, a guide wire is used to access transcutaneously through the femoral artery and progress to the stenosed carotid artery. The stenosis is dilated with a balloon and a stent is installed to keep the artery open. This interventional procedures overview is based on over 300,000 patients from 9 key studies including 1 systematic review and network meta-analysis, 2 systematic reviews , 2 randomised controlled trials , 1 prospective cohort study , 2 retrospective cohort studies and 1 retrospective international administrative dataset. Percutaneous transarterial carotid artery stent placement for asymptomatic extracranial carotid stenosis should only be used with special arrangements for clinical governance, consent, and audit or research. ";2023;;;Uncertain;-;"https://www.nice.org.uk/guidance/ipg777" 6968;1;"NICE ";NICE;English;"It is recommended to perform percutaneous thrombectomy for high-risk pulmonary embolism when alternative treatments are not adequate and for intermediate- or high-risk pulmonary embolism when alternative treatments are adequate, in the adult population. ";"A pulmonary embolism is when a pulmonary artery is obstructed by an embolus (usually a blood clot) that travels to the lungs from deep veins in the leg or pelvis. A high-risk PE is defined by sustained systemic hypotension or shock. An intermediate-risk PE involves right ventricular dysfunction or myocardial injury without major haemodynamic compromise. High?risk PE accounts for less than 10% of acute PE cases and is a medical emergency with a high mortality rate. The first-line treatment for PE is systemic or oral anticoagulants. For high- or intermediate-risk PE with haemodynamic compromise, systemic thrombolysis may be used or, rarely, open surgical embolectomy. Catheter-directed therapies may also be used, including catheter-directed thrombolysis and percutaneous thrombectomy. Catheter-directed therapies are usually used if someone has a high-risk PE and they cannot have surgery, or when systemic thrombolysis is contraindicated or has failed. In this endovascular procedure, a catheter is inserted percutaneously into the peripheral vasculature (usually by a common femoral vein) and advanced through the right side of the heart into the pulmonary arteries under image guidance. It is usually done using local anaesthesia with or without sedation. It is a minimally invasive procedure that may be used alone or in combination with other treatment options for PE. The aim of the procedure is to rapidly remove the obstruction and restore pulmonary circulation, reducing right ventricular strain, while avoiding the bleeding risks associated with thrombolysis. This interventional procedures overview is based on 2483 patients and 67 ?events? from 2 meta-analyses, 3 single-arm trials (1 trial included with its substudy), 1 safety database review, 2 retrospective comparative studies, 1 prospective non-randomised study, 1 prospective registry, 1 sub-set of the prospective registry and 1 case report. There is enough evidence that the procedure reduces the extent of clot in the circulation but not enough evidence of improvement in short- and long-term outcomes. The evidence on safety does not raise any major concerns. Most of the evidence is for intermediate-risk PE. There is no evidence from randomised controlled trials and very little long-term follow-up evidence, particularly for patient-reported outcomes. There is an unmet need for people with high-risk PE when alternative treatments are not suitable or have failed, and this procedure is the only treatment option. So, this procedure is recommended for use with special arrangements for this population. Because of the lack of evidence, this procedure is only recommended for use in research for intermediate-risk PE, or high-risk PE when alternative treatments are suitable.";2023;;;"High value";-;"https://www.nice.org.uk/guidance/ipg778" 6970;1;"NICE ";NICE;English;"Middle meningeal artery embolization is recommended to prevent hematoma recurrence in patients on anticoagulant or antiplatelet medication.";"Chronic subdural hematoma is formed by the pathological accumulation of blood in the subdural space after an acute process or several days. Its treatment will depend on the severity of the accompanying symptoms, being more conservative in asymptomatic patients and more aggressive in patients with severe symptoms. Middle meningeal artery embolization is a procedure to treat blood buildup by eliminating the blood supply from the artery itself to the membrane surrounding the hematoma, in order to reduce the risk of hematoma recurrence. The evidence is reflected after an exhaustive search for information in 9 sources discussed in committee.";2023;;;"High value";-;"Middle Meningeal Artery Embolization for Chronic Subdural Hematomas" 6976;1;"NICE ";NICE;English;"It is recommended to involve and inform about the diagnosis, monitoring and management of complications to patients with cirrhosis in over 16s.";"People have the right to be involved in discussions and make informed decisions about their care. Evidence from multiple and different reviews (3) suggests that in terms of diagnosis, people over 16s have to be aware about the increased risk of cirrhosis in people who have hepatitis B or C virus infection, misuse alcohol, are living with obesity or have type 2 diabetes. In addition to discuss with the individual the accuracy, limitations and risks of different diagnostic tests, as well as the need for referral to a specialist. Concerning to monitoring, it is recommended to evaluate cases of hepatocellular carcinoma, esophageal varices and the possible risk of complications. At the same time we manage these complications through the safe prescription and use of carvedilol and propranolol in people with cirrhosis, the primary prevention of decompensation, preventing bleeding from medium or large oesophageal varices, preventing spontaneous bacterial peritonitis, the treatment for upper gastrointestinal bleeding and treating refractory ascites.";2023;;;"High value";"Diagnosis, monitoring and complications.";"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6980;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"Screening colonoscopies are not recommended in asymptomatic patients over 75 years of age with a life expectancy of less than 10 years.";"This cross-sectional study with a nested cohort between January 2009 and January 2022 in an integrated health system assessed asymptomatic patients older than 75 years who underwent screening colonoscopy in the outpatient setting. Reports with incomplete data, any indication other than screening, patients who had a colonoscopy within the previous 5 years, and patients with a personal history of inflammatory bowel disease or CRC were excluded.";2023;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 6981;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"It is not recommended the use of intensive blood pressure Management in Hospitalized patients and older adults.";"Intensive blood pressure (BP) treatment is not recommended after the first 48 hours of hospitalization, defined as receipt of intravenous antihypertensives or oral classes not used before admission. A retrospective cohort study examined patients aged 65 years or older hospitalized for non-cardiovascular diagnoses and who experienced elevated blood pressure in the first 48 hours of hospitalization. Findings were consistent across subgroups stratified by age, frailty, pre-admission BP, early hospitalization BP, and history of cardiovascular disease. The findings do not support treatment of elevated BP in hospitalized patients without evidence of end-organ damage, and highlight the need for more randomized clinical trials of BP treatment targets in hospitalized patients. The results of the study conclude that intensive pharmacological antihypertensive treatment was associated with an increased risk of adverse events.";2023;;;"Low value";-;"

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2805021

" 6983;6;"Less Is More Collection - JAMA Network";"JAMA Network";Spanish;"Hay incertidumbre sobre si la consulta m�dica preoperatoria reduce los resultados adversos postoperatorios.";"In this cohort study, preoperative medical consultation was not associated with a reduction but rather with an increase in adverse postoperative outcomes, suggesting a need for further refinement of target populations, processes, and interventions related to preoperative medical consultation. These findings highlight the need for further research and suggest that referral for preoperative medical consultation and subsequent testing should be carefully guided by individual-level consideration of risks and benefits.";2023;;;Uncertain;-;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6984;1;"NICE ";NICE;English;"It is recommended the use of intracutaneous or subcutaneous sterile water injections as a pain relief option for women in labour with back pain.";"This guideline covers the care of women who go into labor at term (37+0 to 41+6 weeks). The care a woman receives during childbirth has the potential to affect her (both physically and emotionally, in the short and long term) and the health of her baby. Good communication, support and compassion from staff, and respect for her wishes can help her feel in control of what is happening and help make birth a positive experience for the woman and her companions. . An example of caring for women at the time of childbirth is intracutaneous or subcutaneous injections of sterile water as an option for back pain relief. These injections can be administered by a midwife trained in the use of sterile water injections. It is important to explain to the woman that sterile water injections can relieve back pain from 10 minutes after the injection for up to 3 hours, but there may be an initial stinging sensation. They are administered at 4 different injection points around the rhombus of Michaelis, using doses of 0.1 ml intracutaneously or 0.5 ml subcutaneously at each injection site.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6985;19;"Choosing Wisely Canada";"Canadian Society of Clinical Chemists ";English;"It is recommended not to repeat the HbA1c testing within 3 months of a previous result in patients with diabetes. ";"The lifespan of a red blood cell is approximately 90-120 days, thus the effects of a patient?s change in behaviour, diet, or newly adjusted medications will not be reflected in the HbA1c measurement until most of the previous RBCs in circulation are replaced (~90 days). Therefore, testing at time intervals earlier than 3 months does not allow enough time to pass to reach the treatment target or new steady-state. Overtesting may lead to unnecessary regimen changes, adverse effects, and higher costs. Testing at 6-month intervals may be considered when glycemic targets are consistently achieved. In pregnant patients with pre-existing diabetes, more frequent HbA1c measurements may be appropriate based on clinical guidelines (i.e. at each trimester). ";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6986;19;"Choosing Wisely Canada";"Canadian Society of Clinical Chemists ";English;"It is not recommended to order random urine protein electrophoresis to screen for a monoclonal gammopathy in patients without unexplained ?CRAB? symptoms or diseases associated with monoclonal gammopathies.";"Screening for monoclonal gammopathies should only be performed in patients with unexplained ?CRAB? symptoms (hyperCalcemia, Renal insufficiency, Anemia, or lytic Bone lesions) or diseases associated with monoclonal gammopathies. For such patients, serum protein electrophoresis (SPE) should be the initial screening test with follow-up immunofixation electrophoresis (IFE) if indicated.";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6987;1;"NICE ";NICE;English;"The use of external beam radiotherapy after oesophageal cancer and oesophagogastric junction stenting is recommended for people with prolonged post-intervention bleeding or a known bleeding disorder. ";"A high quality health technology assessment in the UK provided new evidence on external beam radiotherapy after stenting in people with dysphagia whose condition needed palliation, and the committee agreed that it did not support the routine use of external beam radiotherapy. However, the committee noted that there was some evidence of improved outcomes for gastrointestinal tract-related bleeding. Although this was of low certainty, they agreed that, in their experience, external beam radiotherapy helps prevent prolonged bleeding after insertion of a stent or a known bleeding disorder. Stopping bleeding is important for people with incurable oesophageal and oesophago-gastric junction cancer because it improves their quality of life. ";2023;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6988;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to use lactate in the risk stratification of patients with sepsis. ";"Lactate above 2 mmol/L is associated with increased sepsis severity and mortality, however, lactate elevation may not be indicative of the current perfusion state. Evidence suggests that during states of increased metabolic demand, which can otherwise be thought of as physiologic stress in the critically ill, hyperlactatemia develops. Lactate should be used as an adjunctive screening of patients who may have sepsis to aide in risk stratification of those patients who may need more monitoring. Failure to decrease lactate by 20% after initial resuscitative efforts predict increased mortality; however, base fluid resuscitative efforts on validated physical exam findings such as capillary refill time and measures of dynamic fluid responsiveness, such as passive leg raise. ";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6989;1;"NICE ";NICE;English;"It is recommended to screen for chronic kidney disease by measuring glomerular filtration rate or checking its value in the last 3 months before offering iodine-based contrast media for adults who require non-emergency imaging and who are considered to have a higher . risk of kidney injury.";"Before offering iodine-based contrast media to adults, it is recommended to evaluate their risk of acute kidney injury, but without delaying emergency imaging. An increased risk is associated with chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk), diabetes, but only with chronic kidney disease, heart failure, kidney transplant, over 75 years, hypovolemia, increased volume of contrast agent, intra-arterial administration of contrast medium with first-pass renal exposure.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6991;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"Routine intensification of antihypertensives is not recommended in patients admitted for non-cardiac causes.";"Las afecciones en las que la presi�n arterial desempe�a un papel importante, como la exacerbaci�n de la insuficiencia card�aca congestiva, el accidente cerebrovascular agudo o el s�ndrome coronario agudo, probablemente se benefician de la intensificaci�n de los antihipertensivos. La evidencia de un estudio de cohorte retrospectivo de pacientes mayores de 65 a�os hospitalizados por diagn�sticos no card�acos en el sistema de administraci�n de salud para veteranos.";2023;;;"Low value";Treatment;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6992;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended that adjunctive medications (e.g., clonidine, loperamide, and ondansetron) be offered in addition to opioid agonist treatment to mitigate opioid withdrawal symptoms in adults with opioid use disorder.";"Screen for opioid withdrawal and offer and initiate evidence-based treatment, using shared decision making, regardless of the patient's plan to discontinue opioid use or continue treatment after discharge. More than 50 years of data demonstrate that methadone is safe and effective when appropriately titrated. In one study, methadone dose was only weakly associated with QT prolongation and not with cardiac events.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6993;19;"Choosing Wisely Canada";"Canadian Society of Clinical Chemists ";English;"It is not recommended routinely ordering urine drug tests for the evaluation of adult patients with drug use disorders.";"A directed clinical care plan and laboratory information for ordering urine drug testing are needed to support clinical management. Immunoassays are known for their false positives that can mislead patient treatment. Mass spectrometry testing offers the most reliable and complete results. Physicians considering drug testing should consider consulting with the laboratory for advice on choosing the best testing methodology available and help interpreting the results.";2023;;;"Low value";Diagnosis;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6994;19;"Choosing Wisely Canada";"Canadian Society of Clinical Chemists ";English;"It is not recommended to routinely order an iron profile in an adult patient with iron deficiency.";"Iron measurement is a poor biomarker for acquired iron deficiency as it is susceptible to preanalytical factors such as diurnal variation, diet, and exercise and ultimately does not represent iron storage. In patients with complicated comorbidities (e.g., infection, autoimmune disease, kidney disease, or cancer), ferritin is an acute phase reactant and may be falsely elevated. In this context, ordering a fasting transferrin saturation is useful to help diagnose iron deficiency along with the ferritin result.";2023;;;"Low value";Diagnosis;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6995;1;"NICE ";NICE;English;"It is recommended anual mamography as part of the population screening program in women over 50 years of age with a greater than 30% probability of being a carrier of TP53.";"High risk of breast cancer (not proven but greater than 30% probability of being a TP53 carrier): surveillance recommendations reflect the fact that women who at first evaluation had a 30% probability of being TP53 carriers or older and reach 50 years of age without developing breast cancer or any other type of cancer. TP53-related malignancies will now have a carrier probability of less than 30% and should no longer be offered MRI surveillance. The recommendations in this guide apply to women and men unless otherwise specified.";2023;;;"High value";Diagnosis;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6996;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended educating patients about blood pressure goals for adult outpatients.";"Hospital discharge should include effective patient education and care coordination. To optimize patients' understanding of their current medication, don't miss the opportunity to counsel patients on medication adherence. Many studies reveal that patients adhere less frequently to new medications after discharge. Emphasize that inpatient blood pressure may not reflect its baseline value and that overtreatment may be harmful.";2023;;;"High value";Education;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6998;1;"NICE ";NICE;English;"It is recommended to stop the antidepressant and discontinue an antipsychotic for a person who is developing mania or hypomania.";"If a person develops mania or hypomania and is not taking an antipsychotic or mood stabiliser, offer haloperidol, olanzapine, quetiapine or risperidone, taking into account any advance statements, the person's preference and clinical context If an alternative antipsychotic is not sufficiently effective at the maximum licensed dose, consider adding lithium. the first antipsychotic is poorly tolerated at any dose (including rapid weight gain) or ineffective at the maximum licensed dose, offer an alternative antipsychotic from the drugs listed in recommendation 1.5.3, taking into account any advance statements, the person's preference and clinical context";2023;;;"High value";-;"Link to the recommendation on the website of the initiative" 7001;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely: Things we do for no reason";Spanish;"It is recommended to evaluate indications of aggressive behavior in the clinical history and add an expiration date in any affected patient.";"Quantitative studies of effectiveness usually involve experiences at single centers and are without adequate control groups. BAs were created as a tool for safety, a mechanism through which clinical teams may anticipate and take action to mitigate risk. However, this type of communication facilitates prejudice towards patients. While intended to alter provider behavior to promote safety indiscriminately in the workplace, there is little evidence that BAs actually reduce incidents of violence. Instead, they negatively label patients already at high risk for stigma and have significant potential to bias provider care. Healthcare institutions should reconsider this EMR tool, one with limited evidence for protection and significant potential for harm. Involving patients after behavioral incidents may lead to greater patient awareness and partnership in managing aggressive behavior and increased transparency. There is little evidence that BAs actually reduce incidents of violence. Instead, they negatively label patients already at high risk for stigma and have significant potential to bias provider care.";2023;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 7004;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"The use of valproate is not recommended in people of childbearing potential who are not adhering to a pregnancy prevention program.";"Valproic acid, approved for the treatment of certain types of epilepsy and bipolar disorder, is teratogenic. Babies born to women treated with the drug have an increased risk of neurodevelopmental disorders or congenital malformations. Clinical practice guidelines, drug agencies, and consensus documents are aligned in the recommendation to avoid prescribing valproate in women with the capacity to conceive, unless the conditions of the pregnancy prevention program are met. When the woman is pregnant and valproic acid is indicated for epilepsy, it is recognized that in some patients it is not possible to stop treatment, given that there is a high risk of recurrence of seizures that are difficult to control, which in itself can pose a risk during pregnancy. In these cases, they should continue taking them, with adequate follow-up by specialist professionals.";2023;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 7006;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"Deferring bisphosphonate therapy in the outpatient setting after fragility hip fracture is not recommended.";"Fragility hip fractures are a major public health problem. After one year, less than half of patients have recovered their pre-fracture functional status, and up to 30% of them have died. One clinical trial randomised 2127 men and women with fragility hip fractures from 115 clinical centres to annual intravenous (IV) infusions of zoledronic acid (started within 90 days of surgical repair) versus placebo. Patients receiving zoledronic acid had a 35% reduction in the risk of new clinical fractures and a 28% reduction in the risk of death from any cause. Maximal secondary fracture prevention and bone mineral density changes occur when patients receive zoledronic acid as early as 2 weeks postoperatively, supporting early administration. Treatment with IV zoledronic acid puts patients with underlying vitamin D deficiency at risk of severe hypocalcaemia, as maximal osteoclastic inhibition occurs soon after infusion. Defer treatment with zoledronic acid until vitamin D levels have normalised. ";2023;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 7008;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";Spanish;"Initiating pharmacological sleep aids in hospitalized patients with AII is not recommended.";"A systematic review summarizing the efficacy and safety of these agents found no consistent trends in their effects on improving sleep with respect to latency, efficiency, quality, or disruptions. Studies associate benzodiazepines, benzodiazepine receptor agonists, barbiturates, SGAs, and antihistamines with delirium, cognitive impairment, fall-related injuries, and death, especially in the elderly. If AII persists despite nonpharmacological interventions, consider prescribing MRAs as a safer alternative to PSAs.";2023;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 7011;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to use intermittent opioid boluses as initial treatment for pain or dyspnea during the last hours of life.";"Opioids are effective for the treatment of pain and dyspnea in dying patients and are recommended as first-line agents by professional guidelines, but dying itself does not automatically require opioid treatment, and many nonpharmacological interventions can increase comfort without involving no medicine. In cases where medication is required, opioid infusions as initial therapy are less effective than opioid boluses. Based on clinical guideline practices, randomized continuous sequential clinical trial.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative" 7012;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely";English;"An active monitoring position by delaying PEG tube placement is recommended in patients with an acceptable probability of swallowing with dysphagia after an acute stroke.";"Dysphagia is a common complication after acute stroke occurring in 51%-55% of cases. Strokes can cause dysphagia through damage to any of the brain areas involved in swallowing physiology, including the cerebral hemispheres, the cerebellum or the brain stem. The diagnosis of dysphagia is important as it can lead to complications such as pneumonia. For those patients who do not recover before discharge, a decision should be made whether to provide prolonged NG tube feeding or to place a PEG tube. In the case of stroke, the PEG tube is routinely instituted during the first 7 days after the event. The decision between early PEG tube placement and active waiting requires shared decision making with patients. Clinicians should take into account the expected recovery potential to guide patients in this decision-making, and remember that in 70% of cases recovery is achieved on an oral diet within 30 days.";2023;;;"High value";-; 7013;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely";English;"It is recommended to continue chronic beta-blocker therapy in patients with cocaine use, whether chronic or remote, without concern for the sequelae of unopposed alpha stimulation.";"Cocaine, a potent sympathomimetic agent that potentiates adrenergic tone, increases inotropy and chronotropy through ?1?receptor agonism at the level of the cardiomyocyte, and vasodilation through ?2?receptor agonism in the peripheral vasculature. Vasoconstriction due to activation of ?1 receptors in the peripheral vasculature via cocaine-induced increases in circulating catecholamines also occurs, and counteracts ??mediated smooth muscle relaxation. This combination results in increased mean arterial pressure through increases in cardiac output (and therefore myocardial oxygen demand) and systemic vascular resistance. ??Blockade therefore allows the unopposed peripheral vasoconstrictive properties of ??receptor stimulation to dominate. This ?unopposed ??stimulation? hypothesis drives most of the concern. Hospitalists worry that unopposed ??stimulation due to cocaine use will worsen hypertension and coronary artery vasoconstriction.";2023;;;"High value";-; 7014;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"Se recomienda realizar una angiograf�a coronaria por tomograf�a computarizada, si va a cambiar el manejo, para la evaluaci�n de dolor tor�cico agudo en un paciente de riesgo intermedio despu�s de descartar s�ndrome coronario agudo para pacientes <65 a�os sin enfermedad de arterias coronarias conocidas (EAC). o para pacientes con prueba de esfuerzo funcional previa no concluyente sin EAC.";"Functional stress tests have served as the standard of care for the evaluation of cardiac ischemia for decades. Before 2021, guidelines recommended a functional stress test as the diagnostic imaging modality of choice for patients with low or intermediate?risk chest pain. As a result, clinicians most commonly ordered stress tests for the diagnosis of coronary artery disease. Evidence of moderate to severe reversible ischemia on imaging?based functional stress tests and severe ischemia on ECG exercise tests identify patients who may benefit from Guideline directed medical therapy, percutaneous coronary intervention (PCI), and/or referrals for coronary artery bypass graft (CABG) surgery. The updated 2021 AHA/ACC chest pain guidelines now recommend either functional stress testing or Coronary computed tomography angiography for intermediate?risk chest pain.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative" 6759;36;"Choosing Wisely UK";"Royal College of Emergency Medicine (2018)";English;"It is not recommended to treat asymptomatic bacteriuria with antibiotics in men and non-pregnant women because it is not a health risk factor. ";"Unnecessary antibiotic treatment of asymptomatic bacteriuria is associated with an increased risk of adverse effects and provides no clinical benefit, increases the resistance of the bacteria causing the infection, reducing the efficacy of antibiotics in the future. Asymptomatic bacteriuria is very problematic for older people, as its incidence increases with age and is high in nursing homes. Symptoms should be assessed and identified before sending a urine sample for culture. Antibiotics should not be routinely prescribed when a urine culture identifies bacteriuria in an asymptomatic person. In the elderly, symptoms may include non-specific signs of infection such as delirium.";2023;;;"Low value";"Treatment ";"Link to the recommendation on the website of the initiative" 7019;1;"NICE ";NICE;English;"Velmanase alfa is recommended as an option to treat non-neurological signs and symptoms of mild to moderate alfamannosidosis, only if treatment is initiated in people under 18 years of age.";"Clinical trial evidence suggests that velmanase alfa may lead to improvements in functions such as walking, stair climbing and lung capacity, and quality of life, for people with alpha?mannosidosis. But the size and nature of these benefits are highly uncertain because of the ultra-rare nature of the condition, which makes evidence generation difficult. The most likely cost-effectiveness estimate for velmanase alfa is around what is considered value for money in the context of a highly specialised service. Although there are some uncertainties in the economic model, when taking into account all the evidence and the factors affecting the decision, velmanase alfa is recommended.";2023;;;Uncertain;Treatment;"Link to the recommendation on the initiative's website" 7020;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is not recommended to routinely order a Nil per os diet for patients with acute pancreatitis.";"Current data suggests that patients admitted with acute pancreatitis benefit from hospitalists initiating early oral nutrition. Initial studies investigating the benefit of feeding in pancreatitis revealed an association between bowel rest therapy, usually with parenteral nutrition, and an increased likelihood of the development of disruptions of the gut?mucosal barrier, persistence of the systemic inflammatory response, and admission to the intensive care unit. Indeed, data from human trials demonstrate that these gut-mucosal barrier disruptions cause microbial gut translocation which in turn leads to infection, worsening inflammation, and severe disease. More recent evidence supports the benefits of early oral feeding as compared with delayed oral feeding in the initial management of acute pancreatitis, with several systematic reviews and meta-analyses further clarifying the positive effect of early oral feeding on patient outcomes.";2023;;;"High value";Diet;"Link to the recommendation on the initiative's website" 7022;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to significantly reduce or eliminate the use of patient safety indicators, in addition to evaluating the relevance of existing ones, in order to avoid the stigmatization of patients and the cycle of violence generated by permanent labeling in health institutions.";"Given the low effectiveness of safety indicators in preventing violence and the growing evidence of harm, we recommend significantly reducing their use. For existing ones, we recommend that institutions assess their current relevance (what circumstances surround previous behavioral incidents) and remove obsolete ones. Institutions should evaluate their stigma potential (word choice, tone, criminalizing language) and application (certain patient populations have more indicators than others) as well as eliminate those that are irrelevant and inappropriate. When developing a new patient safety indicator, it is recommended to implement standardized templates that require authors to examine the medical context of the incident and avoid the use of stigmatizing language in the electronic medical record. It is also recommended to involve staff at a specific level to generate best practices and violence prevention programs. As well as the patients after the incident of aggressive behavior for greater collaboration and transparency.";2023;;;"Low value";"Clinical practice";"Enlace a la recomendaci�n en la web de la iniciativa/Enlace a la recomendaci�n en la web de la iniciativa" 7023;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to evaluate the exacerbation of inflammatory bowel disease in patients with rectal bleeding, evaluate predisposing risk factors during hospital admission and, in their absence, prescribe prophylactic medications to all hospitalized patients with flares of inflammatory bowel disease.";"It is recommended to evaluate the exacerbation of inflammatory bowel disease in patients with a known history when presenting to the hospital for rectal bleeding or hematochezia. It is also recommended to evaluate risk factors that predispose the patient to an excessive risk of major bleeding during hospitalization. In the absence of risk factors for major bleeding, it is recommended that prophylactic medications be prescribed for all hospitalized patients with flares of inflammatory bowel disease since they have been found to significantly increase the risk of venous thromboembolism and there are no other contraindications. Several studies have shown that inflammatory bowel diseases (both ulcerative colitis and Crohn's disease) increase the overall risk of venous thromboembolism threefold compared to the general population.";2023;;;"High value";"Pharmacological prophylaxis of venous thromboembolism";"Enlace a la recomendaci�n en la web de la iniciativa/Enlace a la recomendaci�n en la web de la iniciativa/Enlace a la recomendaci�n en la web de la iniciativa" 7025;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to avoid routinely ordering repeat transthoracic echocardiography for patients with decompensated acute heart failure in known congestive heart failure during their hospital stay, especially if a clear precipitating cause of the decompensation is known.";"The ""Things We Do for No ReasonTM (TWDFNR)? series reviews practices, which have become common parts of hospital care, may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent ?black and white? conclusions or clinical practice standards, but are meant as a starting place for research and active discussions among hospitalists and patients";2023;;;"Low value";"diagn�stica ";"link to the recommendation on the initiative website" 7033;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"It is uncertain that testing for coronary heart disease before kidney transplant is associated with reduced adverse outcomes early after transplant in first-time kidney transplant recipients.";"Coronary heart disease screening is a cornerstone of kidney transplant evaluation and, to our knowledge, is recommended by every guideline to date. Testing, either noninvasive or invasive, in asymptomatic patients awaiting kidney transplant is prevalent in practice. High rates of testing have persisted despite multiple large randomized clinical trials published during the 2000s that argued against coronary heart disease screening in asymptomatic patients. Proponents of screening contend that these trials did not include patients with advanced kidney disease and/or did not examine perioperative risk specifically. In this quasiexperimental cohort study, the cohort comprised 79?334 adult, first-time kidney transplant recipients. This quasiexperimental cohort study using program-level coronary heart disease testing as an intravenous was unable to demonstrate that pretransplant coronary heart disease testing was associated with reduced early death and MI within 30 days of kideny transplant. The study findings potentially challenge the ubiquity of coronary heart disease testing before kidney transplant and should be confirmed in interventional studies. ";2023;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 7035;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"It is not recommended to use a polygenic risk score for the early diagnosis of prostate cancer.";"Prostate cancer screening instruments frequently result in men undergoing prostate biopsies that find either clinically insignificant cancer or no cancer. A polygenic risk score measures the burden of risk-associated single-nucleotide polymorphisms that an individual carries, and there is interest in using these scores to improve risk prediction for prostate cancer. Although polygenic risk scores have been associated with prevalent and incident disease, prior studies have shown that they do not improve risk prediction for aggressive prostate cancers with the potential to be fatal. In this study, we compared the polygenic risk score with a risk calculator, a clinical tool that computes the probabilities of finding any cancer and high-grade cancer on biopsy results in men undergoing a first prostate biopsy. This retrospective cohort study was approved by the Vanderbilt University Medical Center institutional review board and examined 655 men of African and European ancestries aged 40 to 80 years without prostate cancer who underwent a prostate biopsy. A prostate cancer polygenic risk score did not improve risk prediction of aggressive prostate cancer compared with a contemporary clinical risk predictor. Although the PRS269 improved model discrimination for all cancers, improvement was less than has been observed for other validated prostate cancer biomarker predictors such as the Prostate Health Index. ";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6863;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea";Spanish;"The exhaustive recommendation not to perform any medical procedure on the ipsilateral upper extremity of mastectomy patients is not supported.";"The exhaustive recommendation not to perform any procedure on the arm on the side that underwent mastectomy is not supported. The following approach is proposed for making recommendations to patients regarding this issue:

- The opinion of the patient and certain factors must be taken into account, such as the type of procedure to be performed (injection, venous access channelling, blood pressure measurement, capillary blood glucose measurement, etc.), the previous state of the extremity (presence of swelling, cellulitis or other signs) or a history of complications in the extremity.

- Considering the above, in patients undergoing unilateral mastectomy, it is recommended to prioritize the contralateral arm for medical procedures and for taking constants when possible. However, if there are difficulties in this, it will be preferable to use the ipsilateral arm rather than make more attempts in the contralateral arm or resort to other locations, such as the veins of the foot. Regarding bilateral mastectomies, it is recommended to prioritize the upper limbs over the lower ones.

- In the absence of lymphedema, a puncture in the ipsilateral arm carries little or no risk of additional complications, and patients should be reassured accordingly.

- In any case, special care must be taken with asepsis and careful performance of the procedures to minimize the risk of infections.";2023;;;"Low value";mastectomy;"Link to the recommendation on the website of the initiative." 6864;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea";Spanish;"Requesting a proteinogram in patients without clinical suspicion of monoclonal gammopathy is not recommended.";"The proteinogram is a semiquantitative method of analysis that provides information corresponding to the major protein in each electrophoretic band. However, it should not be used to assess specific proteins quantitatively. Its main indication is the diagnosis and monitoring of monoclonal gammopathies, characterized by the secretion of a monoclonal component. For most other clinical applications, the determination of serum plasma protein concentration is more useful than electrophoretic tracing, so it would not be justified in the context of situations acute non-hematologic diseases or in patients with chronic infectious or inflammatory diseases. Monoclonal gammopathies are a group of rare diseases. The mean age at diagnosis is 65 years, and less than 15% of cases appear in patients younger than 50. The main associations and scientific societies recommend restricting the proteinogram to patients with suspected monoclonal gammopathy (mainly >50 years) and not repeating the test before one year if the electrophoretic pattern has been reported as normal unless justified by a change in the patient's clinical condition. Recommendations: � Limit the proteinogram request to patients with suspected monoclonal gammopathy or for follow-up. � Do not repeat the proteinogram before one year has elapsed in the absence of monoclonal gammopathy in an initial study unless there are clinical or analytical changes that justify it. � In patients presenting an acute process, the proteinogram should be performed once the acute clinical picture has been resolved, in a stable situation.";2023;;;"Low value";"proteinogram, monoclonal gammopathy";"Link to the recommendation on the website of the initiative." 6865;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea";Spanish;"Criteria for the use of immunoglobulins in neurological and hematological pathologies";"HEMATOLOGY: In immunodeficiencies or parental transplants, immunoglobulins (Ig) are only recommended in patients with hypogammaglobulinemia, recurrent infections, and poor response to vaccines. In catastrophic antiphospholipid syndrome, Ig is considered an alternative to first-line therapeutic plasma exchange (TPR), anticoagulation, and corticosteroids. Ig should not be used routinely in autoimmune hemolytic anaemia (AIHA) and is considered an alternative to transfusion and RPT in cases of emergency AIHA (hemodynamic involvement or cardiac or neurological symptoms), although the evidence is limited. In idiopathic thrombocytopenic purpura, Ig is restricted to cases of severe thrombocytopenia with critical bleeding or requiring urgent invasive surgery without delay. Early treatment with Ig is not recommended for Kawasaki disease. In hemophagocytic lymphohistiocytosis, Ig is used in unstable or severe patients as an additional treatment. NEUROLOGY: In inflammatory myopathies, Ig is restricted to the 2nd line in case of insufficient response or failure of the 1st line. In multifocal motor neuropathy, Ig is a treatment option (low quality of evidence). In patients with chronic inflammatory demyelinating polyradiculoneuropathy with moderate to severe disability, Ig is a first-line option. In Guillain-Barr� syndrome, Ig is a first-line option, prioritizing RPT whenever possible. There is no evidence of benefit with administering a 2nd cycle of IV Ig in the absence of response. In exacerbation and myasthenic crisis, Ig is used if RPT is impossible. The use of Ig in refractory Lambert-Eaton syndrome is justified. In immune-mediated neuropathy associated with IgG or IgA, the evidence on the efficacy of IV Ig is of low quality and shows doubtful results. It is used in paraneoplastic and autoimmune encephalitis if corticosteroid treatment is impossible. In neuromyelitis optica and acute autoimmune dysautonomia, Ig is restricted to 3rd line.";2023;;;"High value";immunoglobulins;"Link to the recommendation on the website of the initiative." 6878;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is recommended to avoid the routine use of bronchodilators for bronchiolitis in infants.";"Bronchiolitis is a very common lower respiratory viral infection in infants, especially in their first year of life. The use of B2 adrenergic bronchodilators, such as salbutamol, is common and widespread in our environment; non-use of bronchodilators avoids the adverse effects of this medication and unnecessary expense. The use of bronchodilators is associated with side effects in the form of tachycardia, tremors and irritability, which can be significant, but are difficult to assess in an infant with respiratory distress. The systematic review by Cai et al. , maintains that treatment with salbutamol does not improve clinical severity or oxygen saturation, nor reduce the need for hospitalization or the length of hospital stay.";2023;;;"High value";-;"Link to the recommendation on the website of the initiative" 6880;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial salud";Spanish;"It is not recommended treatment with an antibiotic other than uncombined penicillins as a first option in acute streptococcal pharyngotonsillitis in adults.";"In adults, most acute pharyngotonsillitis is of viral origin. Antibiotic treatment is only indicated when the cause is group A beta-hemolytic streptococcus. The antibiotic choice is based on reducing the risk of generating resistance. Therefore, the first choice antibiotics are penicillins, especially phenoxymethylpenicillin, since GABHS is sensitive. Macrolides can generate resistance and should be reserved, together with cephalosporins, for cases of allergy or intolerance to penicillins. Furthermore, the association of amoxicillin with clavulanic acid is not recommended, since GABHS does not produce beta-lactamases. Cephalosporins and macrolides, especially clarithromycin or azithromycin, are reserved in cases where the person has an allergy or intolerance to penicillins. The amoxicillin/clavulanic acid association may be indicated in recurrent pharyngotonsillitis.";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6884;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada";English;"It is not recommended the screening to prevent fragility fractures in women 40 to 64 years of age and in men ? 40 years of age.";"Fragility fractures result from a minor impact that would not damage normal bone. These occur due to a weakened bone structure or low bone mineral density (known as osteoporosis). Actual screening practice to prevent fragility fractures is often based solely on bone mineral density (BMD) testing, with the possible addition of risk assessment. Fracture risk assessment tools (eg, FRAX, CAROC) estimate the percent risk or risk category of a fracture over a 5- to 10-year period. BMD involves dual-energy X-ray absorptiometry of the femoral neck (hip) and provides a T-score (based on standard reference values) that can also be used as a risk assessment element. The evidence indicates that initial risk assessment probably reduces hip fractures and probably slightly reduces clinical fragility fractures (also called major osteoporotic fractures) among women ? 65 years (moderate-certainty evidence). However, for younger women (<65 years) and men ?40 years, the evidence was indirect or very uncertain and did not establish a benefit. These recommendations apply to people living in the community who are not currently receiving pharmacotherapy to prevent fragility fractures.";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6887;1;"NICE ";NICE;English;"There is not enough evidence to recommend LiverMultiScan or magnetic resonance elastography (MRE) to assess non-alcoholic fatty liver disease (NAFLD) in people with indeterminate or discordant results from previous fibrosis testing or when transient elastography or acoustic radiation force impulse (ARFI) elastography is unsuitable or has not worked.";"LiverMultiScan aims to identify a stage of NAFLD called non-alcoholic steatohepatitis (NASH). It is not clear how diagnosing NASH affects care decisions, partly because there are currently no medicines approved for treating NASH. MRE aims to identify how much liver scarring (fibrosis) there is. More evidence is needed, particularly on how LiverMultiScan or MRE test results would affect decisions about care. Also, more information is needed about whether MRI-based tests help people make lifestyle choices to help prevent or slow NAFLD progression. So, research is recommended. ";2023;;;"Low value";"non-alcoholic fatty liver disease, NAFLD, magnetic resonance elastography, MRE";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6888;1;"NICE ";NICE;English;"It is recommended to perform a trabeculectomy with a biodegradable collagen matrix implant in patients with glaucoma.";"Glaucoma is usually a chronic condition associated with raised intraocular pressure. It leads to progressive damage to the optic nerve. Trabeculectomy with an adjunctive biodegradable collagen matrix aims to modify wound healing and improve the drainage of aqueous humour to lower intraocular pressure. It reduces or avoids the use of antimetabolites and antifibrotic agents (mitomycin C, 5?fluorouracil).";2023;;;"High value";"glaucoma, trabeculectomy";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6889;1;"NICE ";NICE;English;"Image-guided percutaneous cryoablation is not recommended to treat chronic pain in patients with peripheral neuroma.";"Neuromas are thickenings of tissue around a nerve, which can happen after injuries to the nerve, such as a cut, a crushing injury, nerve compression or an excessive stretch. Peripheral neuromas affect nerves outside the brain and spinal cord that can carry pain signals between the brain and the rest of the body. This can cause chronic pain. The main aim of the procedure is to relieve pain but it can also reduce swelling associated with the neuroma. Evidence on the safety and efficacy of percutaneous image-guided cryoablation of peripheral neuroma for chronic pain is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. ";2023;;;"Low value";"neuroma, cryoablation, chronic pain";"Link to the recomendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6890;1;"NICE ";NICE;English;"Percutaneous transluminal renal sympathetic denervation for resistant hypertension should only be used with special arrangements for clinical governance, consent, and audit or research.";"Clinicians wanting to do percutaneous transluminal renal sympathetic denervation for resistant hypertension should: Inform the clinical governance leads in their healthcare organisation, ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these, audit and review clinical outcomes of everyone having the procedure and discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. This procedure is usually done using local anaesthesia, with sedation and anticoagulation. A catheter is introduced through the femoral artery and advanced into each renal artery under fluoroscopic guidance.";2023;;;Uncertain;"hypertyension, transluminal renal sympathetic denervation";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6891;1;"NICE ";NICE;English;"Transvenous obliteration for gastric varices is only recommended in special arrangements for clinical governance, consent, and audit or research.";"Varices are dilated veins. Gastric varices are prone to bleeding, and this is associated with high mortality and poor prognosis. The aim of this treatment is to obliterate the varices and manage acutely bleeding gastric varices or those at high risk of bleeding. Evidence on the safety and efficacy of transvenous obliteration of gastric varices is adequate in the short term but limited in the long term.";2023;;;Uncertain;"gastric varices, tranvenous obliteration";"Link to the recomendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6892;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"It is not recommended to routinely perform vaginal examinations at intervals of less than four hours in the first phase of labor.";"Performing a vaginal examination is the method used by obstetrics professionals to determine the onset of labor, evaluate its progression and diagnose labor dystocia. Performing vaginal examinations at intervals more frequently than necessary in pregnant women during the birth process can lead to an overdiagnosis of labor dystocia, triggering a cascade of interventions, such as the use of oxytocin or the performance of cesarean sections. Performing frequent vaginal examinations may increase the risk of intrapartum infections. Likewise, vaginal examinations can be painful, disempowering and traumatic. Before performing a vaginal examination, it is important to ensure that the examination is necessary, that it will add important information for decision-making and requesting consent.";2023;;;"Low value";"vaginal examination, pregnancy ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6893;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"It is not recommended to routinely initiate oxytocin in pregnant women in labor to whom epidural analgesia has been administered.";"Pregnant women in labor with epidural analgesia do not have to be routinely administered oxytocin, neither to prevent slowing of the birth process, nor to reduce the incidence of instrumental deliveries. Regardless of epidural analgesia, confirmation of delayed labor progress is required to consider oxytocin treatment. The benefits of administering oxytocin without this confirmation do not outweigh the risks and its inappropriate use may cause harm to the woman or baby.";2023;;;"Low value";"Epidural, oxytocin, birth";"Link to the recomendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6894;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"It is not recommended to perform an elective cesarean section in pregnant women with a previous segmental cesarean section.";"Attempted vaginal birth after cesarean section is a safe and appropriate option for most women with a previous segmental cesarean section and they should be offered this option and counseled accordingly. Exceptionally, an elective cesarean section will be recommended in cases with a high risk of uterine rupture and when there is a contraindication to vaginal delivery for another reason. Vaginal delivery after cesarean section is successful in more than 70% of cases and can reach 90% in patients with a previous vaginal delivery. Elective cesarean section, compared to vaginal delivery after cesarean section, has more maternal complications. With an elective cesarean section there is a greater risk of hemorrhage, infection, thromboembolism, a longer recovery period and hospital stay, as well as a greater risk of transient tachypnea in the newborn.";2023;;;"Low value";"cesarean section";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6895;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"In patients with chronic non-cancer pain receiving treatment with opioids, it is not recommended to increase their dose without having analyzed and reviewed the individual benefits and risks.";"It is necessary to avoid increasing the dose of opioids without having analyzed and reviewed the individual benefits and risks. Healthcare professionals should exercise caution when prescribing opioids at any dose and escalation should be avoided when possible. There are studies in patients with NOCD that show that increasing the opioid dose above a morphine equivalent dose (MED) of 50 mg/day does not produce a substantial improvement in pain or function and, instead, patients may be exposed to progressive increases in risk.";2023;;;"Low value";"chronic pain, opioids";"Link to the recomendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6896;1;"NICE ";NICE;English;"Evidence on devices for remote monitoring of Parkinson's disease is lacking";"Monitoring symptoms of Parkinson's disease is important to help clinicians make decisions about a person's care. But this can be difficult in current practice because symptoms can come and go and may be difficult to remember or describe. Review appointments may also be infrequent. Sometimes people with Parkinson's disease may struggle to accurately assess their symptoms, and how severe they think they are may differ from the view of their carer (care partner). More objective monitoring of symptoms is therefore an unmet need. Using these devices could help clinicians to better determine when changes to treatment are needed. This may help better manage symptoms of Parkinson's disease and improve quality of life for people with Parkinson's disease and their carers. There is a lack of evidence on the impact that the use of devices would have on the National Health Service in England and on the quality of life of both people with Parkinson's disease and their carers as each device varies and no study compared them. Additionally, in the main trial, people who did and did not have the device had more checks than in the National Health Service in England.";2023;;;Uncertain;"Disease monitoring";"Link to recommendation on the website of the initiative" 6897;1;"NICE ";NICE;English;"There is uncertainty regarding the use of transcutaneous electrical stimulation of the trigeminal nerve for the treatment of Attention Deficit Hyperactivity Disorder, and it is recommended to use it only in a research context.";"Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder characterised by the core symptoms of hyperactivity, impulsivity and inattention, which are judged excessive for the person's age or level of overall development. Symptoms are usually evident in childhood and may persist into adulthood. Treatment for ADHD may be non-pharmacological, pharmacological or a combination of both. In this procedure, an external trigeminal nerve stimulation device is worn on the clothes and attached by wires to a single-use adhesive patch which is worn overnight. In a typical treatment course, stimulation is given nightly for approximately 4 weeks. The mechanism of action is not completely understood. The evidence included 1 randomised controlled trial (with 1 secondary analysis) and 1 open-label trial.";2023;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative" 6898;1;"NICE ";NICE;English;"There is uncertainty in biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer";"This therapy involves moving the rectum slightly away from the prostate by inserting a balloon or injecting a gel (spacer) between them. Evidence on the safety and effectiveness of biodegradable spacer insertion to reduce rectal toxicity during radiotherapy for prostate cancer is of limited quality. Therefore, this procedure should only be performed by physicians with training and experience in transperineal interventional procedures.";2023;;;Uncertain;"Prostate cancer radiotherapy";"Link to the recommendation on the website of the initiative" 6899;1;"NICE ";NICE;English;"There is uncertainty regarding endoluminal gastroplication for gastro-oesophageal reflux disease";"This involves an endoscopic fastening device being inserted through the mouth and into the stomach, along with an endoscope for constant visualisation. The device is used to attach the fundus to the anterior and left lateral wall of the distal oesophagus slightly above the oesophagogastric junction. Evidence on the safety of endoluminal gastroplication for gastro-oesophageal reflux disease is adequate. However, evidence on its efficacy is inadequate in quality (should include suitably powered randomised controlled trials with details of patient selection, physiological measurements, and long-term outcomes), particularly in terms of patient selection and long-term outcomes. Therefore, this procedure should be used only in research.";2023;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative" 6900;1;"NICE ";NICE;English;"The use of laparoscopic insertion of a magnetic ring for gastroesophageal reflux disease is recommended in patients selected by physicians who have specific training in the procedure and experience in laparoscopic upper gastrointestinal surgery and the management of gastroesophageal reflux disease.";"Gastro-oesophageal reflux disease is a condition usually caused by the sphincter at the lower end of the oesophagus becoming weakened. Symptoms include heartburn, regurgitation, chest pain, nausea, dysphagia and respiratory difficulties. Repeated episodes can lead to oesophageal ulceration, oesophageal stricture and Barrett's oesophagus. The standard treatments are lifestyle modification and drug therapy. People may be offered anti-reflux surgery if their symptoms do not improve, develop complications despite medication or have an intolerance to medication. The aim of laparoscopic insertion of a magnetic ring is to relieve reflux-related symptoms without impeding the ability to swallow, belch or vomit. The procedure is done using a laparoscopic approach, placing an implant at the gastro-oesophageal junction consisting of a ring of interlinked beads with a weak magnetic force that holds the beads together and reduces reflux. The evidence included 3 systematic reviews and meta-analyses, 1 randomised controlled trial, 3 non-randomised comparative studies and2 case series.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 6901;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"The lithotomy position in the second stage of labor is not recommended as the only option";"In pregnant women without epidural anesthesia, only the lithotomy position is not recommended during the second phase of labor, since vertical positions also show benefits; However, the pregnant woman must be able to choose the position that is most comfortable for her. Upright positions decrease the probability of instrumental delivery, duration of labor, rate of episiotomies, unfavorable heart rate patterns, and pain reported by women; On the other hand, horizontal positions reduce the risk of bleeding and, probably, second-degree tears.";2023;;;"Low value";Procedure;"Link to the recommendation on the website of the initiative" 6902;1;"NICE ";NICE;English;"Ataluren is recommended as an option for treating Duchenne muscular dystrophy resulting from a nonsense mutation in the dystrophin gene in people 2 years and over who can walk";"Duchenne muscular dystrophy, with a nonsense mutation in the dystrophic gene, is a rare and progressive condition. Over time it causes muscle weakness resulting in the loss of the ability to walk and reductions in respiratory ability, and it significantly reduces life expectancy. Current treatment options are limited. This evaluation reviews existing trial data (including 2 randomised controlled trials), additional evidence collected as part of the managed access agreement, and new real-world evidence (evidence collected outside clinical trials) on ataluren, which estimate the treatment benefits compared with best supportive care. The cost-effectiveness estimates are uncertain because of how treatment benefits were estimated and because of the limitations in the clinical effectiveness data. In spite of this, the evidence provided, along with feedback from clinicians and people with the condition, suggests that ataluren is likely to slow down disease progression and delay the loss of the ability to walk, so it is recommended.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 6903;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"It is not recommended to extend the duration of opioid treatment in chronic non-cancer pain";"Evidence on the effectiveness of long-term treatment of chronic non-cancer pain with opioids is very limited. On the contrary, the risks are well known, for this reason, it is important to re-evaluate every 3 months whether opioid treatment is being effective, or if the person is experiencing adverse events or showing a pattern of possible misuse. In addition to the adverse events that opioids present, regardless of the duration of treatment, there are others that are related to long-term use. Some of these may be tolerance, opioid-induced hyperalgesia, central sleep apnea, or neuroendocrine dysfunctions.";2023;;;"Low value";"Pain treatment";"Link to the recommendation on the website of the initiative" 6904;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"The routine prescription of benzodiazepines or Z drugs for the treatment of insomnia in the adult population is not recommended.";"20% of people in our environment report episodes of insomnia and, in people over 65 years of age, this percentage is around 40-50%. In Catalonia, it is estimated that, in 2022, 17.5% of the adult population had been prescribed a benzodiazepine or Z drug. Even so, the routine prescription of benzodiazepines or Z drugs for the treatment of insomnia is not recommended, since their risk/benefit ratio is unfavorable (European clinical practice guidelines for the diagnosis and treatment of insomnia). Benzodiazepines cause sedation, dizziness, rebound insomnia, tolerance and dependence and present a potential risk for abuse. In older people, the risk of cognitive deterioration, falls and fractures also increases. Non-pharmacological measures are the treatment of choice for insomnia in the adult population of any age.";2023;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6905;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"The use of fluoroquinolones or amoxicillin/clavulanic acid is not recommended as first-line antibiotic treatment in women with acute uncomplicated cystitis.";"In adult women, most uncomplicated acute cystitis is caused by Escherichia coli, which causes more than 75% of infections. Clinical practice guidelines position fosfomycin trometamol (3 g in a single dose) as the treatment of choice in uncomplicated acute cystitis, since the most common uropathogens are sensitive, and it has a narrow spectrum. Alternatively, nitrofurantoin (for five days) could be considered. Treating uncomplicated acute cystitis with fluoroquinolones or amoxicillin/clavulanic acid is therefore not indicated as a first option, since they have a greater risk of generating antimicrobial resistance.";2023;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6906;1;"NICE ";NICE;English;"It is recommended Asfotase alfa for treating hipophosphatasia in pediatrics";"This evaluation reviews the evidence for asfotase alfa for treating paediatric?onset hypophosphatasia (NICE highly specialised technologies guidance 6), including evidence collected as part of the managed access agreement. Paediatric?onset hypophosphatasia is a rare genetic condition that affects how calcium and phosphorous are deposited in developing bones and teeth. It includes perinatal-, infantile- and juvenile?onset forms of the disease. There are limited treatment options and it can substantially affect the lives of people with the condition and their families and carers. People with perinatal- or infantile?onset hypophosphatasia can have breathing complications, craniosynostosis (when the bones in a baby's skull join together too early) and pressure around the brain. The risk of death in the first year of life in these populations is high. The risk of death is lower for people with juvenile?onset hypophosphatasia. But, juvenile?onset hypophosphatasia can be associated with severe symptoms that affect quality of life, including impaired mobility, pain and regular fractures. Because of the difference in severity, the committee considered the 2 populations separately.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6907;1;"NICE ";NICE;English;"It is recommended Radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases in adults ";"Evidence-based recommendations on radiofrequency ablation as an adjunct to balloon kyphoplasty or percutaneous vertebroplasty for palliation of painful spinal metastases. This involves inserting a needle-like probe containing an electrode into the spinal metastases. This produces an electrical current that aims to relieve pain and other symptoms. ";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6908;1;"NICE ";NICE;English;"It is recommended Eladocagene exuparvovec, as an option for treating aromatic L?amino acid decarboxylase deficiency with a clinical, molecular and genetically confirmed diagnosis, with a severe phenotype, in people 18 months and over.";"AADC deficiency is a rare genetic disorder that causes a wide range of debilitating symptoms. Normal motor development in young children (such as head control, sitting and walking with help) is particularly affected.Severe AADC deficiency is associated with a high risk of death in childhood. It also has a substantial effect on the quality of life of the person with the condition, and their family and carers. The evidence is clinical, because the results of the studies are uncertain because they are very small, and provide limited long-term data and limited information about non-motor outcomes.";2023;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6909;1;"NICE ";NICE;English;"There is not enough evidence to recommend radiofrequency ablation for palliation of painful spinal metastases in adults";"Evidence on the safety and efficacy of radiofrequency ablation for palliation of painful spinal metastases is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wanting to do radiofrequency ablation for palliation of painful spinal metastases should: - Inform the clinical governance leads in their healthcare organisation. - Give people (and their families and carers as appropriate) clear written information to support shared decision making - Ensure that people and their families and carers understand the procedure's safety and efficacy, and any uncertainties about these. - Audit and review clinical outcomes of everyone having the procedure. - Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.";2023;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6910;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"Is not recommended the use of Opioids and gabapentinoids in chronic non-cancer pain in adults";"In general, the concomitant treatment of opioids and gabapentinoids (gabapentin and pregabalin) in people with chronic non-cancer pain is considered a practice of little value. The reason is that the effectiveness of this combination is uncertain compared to monotherapy with either, and it increases the risk of respiratory depression or opioid overdose. Clinical practice guidelines and consensus documents recommend paying special attention to the combined prescription of opioids and gabapentinoids in patients with. On the one hand, current evidence does not allow us to conclusively establish the effectiveness of the combination of opioids and gabapentinoids, compared to monotherapy of either of the two. On the other hand, two recent systematic reviews, based on observational studies, found that people taking the combination of gabapentinoids and opioids had more overdoses than those taking opioids alone. This risk is higher at the beginning of treatment with these medications, as well as in people receiving a higher dose of gabapentinoids. Other observational studies show that there is an increase in opioid-related deaths when the person also takes gabapentin or pregabalin.";2023;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa?" 6911;1;"NICE ";NICE;English;"It is not recommended the daytime intraoral neuromuscular electrical tongue stimulation using a removable device for obstructive sleep apnoea.";"Obstructive sleep apnoea is a condition in which the upper airway narrows or closes during sleep when the throat muscles intermittently relax. This causes reduced breathing (hypopnoea) or breathing to temporarily stop (apnoea). OSA can lead to major neurocognitive and cardiovascular sequelae. Management of OSA includes lifestyle changes (such as weight loss), continuous positive airway pressure, oral devices (mandibular advancement devices), neuromuscular electrical stimulation and upper airway surgery. In this new treatment, an intraoral removable device is used to deliver neuromuscular electrical stimulation to the intrinsic and extrinsic (genioglossus) muscles of the tongue. The aim is to improve tongue endurance and reduce airway obstruction during sleep. The evidence included 1 single-arm clinical trial and 1 pilot study. It concuded that evidence on the safety and efficacy is inadequate in quality and quantity. So, this procedure should be used only in research.";2023;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6656;33;"Choosing Wisely � : Things we do for no reason";"American Society of Consultant Pharmacists ";English;"Combining opioids with benzodiazepines or gabapentinoids for pain management is not recommended in older adults.";"Co-prescribing of benzodiazepines or gabapentinoids (gabapentin, pregabalin) with opioids is increasingly utilized in the multimodal treatment of acute and chronic pain despite limited evidence to support the effectiveness of this practice. Population studies have demonstrated that these combinations are associated with increased risk of serious adverse outcomes such as excessive sedation, overdose events, and death. In 2019, The FDA required new warnings about the risk of serious breathing difficulties that can lead to death in patients who use gabapentanoids with opioid pain medicines or other drugs that depress the central nervous system, or those who have underlying respiratory impairment, such as patients with chronic obstructive pulmonary disease, or the elderly. Older adults may be particularly vulnerable due to age-related changes in pharmacokinetics, pharmacodynamics, and medical comorbidity. Initiation of combination therapy should be avoided whenever possible; older patients who require chronic concurrent use of these medication classes should be closely monitored and periodically evaluated for deprescribing. ";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6657;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to routinely prescribe VTE prophylaxis to all hospitalized patients. ";"Pharmacologic prophylaxis has been shown to reduce the risk of clinically significant VTE. While VTE prevention should be considered for every hospitalized patient, excess VTE prophylaxis ? either prophylaxis inappropriately administered to patients at low risk of VTE or to high risk patients with contraindications ? can be harmful. National guidelines recommend objective risk stratification for venous thromboembolism (VTE) prevention in hospitalized medical patients.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6658;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Blood Transfusion";English;"It is not recommended to use peri-operative transfusion for otherwise reversible anemia prior to elective surgery";"Peri-operative transfusions as a means of addressing untreated preoperative anaemia is associated with decreased overall survival rates but not with recurrence free survival. There is some new evidence that these negative associations are due to the clinical circumstances requiring transfusions rather than the transfusions themselves, but this still suggests that it is preferable to identify and manage anaemia prior to surgery";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6659;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"It is not recommended to prescribe or routinely continue medications for older adults with limited life expectancy without due consideration to individual goals of care, presence of comorbidities and time-to-benefit for preventive medications.";"To identify older adults for whom medications are most likely to benefit (and most likely to harm), a framework that compares an individual?s life expectancy with the time to benefit (TTB) has been proposed. TTB may be defined as the point in time at which patients are expected to derive a benefit from a treatment. TTB is increasingly considered in addition to other measures of medication effectiveness to understand and contextualize the benefits and harms of a therapy for an individual patient. Reducing the use of unnecessary medications may reduce pill burden and adverse drug events, as has the potential to improving quality of life.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6660;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Blood Transfusion";English;"It is not recommended to transfuse a standard dose of fresh frozen plasma to correct a mildly elevated (<1.8) international normalized ratio before a procedure.";"There is no evidence to support the prophylactic administration of fresh frozen plasma to correct a mildly elevated international normalized ratio prior to procedure. The evidence supports the use of Vitamin K and suggests the use of fresh frozen plasma correlated with an increased risk of intra-operative bleeding and/or increased risk of transfusion reactions.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6661;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Blood Transfusion";English;"It is not recommended to transfuse red blood cells due to iron deficiency where there is no hemodynamic instability";"Blood transfusion has become a routine medical response despite cheaper and safer alternatives in some settings. Pre-operative patients with iron deficiency and patients with chronic iron deficiency without hemodynamic instability (even with low haemoglobin levels) should be given oral and/or intravenous iron. Possible exceptions are where reliable ingestion of iron may not occur or gastrointestinal issues exist.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6662;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"It is not recommended to use three or more CNS-active medications (antidepressants, benzodiazepines, Z-drugs, opioids, gabapentinoids, antipsychotics, antiepileptics), especially in older adults.";"There is strong evidence linking the use of multiple CNS-active medications with serious adverse drug events in older adults. Specifically, older adults taking multiple CNS-active medications are at an increased risk for falls and fractures. Furthermore, the combined use of opioids with gabapentinoids increases the risk of opioid-related death. There is high quality of evidence for avoiding combined use of benzodiazepine receptor agonists (benzodiazepines or Z-drugs defined as zopiclone, eszopiclone, zaleplon) and moderate evidence for avoiding combinations of other CNS-active medications. Despite these medications being considered potentially inappropriate in older adults who have a history of falls, many continue to take them after a serious injury. Benzodiazepines and Z-drugs have minimal effectiveness for sleep and safer alternatives are available (e.g. for anxiety, consider SSRIs; for insomnia, consider treatment of underlying conditions interrupting sleep, and cognitive behavioral therapy). Maintaining patients on the lowest effective dose and evaluating periodically for deprescribing are prudent strategies to mitigate harm from CNS-active medications. ";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6407;31;"Smarter medicine";"Sociedad Suiza de Otorrinolaringolog�a y Cirug�a Cervicofacial";English;"Diagnostic imaging is not recommended in patients with nonpulsatile tinnitus with symmetrical hearing and an uncomplicated history.";"The usefulness of imaging for the clarification of idiopathic tinnitus has not been proven. Radiological examinations for diagnostic purposes do not modify the management of tinnitus";2022;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6663;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"It is not recommended to prescribe tramadol without due consideration of potential risks and harms related to serotonergic excess, seizures, falls, and drug interactions in older adults.";"The utilization of tramadol, a weak and mixed centrally acting opioid analgesic, has increased steadily over the past decade, a trend influenced by perceived safety advantages over opioid medications like morphine, oxycodone, and hydrocodone. However, a recent national study reported that older adults account for 33% of tramadol-associated emergency department visits and half of subsequent hospitalizations, suggesting that greater scrutiny of tramadol?s safety in this population is warranted. Tramadol?s adverse effects such as sedation, and the potential for serotonin syndrome and hyponatremia are well recognized by clinicians, however tramadol-induced seizures and hypoglycemia are particularly harmful for older adults and may further elevate risk of falls and fractures. The risk of tramadol?s clinically relevant adverse effects is heightened among patients with decreased renal function. By way of brief review, the opioid receptor-mediated analgesic effects are mainly attributed to the active metabolite M1 (O-desmethyltramadol), whereas the inhibition of the neurotransmitter reuptake is caused by the parent drug. The metabolic conversion to the M1 metabolite is mediated primarily through CYP2D6 enzyme, which exhibits substantial genetic variability, consequently the pharmacological effect of tramadol is affected by drug-drug and drug-gene interaction";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6664;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Blood Transfusion";English;"It is not recommended to transfuse more units of blood than necessary.";"Every unit of blood transfused presents benefits and risks to the patients. Risks associated with transfusion include: -febrile reactions -allergic reactions and anaphylaxis -haemolytic reactions -transfusion- transmitted infections -transfusion-associated acute lung injury, transfusion-associated circulatory overload -alloimmunisation. Each unit transfused must have a clear indication and unnecessary transfusions must be avoided. A restrictive transfusion strategy (Haemoglobin (Hb) of 70-80g/L) should be used for the majority of hospitalised, stable (non-bleeding) adult patients. The decision to give a red blood cell transfusion should not be dictated by Hb alone and should also include an assessment of the patient?s underlying condition, any clinical signs and symptoms and response to previous transfusions. A single unit of red cell transfusions is the standard of care for non-bleeding, hospitalised patients. Additional units should only be prescribed after clinical re-assessment of the patient and their haemoglobin value.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6665;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, ANZCA";English;"Do not prescribe currently available medicinal cannabis products to treat chronic non-cancer pain unless part of a registered clinical trial.";"Cannabis-derived products are now available for use with therapeutic intentions in Australia and New Zealand. By far the most common reason for their proposed use is chronic pain. More than 90% of Special Access Scheme ? Category B approvals for cannabis products have been for chronic pain of various types. Cannabidiol-only formulations have not been the subject of a published randomised controlled trial for pain indications, yet they are projected to become the most widely used type of product. However, there is a critical lack of evidence of consistent benefit from cannabinoids of any type for chronic non-cancer pain. The evidence available is either unsupportive or is of such low quality that no valid scientific conclusion can be drawn. In addition, evidence of harms does exist, particularly in relation to sedative effects, interactions with other medications and neuropsychiatric effects (for products which contain tetrahydrocannabinol). Given the above, until high-quality evidence for specific indications is published, the clinical use of cannabinoid products cannot be ethically recommended outside of a properly established and registered clinical trial environment.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6666;2;"Choosing Wisely�";"American Society of Consultant Pharmacists ";English;"Combining the use of strong inhibitors or inducers of CYP3A4 and P-glycoprotein with direct oral anticoagulants is not recommended in older patients.";"Direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban have significantly fewer drug-drug interactions (DDIs) compared with warfarin. However, there are notable DDIs with potent CYP3A4 and P-glycoprotein (p-gp) inhibitors with DOAC, which clinicians should consider requiring dose adjustments and monitoring for their older patients. Each of the DOACs is a substrate for p-glycoprotein (p-gp), an efflux transporter located in the intestinal mucosa, and therefore all DOACs are susceptible to drugs that induce or inhibit p-gp. Dabigatran requires efflux transport by p-gp, however it is independent of the CYP450 enzyme system. Apixaban and rivaroxaban, on the other hand, undergo minor hepatic metabolism by CYP enzymes. Furthermore, alterations in the various rates of renal clearance of DOACs should be equally as possibly additive to the metabolic effects that will eliminate the outcome of DDIs. In a recent review, the drugs that most significantly interacted to cause bleeding events with DOACs were amiodarone and ritonavir through inhibition of p-gp and CYP3A4. Conversely, a reduction in DOAC levels has been observed in some case reports and pharmacokinetic studies when used concomitantly with enzyme inducers (rifampicin, carbamazepine), which may lead to therapeutic failure. It is advisable for all clinicians to periodically assess the patient?s medication regimen for DDIs when DOACs are prescribed. Advanced age, low body weight, renal impairment, or concomitant antiplatelet medications are additional factors that may impact the severity and outcome of DOAC drug-drug interactions.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6667;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, ANZCA";English;"It is not recommended to routinely prescribe slow-release opioids in the treatment of acute pain unless there is a demonstrated need, close follow-up is available, and a smoking cessation plan is in place.";"An individual's experience of pain in response to a noxious stimulus from surgery, trauma, or a general medical condition is variable and generally improves over time. Decisions about the management of acute pain should be tailored according to the individual assessment of the patient and the care setting. If the acute pain is moderate to severe and considered to be responsive to opioids, immediate-release opioids may be indicated as part of a multimodal analgesic regimen. Ideally, they should be titrated for effect and stopped as soon as possible as function returns. Avoid routine prescription of slow-release opioids in the treatment of acute pain, in hospital and community settings, unless there is a demonstrated need, close follow-up is available, and a cessation plan is in place. Its slow start and end do not allow a fast and safe titration. Its use in the setting of acute pain has been associated with an increased risk of opioid-induced ventilatory failure, best clinically recognized as increased patient sedation, and other opioid-related adverse effects; less effective relief of acute pain; and an increased risk of long-term opioid use. Slow-release opioids act as a constant background dose of opioids, which may be excessive for the patient's needs or may act as an unpredictable addition to the opioid load if immediate-release opioids are added on an as-needed basis. If opioid-related adverse effects are found, they will also remain. If there is a demonstrated need for a slow-release opioid, consideration should be given to prescribing opioids with a lower risk of opioid-induced ventilatory failure, for example, the atypical opioids tramadol, tapentadol, or buprenorphine (taking into account individual patient risks). , vulnerabilities and potential drug interactions).";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6669;2;"Choosing Wisely�";"American Society for Radiation Oncology ";English;"Routine use of radiation therapy or other forms of cancer treatment is not recommended without considering the possible financial toxicity to patients.";"Cancer patients are at high risk for financial hardships due to lost productivity and uncovered treatment expenses. Radiation treatment decisions, including implemented technology, fractionation regimen, and whether radiation can be omitted, all may meaningfully influence the financial impact of the treatment on the patient. Heavy financial burdens can accrue, sometimes to the point of financial insolvency. Financial toxicity has been observed to be associated with reduced treatment compliance and lower overall survival. Cancer patients are at high risk for financial hardships due to lost productivity and uncovered treatment expenses. Radiation treatment decisions, including implemented technology, fractionation regimen, and whether radiation can be omitted, all may meaningfully influence the financial impact of the treatment on the patient. Heavy financial burdens can accrue, sometimes to the point of financial insolvency. Financial toxicity has been observed to be associated with reduced treatment compliance and lower overall survival.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6930;1;"NICE ";NICE;English;"Computed Tomography is recommended before performing lumbar puncture";"Performing intracranial computed tomography before lumbar puncture in patients with suspected acute bacterial meningitis can identify patients at high risk for brain herniation and detect alternative diagnoses. There are three arguments against intracranial computed tomography before LP in patients with acute bacterial meningitis. First, very few patients suffer a puncture hernia. Second, intracranial CT scan is not a good test to rule out the possibility of future brain herniation. Third, unnecessary intracranial CT scan may delay the administration of antibiotics and worsen the prognosis.";2022;;;"Low value";"Diagnostic test";"Things We Do for No Reason?: Tomograf�a computarizada de la cabeza antes de la punci�n lumbar en adultos y ni�os de bajo riesgo" 6931;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely";English;"It is recommended that the calculation of pulmonary function tests (PFTs) be adjusted based on the race of the individual.";"The pulmonary function test (PFT) is used to evaluate lung health by measuring air flow and volumes. They help confirm clinical diagnoses such as chronic obstructive pulmonary disease (COPD) and asthma and monitor response to treatment and disease progression.In developing spirometry, several studies in the last century identified differences in lung function between races that led to to the implementation of racial adjustment factors. The racial adjustment factor for PFTs is detrimental because: (1) accepting the racial factor precludes examination of other social, environmental, and genetic factors as drivers of the disease, (2) it leads to underdiagnosis of lung diseases in racial minority patients. and impacting timely diagnosis, access to effective treatments, and ultimately outcomes, 6 and (3) continues to focus on race, a social construct that imprecisely categorizes people, rather than population categories that grouped by genetic groups. Research has not identified genetic variation that could explain racial differences in lung functions. However, multiple studies show the effect of socioeconomic status, environmental toxins, and other SDOH. PFT is an important component in diagnosing a variety of diseases and assessing patients' lung health. Many health professionals are understandably concerned about the unintended harm caused by removing race adjustment. However, supporting racial adjustment perpetuates health care disparities.";2022;;;"Low value";"Diagnostic test";"https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.12974" 6685;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended to order knee radiographs to diagnose Osgood Schlatter Disease in children.";"Osgood Schlatter is a disease that consists of the detachment of the growth cartilage of the tibia as a consequence of making repeated gestures. It is manifested by the appearance of pain on the front side of the knee, below the kneecap and the appearance of a lump in the painful area. It is a clinical diagnosis based on an appropriate history and typical physical findings. Knee radiographs do not need to be performed if there is no acute concern (such as trauma, suspicion of an avulsion fracture or red flag symptoms such as night pain, joint swelling, constitutional symptoms, etc) and patients are responding to treatment. The recommedation was sent to the Pediatric Interest Group of CASEM, as well as a pediatric orthopedic surgeon and a pediatric MSK radiologist at McMaster University, to seek feedback on each suggested recommendation and review existing Choosing Wisely Canada recommendations.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6686;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";Spanish;"It is not recommended to order scoliosis radiographic series for back pain in children";"Scoliosis radiographic series consisting of full spine standing radiographs are not indicated in the evaluation of back pain unless there are clinical signs of scoliosis (asymmetry on Adams forward bend test, asymmetry of the shoulders, etc). When clinically indicated, radiographs are a good initial diagnostic tool to assess back pain but should be limited to the area of interest to limit radiation exposure.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6687;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended to order thoracic spine radiographs if there is clinical concern about scoliosis in adults and children.";"Thoracic spine radiographs are not sufficient to evaluate scoliosis as they may not allow for adequate visualization of the curves, especially potential lumbar components. They also do not allow for assessment of the Risser index, a measure of the degree of iliac apophysis ossification and a marker for both skeletal maturity and potential curve progression. The Canadian Academy of Sport and Exercise Medicine (CASEM) Board approved the development of pediatric-specific sport and exercise medicine (SEM) Choosing Wisely Canada?s recommendations. Final edits were made and approved for submission to Choosing Wisely Canada by the CASEM Board.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6688;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended to order oblique radiographic views for investigation of spondylolysis.";"Due to their efficacy, low cost, and low radiation exposure, 2-view plain films are the best initial study. Oblique radiographs detect less than 30% of spondylolysis lesions and pose increased radiation exposure with little to no increased benefit. Advanced imaging (magnetic resonance imaging, bone scan + single photon emission computed tomography) may detect stress injury not seen on radiographs.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6689;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended ultrasound as an initial investigation for shoulder/knee injuries in children. ";"Bone injury is more common in children and therefore should be ruled out when evaluating injuries in the pediatric patient. Conventional radiography is the main and usually the only imaging modality needed to evaluate the shoulder and knee. Ultrasonography should not be requested as part of the initial diagnostic evaluation; However, if patients do not respond to conservative treatment, additional imaging may be necessary. The recommedation was sent to the Pediatric Interest Group, as well as a pediatric orthopedic surgeon and a pediatric MSK radiologist at McMaster University, to seek feedback on each suggested recommendation and review existing Choosing Wisely Canada recommendations.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6690;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended to order a head CT scan for minor head injuries/concussion in children.";"A number of clinical decision rules for use of CT for minor head injury in children, including PECARN, CATCH and CHALICE rules, have been developed in the last two decades and have shown that children with low risk for clinically important structural brain injury, as in the setting of concussion (no focal neurological deficits, no altered mental state, etc), do not require CT imaging. The Canadian Academy of Sport and Exercise Medicine (CASEM) Board approved the development of pediatric-specific sport and exercise medicine (SEM) Choosing Wisely Canada?s recommendations. Final edits were made and approved for submission to Choosing Wisely Canada by the CASEM Board.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6691;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"It is not recommended to order follow-up radiographs for buckle fractures of the distal radius if there are no clinical symptoms at the time of follow-up. ";"Most if not all buckle fractures heal without complications. Follow up radiographs are not indicated if symptoms have resolved, as this will expose the child to unnecessary radiation. The recommedation was sent to the Pediatric Interest Group of CASEM, as well as a pediatric orthopedic surgeon and a pediatric MSK radiologist at McMaster University, to seek feedback on each suggested recommendation and review existing Choosing Wisely Canada recommendations.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6694;1;"NICE ";NICE;English;"It is not recommended to treat with microwave ablation for primary or metastatic cancer in the lung, only with special arrangements for clinical governance, consent, and audit or research.";"Microwave ablation involves inserting a probe into the lung, through the skin of the chest, to send microwaves into the cancer cells. This produces heat, aiming to destroy the cancer (ablation). Evidence on the safety of microwave ablation for treating primary lung cancer and metastases in the lung is adequate but shows it can cause infrequent serious complications. Evidence on its efficacy shows it reduces tumour size. But the evidence on improvement in survival, long-term outcomes and quality of life is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. The evidence included 3 systematic reviews and/or meta-analyses, 6 non-randomised comparative studies, 2 case series, 1 case report and 1 review of lung microwave ablation database. Further research should be randomised controlled trials or disease registry studies. It should report patient selection, disease progression and quality of life, and take account of the effectiveness of managing oligometastatic disease in patients. Clinicians who want to use microwave ablation to treat primary lung cancer and metastases in the lung should: Inform the clinical governance leads in their healthcare organisation. - Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. - Make sure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. - Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6696;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology - Head & Neck Surgery�";English;"Don?t swab the nasal cavity as part of the work up for rhinosinusitis ";"Acute bacterial rhinosinusitis (ABRS) does not require proof of a culture-identified pathogen. When patients meet criteria for uncomplicated ABRS, empiric antibiotic selection should be based on typical causative pathogens, local bacterial resistance patterns, and patient factors. Nasal swabs are contaminated by normal nasal flora and results correlate poorly with causative pathogens in rhinosinusitis. In situations where cultures are required, such as intraorbital or intracranial complications, endoscopically-guided culture of the middle meatus or a maxillary sinus aspirate are the preferred methods for obtaining samples of the causative pathogen. This list was created by the Rhinology Specialty Group of the Canadian Society of Otolaryngology ? Head & Neck Surgery. The final version of the list was then circulated and approved by the members of the group. Choosing Wisely Canada groups across multiple specialties reviewed and refined the consensus recommendations.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6697;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology - Head & Neck Surgery�";English;"Don?t order plain film sinus x-rays ";"Plain films have poor sensitivity and specificity and they cannot be relied upon to confirm or reject the diagnosis of either acute or chronic sinusitis. Air-fluid levels and complete sinus opacification are not reliably present in rhinosinusitis, and cannot differentiate between viral and bacterial etiologies. The findings of a sinus x-ray cannot be relied upon to diagnose rhinosinusitis, guide antibiotic prescribing, or plan surgery, they do not provide value in patient care and should be avoided. This list was created by the Rhinology Specialty Group of the Canadian Society of Otolaryngology ? Head & Neck Surgery. Choosing Wisely Canada groups across multiple specialties reviewed and refined the consensus recommendations. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6699;19;"Choosing Wisely Canada";"Pediatric Sport & Exercise Medicine";English;"Don?t immobilize a joint with suspected amplified pain syndrome (complex regional pain syndrome). ";"Complex regional pain syndrome is a chronic severe pain condition that involves peripheral, central and autonomic nervous system and immune system mechanisms. Immobilization of the painful area can lead to prolonged symptoms and poor outcomes and should be avoided unless required for underlying pathology. The Canadian Academy of Sport and Exercise Medicine (CASEM) Board approved the development of pediatric-specific sport and exercise medicine (SEM) Choosing Wisely Canada?s recommendations. Final edits were made and approved for submission to Choosing Wisely Canada by the CASEM Board.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6701;1;"NICE ";NICE;English;"It is not recommended to treat withdrawal symptoms with another medicine that is associated with dependence or withdrawal symptoms, nor to offer sodium valproate or buspirone to aid withdrawal from a benzodiazepine.";"Exceptional medical circumstances include the occurrence of serious side effects (for example, upper gastrointestinal bleeding from an antidepressant, respiratory depression from an opioid or severe ataxia from a gabapentinoid). In these circumstances, consider: -scheduling more frequent reviews -short-term use of medicines to treat the physical symptoms of withdrawal (for example, abdominal cramps and diarrhoea during withdrawal of an opioid). Medicines associated with dependence include benzodiazepines, Z?drugs (such as zopiclone and zolpidem), opioids, gabapentin and pregabalin. Antidepressants, although historically not classified as dependence-forming medicines, can nevertheless cause withdrawal symptoms when they are stopped. This guideline focuses on medicines that are usually used for conditions that are chronic, complex and difficult to treat, such as anxiety and insomnia, chronic pain including neuropathic pain, depression and generalised anxiety disorder. It also covers medicines that were initially prescribed for acute pain but continue to be prescribed over a longer term.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6702;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended to offer a structured program of education and neuromuscular exercise to patients with osteoarthritis, to allow self-management and coping with arthritis in patients from 16 years of age. ";"Osteoarthritis is a disease that affects the joints. It is the most common type of arthritis and is seen more frequently in older people. Osteoarthritis causes pain, stiffness, and problems moving the joint. It usually affects the hips, knees, hands, and feet, but it can affect other joints. It can also affect more than one joint. It is diagnosed clinically and imaging tests are not usually necessary to confirm the diagnosis. The basic treatments are therapeutic exercise and weight control (if appropriate), along with information and support. There are various pieces of evidence supporting the importance of non-pharmacological therapy.""";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6454;31;"Smarter medicine";"Sociedad Suiza de Otorrinolaringolog�a y Cirug�a Cervicofacial";English;"X-rays are not recommended to diagnose a nasal fracture without clinical signs suggesting a fracture of the basilar skull or associated facial bone.";"Photographic documentation (face/profile) is recommended. Computed tomography (CT) or cone-beam CT should only be done if an additional facial bone or basilar skull fracture is suspected.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6456;31;"Smarter medicine";"Sociedad Suiza de Otorrinolaringolog�a y Cirug�a Cervicofacial";Spanish;"Imaging tests are not recommended to diagnose uncomplicated acute rhinosinusitis.";"Acute rhinosinusitis is a clinical diagnosis defined (according to the literature) by at least two of the following acute symptoms: purulent nasal secretions, nasal obstruction, facial pain and/or alteration of smell (up to 12 weeks) with confirmation by nasal endoscopy. If a complication of rhinosinusitis or another underlying diagnosis is suspected, CT or cone-beam CT is recommended.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6459;31;"Smarter medicine";"Sociedad Suiza de Otorrinolaringolog�a y Cirug�a Cervicofacial";English;"Systemic antibiotics are not recommended for acute uncomplicated external otitis.";"Systemic antibiotics have significant side effects and, unlike topical antibiotic drops, do not sufficiently cover the bacteria responsible for these local infections. Furthermore, the development of resistance and the risk of opportunistic infections can be reduced by avoiding systemic antibiotic therapy.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6720;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"It is not recommended for the prevention of cardiovascular disease or cancer in non-pregnant adults.";"The USPSTF recommends against the use of beta carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. Grade: D This recommendation applies to community-dwelling, nonpregnant adults. It does not apply to children, persons who are pregnant or may become pregnant, or persons who are chronically ill, are hospitalized, or have a known nutritional deficiency. For many vitamins and nutrients, there was little evidence of serious harms. However, an important harm of increased lung cancer incidence was reported with the use of beta carotene by persons who smoke tobacco or have occupational exposure to asbestos. Excessive doses of vitamin supplements can cause adverse effects. It is uncertain whether there might be heterogeneity across populations or by baseline nutrient level, or by socioeconomic factors such as food insecurity, in the effects of vitamin, mineral, and multivitamin supplementation on cardiovascular disease and cancer outcomes. Cardiovascular disease and cancer are the 2 leading causes of mortality in the US. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6465;31;"Smarter medicine";"Sociedad Suiza de Otorrinolaringolog�a y Cirug�a Cervicofacial";English;"MRI is not recommended as an initial test for the diagnosis of acute vertigo.";"In the evaluation of acute vertigo, there is a paradigm shift from an evaluation based on history and risk factors to a 3-step clinical examination, the ""HINTS"" test. This acronym stands for head impulse, nystagmus type, tilt test. If a central cause is suspected, brain MRI is indicated with high-resolution sections in the pontocerebellar region.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6721;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"It is not recommended a screening of chronic obstructive pulmonary disease in asymptomatic adults ";"The US Preventive Services decided to use a reaffirmation deliberation process to update this recommendation based on the potential benefits and harms of the process. Using a reaffirmation process, the US Preventive Services concludes with moderate certainty that screening for COPD in asymptomatic adults has no benefit on morbidity, mortality, or quality of life. The evidence review did not include populations at very high risk of COPD, such as people with ?-1 antitrypsin deficiency or workers with known occupational exposures.";2022;;;"Low value";Screening;"Link to the recommendation on the website of the initiative" 6722;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"The use of statins is recommended for the primary prevention of cardiovascular disease in adults aged 40 to 75 years who have 1 or more cardiovascular risk factors and an estimated 10-year risk of cardiovascular disease of 10% or more.";"These recommendations apply to adults 40 years or older who do not already have CVD or signs or symptoms of CVD. They do not apply to adults with a low-density lipoprotein cholesterol level greater than 190 mg/dL (4.92 mmol/L) or known familial hypercholesterolemia. These populations are at very high risk for CVD and considerations on the use of statins in these populations can be found in other organization?s guidelines on management of hypercholesterolemia. This recommendation has to be implemented considering patient's age. For adults aged 40 to 75 years: -Determine whether the patient has a cardiovascular risk factor. -Estimate CVD risk using a CVD risk estimator. -In patients who have a cardiovascular risk factor and an estimated 10-year CVD risk of 10% or greater, initiate a moderate-intensity statin after discussing the rationale and provided the patient agrees. -In patients who have a cardiovascular risk factor and an estimated 10-year CVD risk of 7.5% to less than 10%, the benefit of starting a statin is smaller, so clinicians should selectively offer a statin, taking patient values and preferences into account. -For adults 76 years or older: The evidence is insufficient to recommend for or against starting a statin. It should be considered that: -Age is one of the strongest risk factors for CVD. -Men have a higher prevalence of CVD than women, although women experience higher mortality from certain cardiovascular events. On average, men experience CVD events earlier in life compared with women. -Among both sexes, Black persons have the highest prevalence of CVD. -To achieve the full benefits of statin use, it is essential to equitably improve statin use in both women and men of all races and ethnicities, and especially among Black and Hispanic adults, who have the highest prevalence of CVD and the lowest utilization of statins, respectively. In adults at increased risk of CVD but without prior CVD events, statin therapy for primary CVD prevention was associated with a reduced risk of all-cause mortality and CVD events. The benefits of statin therapy appear to be present in diverse demographic and clinical populations, with consistent relative benefits in groups defined by demographic and clinical characteristics.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6723;15;"U.S. Preventive Services Task Force A and B recommendations";"U. S. Preventive Services Task Force";English;"The current evidence is insufficient to assess the balance of benefits and harms of screening for atrial fibrilation in adults 50 years or older who do not have signs or symptoms";"To update its 2018 recommendation statement, the USPSTF commissioned a systematic review of the evidence on the benefits and harms of screening for AF in older adults, the accuracy of screening tests, the effectiveness of screening tests to detect previously undiagnosed AF compared with usual care, and the benefits and harms of anticoagulant therapy for the treatment of screen-detected AF in older adults. The USPSTF found 3 trials, REHEARSE-AF,37 SCREEN-AF,40 and STROKESTOP,38 that compared screening with no screening and that reported on health outcomes; however, only STROKESTOP was powered to detect health outcomes. The result indicates that the evidence is insufficient to recommend either for or against screening and that more research is needed.";2022;;;"Low value";screening;"

Link to the recommendation on the website of the initiative

" 6724;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"It is recommended to promote a healthy diet and physical activity to adults without cardiovascular risk factors.";"The US Preventive Services Task Force commissioned a systematic evidence review to update its 2017 recommendation on behavioral counseling to promote a healthy diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors The US Preventive Services Task Force concludes with moderate certainty that behavioral counseling interventions have a small net benefit on cardiovascular disease risk in adults without cardiovascular disease risk factors. The term ?healthy diet? is defined as a balance and variety of foods and beverages that assist an individual in achieving and maintaining a healthy weight, supporting health, and preventing disease. A healthy diet includes increased consumption of fruits, vegetables, whole grains, fat-free or low-fat dairy, lean proteins, and oils and limited consumption of foods and beverages with high sodium levels, saturated or trans fats, and added sugars.Additionally, a healthy diet should limit consumption of alcoholic beverages. Physical activity is broadly defined as any bodily activity that enhances or maintains overall health and physical fitness. Cardiovascular disease, which includes heart disease, myocardial infarction, and stroke, is the leading cause of death in the US. Important disparities in diet and physical activity exist across the US population. Social determinants of health and systemic racism contribute to differences in healthy diet and physical activity by influencing healthy food availability and physical activity barriers and opportunities.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6725;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"The current evidence is insufficient to assess the balance of benefits and harms of screening for primary open-angle glaucoma in adults.";"There are several screening tests to identify open-angle glaucoma; however, these tests are not administered in primary care and it cannot be predicted whether glaucomatous changes will progress to visual impairment. Furthermore, early treatment of primary open-angle glaucoma has limited evidence on improvements in vision and quality of life. Glaucoma affects an estimated 2.7 million people in the US. It is the second-leading cause of irreversible blindness in the US and the leading cause of blindness in Black and Hispanic/Latino persons. The US Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to assess the balance of benefits and harms of screening for glaucoma in adults (I Statement). More research is needed. ";2022;;;Uncertain;Screening;"Link to the recommendation on the website of the initiative" 6726;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is not recommedned the long-term use of benzodiazepines in the treatment of anxiety disorders in adults";"Anxiety disorders represent one of the most frequent mental health problems among the general population. The consumption of benzodiazepines in our environment is one of the highest in the world, especially in the elderly. Prolonged use, of more than 4 weeks, of benzodiazepines in the treatment of anxiety disorders in adults is not recommended due to the risk of tolerance, dependence and associated serious adverse effects: cognitive and memory alterations, drowsiness, increased risk of falls and traffic accidents. For this reason, its use should be limited to patients who do not respond to other treatments, or as adjuvant treatment, especially in those situations in which a faster response is required, such as anxiety attacks, agitation or during the period initial treatment with antidepressants, when these drugs are not yet effective. In Catalonia, 41.6% of people diagnosed with anxiety in the 12 months prior to May 2022 received treatment with benzodiazepines that exceeded 4 weeks. This represents a total of 65,735 individuals. In conclusion, when it is indicated to prescribe benzodiazepines for the treatment of anxiety, the treatment should not be prolonged beyond 4 weeks, due to the risk of tolerance, dependence and serious side effects associated with these drugs and because there are other effective and more therapeutic alternatives. safe.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6982;6;"Less Is More Collection - JAMA Network";"JAMA Network";English;"There is uncertainty about the safety of perioperative use of gabapentin in elderly patients.";"Retrospective, multicenter cohort study. The database used contains information on demographic characteristics, admission status, diagnosis codes, discharge status, and dated medication and procedure records. In this cohort study of 237,872 propensity score-matched adults aged 65 years or older, perioperative gabapentin use was associated with an increased risk of delirium, new antipsychotic use, and pneumonia among older patients after major surgery. Based on these findings and those of meta-analyses of randomized clinical trials showing a weak opioid-sparing effect of gabapentin, clinicians should reconsider the routine use of gabapentin for perioperative pain management among older adults and individualize the decision. of treatment after assessing the risk. For older patients receiving gabapentin as part of multimodal analgesia, daily assessment of the appropriateness of gabapentin use may be necessary to avoid unwanted harm. This study has limitations. The findings should be interpreted within the limitations of an administrative database study. ";2022;;;Uncertain;Treatment;"https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2796501" 6727;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"Evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in children and adolescents younger than 18 years who do not have any symptoms of type 2 diabetes. ";"Type 2 diabetes affects approximately 23,000 children and adolescents in the US. The incidence of type 2 diabetes is on the rise. Youth with type 2 diabetes have an increased prevalence of associated chronic comorbid conditions, including hypertension, dyslipidemia, and nonalcoholic fatty liver disease. The study shows there is insufficient evidence to recommend for or against screening for type 2 diabetes in children and adolescents without symptoms of diabetes or prediabetes. For this reason, clinicians should use their clinical judgement to determine if screening is appropriate for individual patients. This is a grade I recommendation that applies to children and adolescents younger than 18 years who have no signs or symptoms of diabetes or prediabetes. Screening for diabetes in adolescents who are pregnant is covered in a separate USPSTF recommendation. This recommendation was elaborated with a sistematic review. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6728;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services";English;"The current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults";"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults (65 years or older). The evidence is lacking, and the balance of benefits and harms cannot be determined. More research is needed. Advancing age is a major risk factor for most types of visual impairment. However, there are known risk factors for specific conditions that cause visual acuity impairment that vary by condition such as family history.";2022;;;Uncertain;Screening;"Link to the recommendation on the website of the initiative" 6729;15;"U.S. Preventive Services Task Force A and B recommendations";"U S Preventive Services";English;"The evidence is insufficient to recommend the screening for eating disorders (eg, binge eating disorder, bulimia nervosa, and anorexia nervosa) in asymptomatic adolescents and adults 10 years or older.";"The USPSTF commissioned a systematic review to evaluate the benefits and harms of screening for eating disorders in adolescents and adults with a normal or high BMI. Evidence limited to populations who are underweight or have other physical signs or symptoms of eating disorders was not considered. The USPSTF has not previously made a recommendation on this topic. Seventeen studies (10 of good quality) evaluated the accuracy of various screening questionnaires for detecting any eating disorder or specific eating disorders. The USPSTF determined there was insufficient evidence to assess the balance of benefits and harms of screening for eating disorders. In deciding whether to screen, clinicians may consider the following: potential preventable burden (organ systems, disturbances in cognitive and emotional functioning and psychiatric conditions), potential harms (false-positive screening results that lead to unnecesary treatment), current practice (changes in growth or weight may result in the detection of some eating disorders) and assessment of Risk (higher prevalence of eating disorders are found among athletes, females, younger adults aged 18 to 29 years, and transgender individuals)";2022;;;"Low value";screening;"

Link to the recommendation on the website of the initiative

" 6730;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is not recommended to transfuse more than one unit of red blood cells at a time in hemodynamically stable patients without active bleeding who require transfusion.";"Although transfusions can save lives and are generally a safe practice, they are also associated with increased morbidity and mortality in hospitalized patients. The decision to indicate a transfusion should be based on the patient's clinical picture, and not only on the hemoglobin concentration. In 2012, the Joint Commission identified blood transfusion as one of the five most overused procedures. In general, studies also show that the population over 60 years of age is the one who receives the most transfusions Prior to the creation of the Patient Blood Management program, it was common to transfuse two units of red blood cells at the same time, since a single unit was not considered sufficient to correct anemia. However, evidence has shown that, in hemodynamically stable patients without active bleeding, transfusions of a single unit of red blood cells are the standard, since they are usually adequate to treat the signs and symptoms of anemia and, in addition, are reduce the risks associated with transfusion. It should be noted that the decision to transfuse should be based on both hemoglobin levels and the clinical status of the person. It is relevant to highlight that, although blood transfusion can save lives, it also carries risks, has a significant cost and is a resource of limited availability, which comes from voluntary donations. Transfusion errors, especially those linked to inadequate identification of patients at the time of extraction and administration of blood components, can cause acute hemolytic reactions due to ABO group incompatibility, being the most frequent serious adverse reaction. Cardiogenic pulmonary edema due to circulatory overload also stands out as one of the main causes of morbidity and mortality. Likewise, hemosiderosis is another of the most frequent complications, cases of transfusion-associated acute lung injury are occasionally recorded, and blood-borne infections are currently a rare complication in our environment. Since the risk increases with the number of units transfused, it is important that the patient receive only those transfusions that are necessary. In conclusion, in hemodynamically stable patients without active bleeding, it is not recommended to transfuse more than one unit of red blood cells at a time and it is necessary to evaluate the response after each transfused unit. This procedure has the potential to reduce unnecessary transfusions, as well as the associated risks and costs.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6731;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";" Sociedad Catalana de Medicina Familiar y Comunitaria ";Spanish;"Prescribing antibiotics without diagnostic confirmation of group A beta-hemolytic streptococcus by rapid diagnostic test is not recommended for acute pharyngitis in adults.";"n adults, most acute tonsillopharyngitis is viral in origin. Antibiotic treatment is only indicated when the microorganism involved is group A beta-hemolytic streptococcus (GABHS). When there is suspicion of tonsillopharyngitis due to GABHS, the diagnosis must be confirmed by means of a rapid diagnostic test before prescribing the antibiotic. There are clinical prediction scales based on signs and symptoms, such as the Centor, which are useful when selecting patients for rapid diagnostic testing. The prescription of antibiotic treatment for acute pharyngotonsillitis, without diagnostic confirmation by GABHS, leads to an inappropriate use of antibiotics. Consequently, it increases the risk of adverse reactions, the risk of antibiotic resistance and has repercussions in an increase in economic spending. The data estimate that 50% of antibiotic treatments by acute tonsillopharyngitis in the Catalan adult population have been inadequate.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6732;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"It is not recommended to continue treatment with long-acting bisphosphonates in postmenopausal women with low risk of fracture.";"Two recent systematic reviews show that, in low-risk postmenopausal women, no better results are observed in terms of fragility fracture prevention when bisphosphonates are compared with placebo. Most clinical practice guidelines recommend reassessing the therapeutic indication in patients treated with bisphosphonates after 3 to 5 years, depending on whether they received zoledronate (3 years) or oral bisphosphonates (5 years). If the patient is considered low risk at that time, it is recommended to start a therapeutic vacation. Bisphosphonates are considered to be safe and generally well tolerated drugs, but the most serious effects refer to the appearance of atypical femoral fractures, the relative risk of presenting them increases with time and decreases with drug withdrawal. There is no evidence that treatment beyond 3 years (zoledronate) or 5 years (oral bisphosphonates) is of benefit, and the effect of bisphosphonates is maintained after discontinuation of treatment. Patients with a high risk of fracture or in active treatment with drugs that can induce osteoporosis and the use of bisphosphonates for other bone diseases where they may also be indicated (Paget or hypercalcemia) would not be candidates for therapeutic holidays.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6733;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Pediatr�a ";Spanish;"It is not recommended for acute tonsillopharyngitis in children, to prescribe antibiotics without having a diagnostic confirmation of group A beta-hemolytic streptococcus using a rapid diagnostic test";"In the child population, the majority of acute pharyngotonsillitis (AFT) are of viral origin, especially in younger children. Antibiotic treatment is only indicated when the microorganism involved is group A beta-hemolytic streptococcus (GABHS). When there is suspicion of FAA due to GABHS, the diagnosis must be confirmed by means of a rapid diagnostic test before prescribing the antibiotic. The evidence does not allow us to establish a definitive conclusion about the usefulness of the clinical prediction scales (Centor, Centor-Mclsaac, and FeverPAIN) for the selection of patients on whom to perform the rapid diagnostic test. The prescription of antibiotic treatment for AAF in children, without having a positive GABHS result with a rapid diagnostic test, leads to unjustified use of antibiotics. Consequently, it carries a risk of adverse reactions due to treatment, a risk of selection of resistances and inadequate resource management.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6734;15;"U.S. Preventive Services Task Force A and B recommendations";"U S Preventive Services";English;"It is not recommended to initiate low-dose aspirin use for the primary prevention of cardiovascular disease in adults 60 years or older.";"To update its 2016 recommendation, the USPSTF commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on CRC incidence and mortality in primary CVD prevention populations, as well as the harms, particularly bleeding harms, associated with aspirin use Evidence indicates that the decision to initiate low-dose aspirin use for the primary prevention of CVD in asymptomatic adults aged 40 to 59 years with an estimated 10% or greater 10-year cardiovascular disease (CVD) risk should be an individual one. Those who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, oruseof medications that increase bleedingrisk) are more likely to benefit.";2022;;;"Low value";treatment;"Link to the recommendation on the website of the initiative" 6735;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"The routine use of the combination of ACE inhibitors and ARBs in patients with heart failure is not recommended";"In patients with heart failure, the studies carried out have not identified a benefit in terms of mortality, but a higher incidence of renal alterations and hyperkalemia. Therefore, the routine use of the combination of ACE inhibitors and ARBs in patients with heart failure is not recommended. In those selected patients who remain symptomatic with standard treatment despite good compliance and in whom aldosterone antagonists are not an option (due to intolerance or contraindication), combined treatment with ACEI + ARA-II can be considered. after consulting with a specialist. In the case of combined treatment, it is recommended to add an ARA-II with an authorized indication in combination such as candesartan and valsartan to the ACEI. It is recommended to carefully assess the risk-benefit balance and, if starting this treatment, to carry out strict monitoring of renal function and electrolyte balance.";2022;;;"Low value";Treatment;"https://essencialsalut.gencat.cat/es/detalls/Article/IECA_ARA-II_pacients_insuficiencia_cardiaca" 6739;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is not recommended to maintain the line of a peripheral venous catheter in patients in whom it has not been used for 24-48 hours, or sooner if it is no longer necessary.";"Keeping unused peripheral venous catheters inserted increases the risk of potentially preventable complications such as local infections, bacteraemia, or phlebitis. Clinical practice guidelines recommend removing any catheter that is not being used as soon as possible. It is necessary to evaluate the need on a daily basis and remove them if they are not used, or as soon as signs of complications appear. In conclusion, it is not recommended to leave any peripheral catheter inserted that is not being used, or if it has not been used in a period of 24 or 48 hours. The removal of unnecessary catheters means a reduction in the risk of presenting potentially avoidable complications, an increase in patient safety and a more efficient use of resources";2022;;;"Low value";"Diagnosis and treatment";"https://essencialsalut.gencat.cat/es/detalls/Article/cateter_venos" 6740;36;"Choosing Wisely UK";"British Society for Antimicrobial Chemotherapy";English;"There is insufficient evidence of benefit to recommend or not the use of antibiotics in patients who are close to the end of life.";"Studies reveal a high infection rate and a high antibiotic prescription rate during the last month of life in cancer patients. But there was no change in symptomatic improvement in more than half of the patients. A review of non beneficial treatments in hospital at the end of life determined that the administration of antibiotics, cardiovascular, digestive and endocrine treatments was not beneficial in dying patients in 11-75% (mean 38%). Also end of-life treatment is independently associated with acquisition of resistant bacteria. Patients dying without withdraw orders receive more antibiotics and develop more resistant organisms. These patients may represent a reservoir of resistant bacteria in the ICU. the use of antibiotics with patients who are close to the end of life must be discussed and more studies should be done to clarify the benefits and harms.";2022;;;Uncertain;Treatment;"https://choosingwisely.co.uk/recommendations-archive/#1572878782671-7a44ad60-f191" 6491;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire international";English;"The use of romosozumab for the treatment of osteoporosis in postmenopausal women is not recommended.";"Romosozumab is authorised for severe osteoporosis in postmenopausal women, on the basis of a trial in several thousand women that showed a slightly lower risk of clinical fractures than with alendronic acid. This gain must be weighed against a possible increase in the risk of cardiovascular events, with higher mortality among patients aged 75 years and older. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6492;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire international";Spanish;"The use of Meloxicam as a systematic anti-inflammatory treatment is not recommended.";"Meloxicam, piroxicam and tenoxicam are part of the nonsteroidal anti-inflammatory drugs (NSAIDs) that are used to reduce inflammation and pain in joints and muscles. When used systemically, they expose patients to an increased risk of gastrointestinal and skin disorders (including Stevens-Johnson syndrome and toxic epidermal necrolysis), but are no more effective than other NSAIDs.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6494;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"Finasteride is not recommended for use as a treatment for male pattern baldness in men.";"Finasteride 1 mg, a 5-alpha reductase inhibitor, has very modest efficacy against male pattern baldness in men, slightly increasing hair density at the crown (by about 10%), but only while treatment continues. treatment. Notable side effects include sexual dysfunction (erectile dysfunction, ejaculation disorders, decreased libido), depression, suicidal ideation, and breast cancer. When a pharmacological approach is chosen, topical minoxidil is less dangerous, although certain precautions must be taken.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6497;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International: Drugs to avoid in 2022";English;"Esketamine is not recommended for the treatment of treatment-resistant depression, although it is approved for this situation in clinical practice.";"Its neuropsychiatric side effects are common and include dissociative symptoms. Addiction and misuse are likely. In this difficult clinical situation, it is more prudent to consider other less dangerous options, even if their efficacy is uncertain: psychotherapy; increasing the dose of the initial antidepressant; switching to an antidepressant from a different pharmacological class; add a so-called atypical neuroleptic; or electroconvulsive (electroshock) therapy. The choice of treatment will depend mainly on the adverse effect profile.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6753;36;"Choosing Wisely UK";6753;English;"Outpatient magnetic resonance is recommended for paediatric and adult patients with epilepsy to identify the cause, inform prognosis and choice of treatment. ";"Magnetic resonance is the technique of choice for people with epilepsy. People who have had a first seizure, have fully recovered, have no headache and have a normal neurological examination do not usually need a CT scan while in the emergency department. Instead, they should be offered an outpatient magnetic resonance scan. Early performance of this test is important for timely decision making. The diagnosis should be made as soon as possible, ideally no more than a 6-week wait. There may be situations in which magnetic resonance is not indicated (claustrophobia, pacemakers...) and therefore a CT scan may be appropriate. MRI is unnecessary in cases of idiopathic generalised epilepsy or self-limited epilepsy with centrotemporal spikes. ";2022;;;"High value";Diagnostic;"Link to the recommendation on the website of the initiative" 6498;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire Internationat";English;"The use of Piracetam is not recommended against vertigo, cognitive or sensorineural impairment in elderly patients, dyslexia in children and myoclonus of cortical origin.";"Piracetam, a ?psychostimulant?, is authorised for use in various clinical situations, including vertigo, cognitive or neurosensory impairment in elderly patients, dyslexia in children, and myoclonus of cortical origin. Piracetam?s efficacy in these situations has not been established, but it can provoke haemorrhage, nervousness, agitation and weight gain. No drugs are known to have a favourable harm-benefit balance in vertigo, cognitive or neurosensory impairment, or dyslexia. The antiepileptics, valproic acid and clonazepam, are options for cortical myoclonus. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6499;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International: Drugs to avoid in 2022";Spanish;"Pimecrolimus administration is not recommended for the treatment of atopic eczema.";"Topical pimecrolimus and topical tacrolimus, two immunosuppressants used in atopic eczema, can cause skin cancer and lymphoma. These adverse effects are disproportionate since their efficacy is slightly different from that of high-potency topical corticosteroids (Prescrire Int n� 101, 110, 131, 224; Rev. Prestituci�n n� 367, 428) (d). Rational use of a topical corticosteroid to treat flare-ups is a better option in this situation. Hardly any comparative evaluations provide available data on Pimecrolimus or Tacrolimus in patients in whom a topical corticosteroid has failed.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6500;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Glyfozins are recommended for use in certain patients with type 1 and 2 diabetes, heart failure, and chronic kidney disease";"Four gliflozins are authorised in the European Union: canagliflozin (alone or combined with metformin), dapagliflozin (alone or combined with metformin or saxagliptin), empagliflozin (alone or combined with metformin or linagliptin), and ertugliflozin (alone or combined with metformin or sitagliptin). All the gliflozins have an unfavourable harm-benefit balance in the prevention of the complications of type 1or type 2 diabetes. However, limited data have shown a reduction in all-cause mortality with dapagliflozin in patients with moderate or severe kidney disease, most of whom had diabetes; or a reduced risk of progression to end-stage kidney disease after 3 years of treatment with canagliflozin in patients with diabetic nephropathy, but a substantial increase in the risk of ketoacidosis. In certain heart failure patients, with or without diabetes, whose physical activity remains limited despite optimised treatment, dapagliflozin reduced the incidence of the serious complications of heart failure, although robust evidence of a reduction in mortality is lacking. All the gliflozins share a burdensome adverse effect profile, which includes urogenital infections, serious skin infections affecting the perineum, ketoacidosis, and possibly an increased risk of toe amputation. It is still not clear which patients are likely to derive a real benefit.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 7016;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is not recommended to performe a noncontrast head computed tomography before lumbar puncture in adults and children with low-risk for brain herniation ";"There are three arguments against noncontrast head computed tomography before lumbar puncture in acute bacterial meningitis patients. First, very few patients herniate from lumbar puncture. Second, noncontrast head computed tomography is not a good test to rule out the possibility of future brain herniation. Third, unnecessary noncontrast head computed tomography can delay antibiotic administration and worsen prognosis. Evidence from two cohort studies indicates the importance of physical examination in determining the initial risk of brain herniation. In patients at high risk of brain herniation, antibiotic and anti-inflammatory treatment should be administered prior to computed tomography. On the other hand, in low-risk patients, lumbar puncture should be performed first. Clinical practice standards are not presented, but are intended to establish a starting point for research and active discussions between hospitalists and patients.";2022;;;"Low value";Diagnostico;"link to the recomendation on the website of the initiative/ enlace a la recomendaci�n en la p�gina web de la iniciativa" 7017;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is recommended to forego the routine preoperative coagulation package for each neurosurgical patient, focus on the history that will help predict bleeding complications, and for patients with a positive history or history indicative of possible abnormal hemostasis, request preoperative coagulation testing.";"Preoperative evaluation of patients undergoing any type of surgery requires an assessment of the risk of perioperative bleeding. Although the evaluation includes a history of bleeding risk, physicians are concerned that a subset of patients will be at increased risk of bleeding despite having a normal medical history. It consists of a history of bleeding risk. questions about bleeding symptoms, vitamin K deficiency or clotting disorders, any condition or treatment that may interfere with hemostasis, family history of bleeding symptoms or bleeding.";2022;;;"High value";"preventiva ";"link to the recommendation on the website of the initiative / enlace a la recomendaci�n en la p�gina web de la iniciativa." 7018;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"It is not recommended the routine hispitalization in children presenting with fecal impactation for a cleanout ";"Functional constipation is one of the most common pediatric problems and can lead to fecal impaction, defined as a large mass of stool identified in the distal colon in the abdominal or rectal examination, the diagnosis of which often involves admitting the patient for ?cleanout.? There are certain criteria to indicate hospitalization for fecal impaction but the assumptions underlying these decisions are not evidence-based, relying instead on arbitrary rules and subjective determinations. This lack of standardization drives the wide variation in practice regarding the management of fecal impaction. Evidence from 3 randomized clinical trials and a retrospective cohort study have demonstrated the efficacy and safety of treating fecal impaction at home with oral polyethylene glycol and/or enemas.";2022;;;"High value";"Home treatment";"Link to the recommendation on the websit of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 7021;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason ";English;"It is not recommended to perform routine preoperative hemostatic testing for every neurosurgical procedure";"Routine coagulation testing in the preoperative assessment of patients undergoing neurosurgical procedures is ineffective and leads to unnecessary additional costs. Based on history, the patient in the clinical scenario has no increased risk for bleeding complications, including no pertinent family history or bleeding history. Despite this, the patient (like many others) underwent additional testing including an unnecessary consultation, which ultimately added to the cost of care. To avoid situations like this, hospitalists should advocate for their system to adopt prudent testing algorithms comprised of purposeful coagulation testing based on clinical history, rather than routine coagulation testing on all patients.";2022;;;"High value";"Diagnosis (lab tests)";"Link to the recommendation on the initiative's website" 6536;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital Universitari Germans Trias i Pujol";Spanish;"Routine post-EBUS-TBNA chest X-ray is not recommended";"EBUS-TBNA is a minimally invasive, high-precision technique that enables real-time needle aspiration of mediastinal and hilar lymph nodes guided by ultrasound images. Since the incorporation of this technique, it has been common practice to perform a chest X-ray after EBUS-TBNA to rule out the existence of complications, basically pneumothorax. The vast majority of identified studies do not report the appearance of pneumothorax as a post-EBUS-TBNA complication and what they do report describes a low frequency. In conclusion, routine post-EBUS-TBNA chest radiography is not recommended except in cases where complications are suspected. This recommendation is based on the low frequency of pneumothorax as a post-EBUS-TBNA complication reported in the literature.";2022;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 6537;1;"NICE ";NICE;Spanish;"Bioresorbable stent implantation is not recommended to treat coronary artery disease in affected patients, only in the context of research";"Coronary artery stenosis is usually due to atherosclerotic plaque deposition. This reduces blood flow to the heart muscle and is usually progressive. Symptoms of coronary artery disease usually include angina (chest pain that is exacerbated by exertion). A critical reduction in blood supply to the heart can lead to a heart attack or death. Evidence on the safety of bioresorbable stents has shown an increased risk of serious long-term complications. This includes an increased risk of heart attack and death with some types of bioresorbable stents. Therefore, this procedure should only be used in the context of research.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6541;1;"NICE ";NICE;English;"It is not recommended aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection in affected patients";"An aortic dissection is a serious condition in which a tear occurs in the inner layer of the aorta. Blood flows through the tear and into the wall of the aorta. This forces the inner and middle layers of the aorta to split apart (dissect), creating 2 passages (a true lumen and a false lumen). As more blood flows into the new false lumen the dissection extends along the aorta. This can lead to aortic rupture or decreased blood flow (ischaemia or malperfusion) to organs. Evidence on the safety and efficacy of aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wanting to do aortic remodelling hybrid stent insertion during surgical repair of an acute type A aortic dissection should: ? Inform the clinical governance leads in their healthcare organisation. ? If possible, give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. ? If possible, ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. ? Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: ? Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. This procedure should only be done in specialised centres by surgeons experienced in aortic surgery and with special training in this procedure.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6542;1;"NICE ";NICE;English;"It is not recommended vertebral body tethering for idiopathic scoliosis in children and young people, only in the context of research";"Scoliosis is a 3?dimensional spinal deformity. It causes the bones of the spine to twist or rotate so that the spine curves sideways. In many cases, idiopathic scoliosis is mild and does not need treatment other than close monitoring and physical therapy. For moderate and severe scoliosis, treatment may progress through casting and bracing to spinal surgery. Vertebral body tethering is a nonfusion spinal treatment for idiopathic scoliosis. The aim is to preserve the flexibility of the spine and modulate its growth on the concave and convex sides, so slowly correcting the scoliosis. The technique exploits a known reaction of bone to being stretched or being compressed. Evidence on the safety of vertebral body tethering for idiopathic scoliosis in children and young people is limited but raises concerns of serious complications. Evidence on its efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6543;1;"NICE ";NICE;English;"It is recommended placental growth factor (PLGF)-based tests, used with standard clinical assessment to help decide on care (to help rule in or rule out pre-eclampsia) for people with suspected preterm (between 20 weeks and 36 weeks and 6 days of pregnancy) pre?eclampsia";"Pre-eclampsia is a potentially serious complication of pregnancy, thought to be related to problems with the development of the placenta. Pre-eclampsia is characterised by high blood pressure (hypertension) and proteinuria, which is when the kidneys leak protein into the urine. If pre-eclampsia is not diagnosed and closely monitored, it can lead to potentially life-threatening complications including eclampsia, HELLP syndrome (haemolysis, elevated liver enzymes and low platelets), disseminated intravascular coagulation, stroke or organ dysfunction Se recomiendan las siguientes pruebas basadas en el factor de crecimiento placentario (PLGF), utilizadas con una evaluaci�n cl�nica est�ndar, para ayudar a decidir sobre la atenci�n (para ayudar a descartar o descartar la preeclampsia) para las personas con sospecha de ser pret�rmino (entre 20 semanas y 36 semanas y 6 d�as de embarazo) preeclampsia: -DELFIA Xpress PLGF 1?2?3 -Relaci�n DELFIA Xpress sFlt?1/PLGF 1?2?3 -Relaci�n SFlt-1/PLGF del inmunoensayo Elecsys -Prueba de triaje de PLGF. No todos los fabricantes indican el uso de sus pruebas en el rango completo de 20 semanas a 36 semanas y 6 d�as de embarazo. Las pruebas deben utilizarse de acuerdo con sus indicaciones de uso. Las pruebas basadas en PLGF pueden beneficiar particularmente a los grupos con mayor riesgo de resultados adversos graves en el embarazo, como las personas con antecedentes familiares africanos, caribe�os y asi�ticos. No utilice pruebas basadas en PLGF para tomar decisiones sobre si ofrecer un parto temprano planificado a personas con preeclampsia prematura. Las pautas NICE sobre hipertensi�n en el embarazo tienen recomendaciones sobre el momento del parto. Use una prueba basada en PLGF una vez por episodio de sospecha de preeclampsia prematura. La relaci�n BRAHMS sFlt-1 Kryptor/BRAHMS PLGF m�s Kryptor PE no se recomienda para uso rutinario en el NHS. Se necesita m�s investigaci�n para mostrar la precisi�n de esta prueba cuando se utilizan umbrales espec�ficos.";2022;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative" 6545;1;"NICE ";NICE;English;"It is recommended setmelanotide for treating obesity and controlling hunger caused by pro-opiomelanocortin deficiency, including proprotein convertase subtilisin/kexin type 1 or leptin receptor deficiency in people 6 years and over.";"Pro-opiomelanocortin (POMC) and leptin receptor (LEPR) deficiencies are rare genetic disorders of obesity. These genes are involved in signalling through the melanocortin?4 receptor (MC4R) neuroendocrine system in the hypothalamus. This system regulates hunger, satiety (a feeling of fullness) and energy expenditure. Setmelanotide (Imcivree, Rhythm Pharmaceuticals) has a marketing authorisation for the 'treatment of obesity and the control of hunger associated with genetically confirmed loss-of-function biallelic pro-opiomelanocortin (POMC), including PCSK1, deficiency or biallelic leptin receptor (LEPR) deficiency in adults and children 6 years of age and above'. ";2022;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 6547;1;"NICE ";NICE;English;"It is not recommended transcatheter tricuspid valve annuloplasty for people with severe and symptomatic tricuspid regurgitation";"Tricuspid regurgitation is when blood flows backwards through the tricuspid valve because it doesn't close properly during systole. Treatment may not be needed if symptoms are mild or absent. There are no specific medications to treat tricuspid regurgitation itself, but the symptoms of heart failure are controlled with diuretics and other medications. People with severe symptoms may have surgery to repair or replace the tricuspid valve. The safety of transcatheter tricuspid valve annuloplasty shows that there are serious but well-recognized complications. For people with severe and symptomatic tricuspid regurgitation, the evidence on the efficacy of transcatheter tricuspid valve annuloplasty is limited in quantity and quality. The evidence on its safety shows that there are serious but well-recognized complications. Therefore, for these individuals, this procedure should only be used with special arrangements for clinical monitoring, consent, and audit or investigation. For people with mild or moderate tricuspid regurgitation, the evidence on the safety and efficacy of transcatheter tricuspid valve annuloplasty is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Clinicians who wish to perform a transcatheter tricuspid valve annuloplasty for people with severe and symptomatic tricuspid regurgitation should: -Inform clinical governance leaders in your healthcare organization. -Give people (and their families and carers, as appropriate) clear written information to support shared decision-making, including NICE information for the public. -Make sure people (and their families and carers, as appropriate) understand the safety and efficacy of the procedure, and any questions about it. -Audit and review of the clinical results of all those who underwent the procedure. Key efficacy and safety outcomes identified in this guideline can be entered into the NICE interventional procedures results audit tool (for use at local discretion). -Discuss the results of the procedure during your annual evaluation to reflect, learn and improve. The procedure should only be performed in specialized centers with experience in the interventional management of tricuspid regurgitation. There should be immediate on-site access to cardiac and vascular surgery.";2022;;;"Low value";Treatment;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6548;1;"NICE ";NICE;English;"Nerve graft for corneal denervation is only recommended with special arrangements for clinical governance, consent, and audit or research.";"Damage to the trigeminal nerve can result in a decrease or loss of corneal sensation. People with neurotrophic keratitis typically have corneal epithelium defects, poor corneal healing, and can develop sight loss. They are also prone to corneal infections. Evidence of nerve graft for corneal denervation is limited. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wanting to do nerve graft for corneal denervation should: -Inform the clinical governance leads in their healthcare organisation. -Give people (and their families and carers as appropriate) clear information to support shared decision making, including NICE's information for the public. -Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure. -Regularly review data on outcomes and safety for this procedure.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6549;1;"NICE ";NICE;English;"Se recomienda la evaluaci�n, el manejo y la prevenci�n de la recurrencia en ni�os, j�venes y adultos que se hayan autolesionado";"It includes those with a mental health problem, a neurodevelopmental disorder, or a learning disability. Self-injury is defined as intentional self-poisoning or injury, regardless of apparent purpose. Provide information and support for people who have self-harmed. Share information with family members or carers (as appropriate). At the earliest opportunity after an episode of self-harm, a mental health professional should carry out a psychosocial assessment. Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm. Do not use risk assessment tools and scales to determine who should and should not be offered treatment or who should be discharged. Do not use global risk stratification into low, medium or high risk to predict future suicide or repetition of self-harm. Do not use global risk stratification into low, medium or high risk to determine who should be offered treatment or who should be discharged. Do not use mechanical restraint in emergency departments to prevent self-harm or to prevent a person from leaving the emergency department. Do not use diagnosis, age, substance misuse or coexisting conditions as reasons to withhold psychological interventions for self-harm. Do not offer drug treatment as a specific intervention to reduce self-harm. Do not use staff who are untrained in clinical observation (for example, security staff or trainee health and social care staff) to undertake such observations in a person who has self-harmed.";2022;;;"High value";"management and prevention ";"Link to the recommendation on the website of the initiative" 6550;1;"NICE ";NICE;English;"It is not recommended transcatheter tricuspid valve leaflet repair for people with severe and symptomatic tricuspid regurgitation";"There are no specific medicines for treating tricuspid regurgitation itself, but symptoms of heart failure are managed with diuretics and other medicines. People with severe symptoms may have surgery to repair or replace the tricuspid valve. Evidence on transcatheter tricuspid valve leaflet repair safety shows there are serious but well-recognised complications. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. For people with mild or moderate tricuspid regurgitation, evidence on the safety and efficacy of transcatheter tricuspid valve leaflet repair is inadequate in quantity and quality. Therefore, for these people, this procedure should only be used in the context of research. Clinicians wanting to do transcatheter tricuspid valve leaflet repair for people with severe and symptomatic tricuspid regurgitation should: Inform the clinical governance leads in their healthcare organisation. Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. -Regularly review data on outcomes and safety for this procedure. The procedure should only be done in specialised centres with experience of the interventional management of tricuspid regurgitation. There should be immediate, onsite access to cardiac and vascular surgery.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative " 6551;1;"NICE ";NICE;English;"It is not recommended to offer an interleukin-1 (IL-1) inhibitor to prevent or treat a gout flare unless NSAIDs, colchicine and corticosteroids are contraindicated, not tolerated or ineffective. ";"Hable con la persona sobre los beneficios y riesgos de tomar medicamentos para prevenir los brotes de gota al iniciar o ajustar la ULT. Para las personas que eligen recibir un tratamiento para prevenir los brotes de gota al comenzar o ajustar la ULT, ofrezca colchicina mientras se alcanza el nivel objetivo de urato s�rico. Si la colchicina est� contraindicada, no se tolera o es ineficaz, considere un AINE en dosis bajas o un corticosteroide oral en dosis bajas. Considere agregar un inhibidor de la bomba de protones para las personas con gota que toman un AINE o un corticosteroide para prevenir los brotes de gota al comenzar o ajustar la ULT. Tenga en cuenta los factores de riesgo individuales de la persona para eventos adversos. Derivar a la persona a un servicio de reumatolog�a antes de prescribir un inhibidor de IL-1.";2022;;;"Low value";"diagnosis and management";"Link to the recommendation on the website of the initiative" 6554;1;"NICE ";NICE;English;"The use of synthetic cartilage implant insertion for osteoarthritis of the first metatarsophalangeal joint is not recommended in patients with inflammatory arthritis or diabetic peripheral neuropathy.";"There was little evidence about the people for whom the procedure is most appropriate, particularly the stage of osteoarthritis at which it should be used. They used a rapid review of the published literature on the efficacy and safety of this procedure. The evidence included 1 randomised controlled trial (described in 2 papers), 4 non-randomised comparative studies, 7 case series, 1 case report and a review of adverse events from the US Food and Drug Administration Manufacturer and User Facility Device Experience database";2022;;;"Low value";treatment;https://www.nice.org.uk/guidance/ipg727/chapter/3-Committee-considerations 6556;1;"NICE ";NICE;English;"Focal resurfacing implants for treating articular cartilage damage in the knee in adults are uncertain.";"Short-term evidence shows no major safety concerns, but long-term evidence on safety is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. ";2022;;;Uncertain;Treatment;https://www.nice.org.uk/guidance/ipg734/chapter/1-Recommendations 6557;1;"NICE ";NICE;English;"it is uncertain the use of Endoanchoring systems in endovascular aortic aneurysm repair.";"NICE did a rapid review of the published literature on the efficacy and safety of this procedure. The evidence included 2 systematic reviews, 1 non-randomised comparative study, 2 cohort studies, 1 single-arm study that was also included in the systematic reviews, a case report, and a case series of reports from the US Food and Drug Administration Manufacturer and User Facility Device Experience Databased. This procedure is primarily intended to be used for people with unfavourable aneurysm morphology and this is where most of the evidence comes from. This procedure is also used for people with favourable aneurysm morphology who develop an intraoperative complication such as an endoleak during a primary EVAR";2022;;;"Not applicable";treatment;https://www.nice.org.uk/guidance/ipg725 6558;1;"NICE ";NICE;English;"Do not routinely test the urine of babies, children and young people 3 months and over who have symptoms and signs that suggest an infection other than a UTI. If they remain unwell and there is diagnostic uncertainty, consider urine testing.";"UTI is a common bacterial infection that causes illness in babies and children. It can be difficult to recognize UTI in children because the presenting symptoms and signs are not specific, particularly in babies and children under 3 years. Symptoms and signs that increase the likelihood that a urinary tract infection (UTI) is present: -Painful urination (dysuria) -More frequent urination -New bedwetting -Foul smelling (malodorous) urine -Darker urine -Cloudy urine -Frank haematuria (visible blood in urine) -Reduced fluid intake -Fever -Shivering -Abdominal pain -Loin tenderness or suprapubic tenderness -Capillary refill longer than 3 seconds -Previous history of confirmed urinary tract infection Symptoms and signs that decrease the likelihood that a UTI is present: -Absence of painful urination (dysuria) -Nappy rash -Breathing difficulties -Abnormal chest sounds -Abnormal ear examination -Fever with known alternative cause";2022;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 6559;1;"NICE ";NICE;English;"It is recommended the diagnosis and management of multiple sclerosis in people aged 18 and over.";"Multiple sclerosis is an acquired chronic immune-mediated inflammatory condition of the central nervous system, affecting both the brain and spinal cord. It is the most common cause of serious physical disability in adults of working age. The guideline is aimed primarily at services provided in primary and secondary care. It covers diagnosing and managing multiple sclerosis in people aged 18 and over. It aims to improve the quality of life for people with multiple sclerosis by promoting prompt and effective symptom management and relapse treatment, and comprehensive reviews. This guideline includes new and updated recommendations on diagnosis, information and support, coordination of care and symptom management and rehabilitation. ";2022;;;"High value";"Management ";"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6560;1;"NICE ";NICE;English;"Transcutaneous electrical neuromuscular stimulation for urinary incontinence in adults is uncertain. ";"Evidence on the safety of transcutaneous electrical neuromuscular stimulation for urinary incontinence raises no major safety concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";2022;;;Uncertain;Treatment;https://www.nice.org.uk/guidance/ipg735 6561;1;"NICE ";NICE;English;"it is not recommended the use of Supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis";"The use of percutaneously assisted supercapsular total hip arthroplasty for osteoarthritis is not recommended because there is little evidence on the safety and efficacy of percutaneously assisted supercapsular total hip arthroplasty for osteoarthritis and therefore it is limited in quality and quantity. however, this procedure should only be used with special arrangements for clinical management, consent, and audit or investigation.";2022;;;"Low value";treatment;https://www.nice.org.uk/guidance/ipg726 6562;1;"NICE ";NICE;English;"It is uncertain the use of personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome";"Evidence is adequate on the short-term safety and efficacy of personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome. Evidence on long-term outcomes is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research";2022;;;Uncertain;treatment;https://www.nice.org.uk/guidance/ipg724 6563;1;"NICE ";NICE;English;"Superficial venous arterialisation is not recommended for chronic limb threatening ischaemia in adults.";"Evidence on the safety of superficial venous arterialisation for chronic limb threatening ischaemia shows well-recognised complications. Evidence on its efficacy is inadequate in quantity and quality. However, in people with no other option for revascularisation, this procedure can be used with special arrangements for clinical governance, consent, and audit or research. ";2022;;;"Low value";Treatment;https://www.nice.org.uk/guidance/ipg736 6564;1;"NICE ";NICE;English;"It is recommended the social, emotional and mental wellbeing in children and young people in primary and secondary education, and people 25 years and under with special educational needs or disability in further education colleges.";"Primary and secondary schools help children and young people learn social, emotional and mental skills through both the taught and the wider curriculum. Schools can provide the supportive, caring and nurturing environment that supports positive social, emotional and mental wellbeing. They are also important settings in which to identify and provide early intervention for children and young people at increased risk of mental ill health. This guideline covers ways to support social, emotional and mental wellbeing in children and young people in primary and secondary education, and people 25 years and under with special educational needs or disability in further education colleges. It aims to promote good social, emotional and psychological health to protect children and young people against behavioural and health problems.";2022;;;"High value";"Manegement ";"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6565;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";NICE;English;"It is recommended treating and managing depression in people aged 18 and over.";"Each year, 6% of adults in England will experience an episode of depression and more than 15% of people will experience an episode of depression over the course of their lifetime. For many people the episode will not be severe, but for more than 20% the depression will be more severe and have a significant impact on their daily lives. This guideline covers identifying, treating and managing depression in people aged 18 and over. It recommends treatments for first episodes of depression and further-line treatments, and provides advice on preventing relapse, and managing chronic depression, psychotic depression and depression with a coexisting diagnosis of personality disorder.";2022;;;"High value";"Treatment and management";"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6567;1;"NICE ";NICE;English;"It is recommended to increase the uptake of all vaccines provided by everyone who is eligible.";"Vaccination coverage needs to be actively maintained, and ideally increased, in the face of increasing vaccine scepticism and misinformation. In addition, certain population groups have lower levels of vaccination than the general public. Additional or different actions may be needed to increase their vaccination rates. Reasons for low uptake may include poor access to healthcare services; inaccurate claims about safety and effectiveness, which can lead to increased concerns and a reduction in the perceived need for vaccines; and insufficient capacity in the healthcare system to provide vaccinations. In addition, problems with the recording of vaccination status and poor identification of people who are eligible to be vaccinated may have contributed to low uptake.";2022;;;"High value";informative;https://www.nice.org.uk/guidance/ng218 6569;1;"NICE ";NICE;English;"It is recommended the use of Selumetinib for treating symptomatic and inoperable plexiform neurofibromas associated with type 1 neurofibromatosis in children aged 3 and over";"Clinical trial evidence suggests that selumetinib is effective at reducing the volume and size of PN compared with best supportive care.";2022;;;"High value";treatment;https://www.nice.org.uk/guidance/hst20 6573;1;"NICE ";NICE;English;"It is uncertain the use of Liposuction for chronic lymphoedema";"A rapid review was done on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 7 sources, which was discussed by the committee. The evidence included 1 systematic review and meta-analysis, 1 systematic review, and 5 before-and-after studies.This is not a curative procedure, and its effectiveness depends on the person wearing compression garments for life.The committee was informed that this procedure should only be used when lymphoedema persists despite conventional conservative treatments. Liposuction is also used to treat patients with chronic lipoedema.";2022;;;Uncertain;treatment;https://www.nice.org.uk/guidance/ipg723 6833;6;"Less Is More Collection - JAMA Network";"Tu et al.";English;"The routine use of crenal CT in patients with common psychiatric services is not recommended if there are no other indications for neuroimaging.";"Head computed tomography (CT) examinations are used in acute settings to exclude structural pathology for patients with various psychiatric presentations. Recommendations for neuroimaging in psychiatric illness vary and mostly address first episodes of psychosis. No current guidelines address specific and common psychiatric presentations such as hallucinations, delusions, and suicidal ideation. The evidence comes from a cross-sectional study that included 369 patients who underwent a head CT due to psychiatric symptoms over 6 years. This study has some limitations. The single health system setting may not capture the full breadth of practice variation. In addition, the database query was based on key terms and may not capture instances in which alternative wording was documented, perhaps reducing case variation and power.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6578;1;"NICE ";NICE;English;"It is not recommended performing supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis in adults, only with special arrangements for clinical governance, consent, and audit or research.";"Evidence on the safety and efficacy of supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis is limited in quality and quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. This procedure involves replacing a hip using smaller cuts than are used in standard surgery. This recomendation is an evidence-based recomendation. Clinicians wanting to do supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis should: -Inform the clinical governance leads in their healthcare organisation. -Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Enter details about all patients having supercapsular percutaneously assisted total hip arthroplasty for osteoarthritis onto the National Joint Registry and review local clinical outcomes. -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.";2022;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 6834;6;"Less Is More Collection - JAMA Network";"McDonald et al.";English;"Electronic support for the clinical decision of deprescribing in older adult patients who are in acute hospitalization is not recommended.";"Deprescribing is the gradual reduction or supervised cessation of medications that are no longer needed or beneficial. In acute hospitalizations, adverse drug events are common and up to 60% are considered preventable. Scalable deprescribing interventions can reduce polypharmacy and potentially inappropriate medication use; however, few studies have been large enough to assess the impact that deprescribing may have on adverse drug events. In this randomized clinical trial in hospitalized patients older than 65 years with survival greater than 3 months, the primary objective is the reduction of adverse drug events within the first 30 days after discharge, The study was conducted with patients admitted to a participating hospital from August 22, 2017 to January 13, 2020. Each participant had a control phase followed by an intervention phase. Study sites were blinded for approximately 4 weeks. prior to assignment to the intervention to allow for preparation. The groups were scheduled to move from one period to the next every approximately 500 patients enrolled. One group (western Canada) had 2 periods in which they were only able to recruit 250 participants out of the 500 planned because the patients had been transferred to non-study units. Patients 65 years of age or older who were regularly taking 5 or more common medications prior to admission were eligible. Patients in palliative care with an expected prognosis of more than 3 months were included. Readmitted patients were eligible only if they had not previously enrolled in the study. The primary intervention was the provision of individualized deprescribing reports based on evidence-based guidelines for safer prescribing in older adults, with tapering instructions where indicated. The report prioritized opportunities for deprescribing based on pre-specified expert consensus as: high-risk potentially inappropriate medications (harms outweigh benefits for most); Intermediate-risk potentially inappropriate medications (harms may approximate benefits, clinical judgment required); and potentially inappropriate medications with little added value (medication that is ineffective or increases the burden of pills). Opportunities for deprescribing were generated by comparing medical conditions, laboratory values, and home medication lists with evidence-based guidelines for safer prescribing in older adults, described above. The primary outcome was the proportion of patients who experienced an adverse drug events within the first 30 days after hospital discharge in the intervention versus control phases. Patients or representatives consented to a structured telephone interview approximately 30 days after hospital discharge, conducted by an experienced interviewer and blinded to intervention status. The interview consisted of a modified Australian report of drug events and adverse reactions and questions about drug changes, new or worsening symptoms, and planned or unplanned visits to medical professionals. Secondary outcomes included the proportion of patients with 1 or more PIM deprescribed at hospital discharge compared to usual care. Despite significant increases in deprescribing, this randomized clinical trial failed to demonstrate any significant impact of deprescribing decision support on short-term adverse drug effects. Although the intervention identified numerous opportunities for deprescribing, many were due to non-beneficial low-risk polypharmacy, deprescribing of which is less likely to affect adverse drug effects, but still has value for the patient and society, as which, for example, avoids the excessive cost, waste and burden of medicines. In driving future studies of adverse drug events, interventions may need to specifically focus on high-risk medications, In conclusion, this randomized clinical trial found that providing deprescribing decision support to acute care medical teams did not impact 30-day adverse drug events; however, this intervention did indeed stop the potentially inappropriate medications, with no evidence of further harm. Short-term adverse drug eventsmay not be the ideal outcome to measure and capture the benefits of deprescribing during acute care hospitalization.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6579;1;"NICE ";NICE;English;"It is not recommended the use of focal resurfacing implants is recommended to treat articular cartilage damage in the knee in patients who cannot undergo arthroplasty or biological treatment, only with special arrangements for clinical governance, consent, and audit or research";"La evidencia sobre la eficacia de los implantes de revestimiento focal para tratar el da�o del cart�lago articular en la rodilla es limitada en calidad y cantidad. La evidencia a corto plazo no muestra problemas de seguridad importantes, pero la evidencia a largo plazo sobre la seguridad es limitada en calidad y cantidad. Por lo tanto, este procedimiento solo debe usarse con arreglos especiales para el manejo cl�nico, consentimiento y auditor�a o investigaci�n. Los m�dicos que deseen utilizar implantes de revestimiento focal para tratar el da�o del cart�lago articular en la rodilla deben: -Informar a los l�deres de gobierno cl�nico en su organizaci�n de atenci�n m�dica. -Dar a las personas (ya sus familias y cuidadores, seg�n corresponda) informaci�n clara por escrito para respaldar la toma de decisiones compartida, incluida la informaci�n NICE para el p�blico. -Aseg�rese de que las personas (y sus familias y cuidadores, seg�n corresponda) entiendan la seguridad y eficacia del procedimiento, y cualquier pregunta al respecto. -Auditar y revisar los resultados cl�nicos, incluidos los resultados a largo plazo, de todos los que se someten al procedimiento. Los resultados clave de eficacia y seguridad identificados en esta gu�a se pueden ingresar en la herramienta de auditor�a de resultados de procedimientos de intervenci�n NICE (para uso a discreci�n local). -Ingrese los detalles sobre todas las personas que tienen implantes de revestimiento focal para tratar el da�o del cart�lago articular en la rodilla en un registro apropiado y revise los resultados cl�nicos locales. -Discutir los resultados del procedimiento durante su evaluaci�n anual para reflexionar, aprender y mejorar. Las organizaciones de salud deben: -Aseg�rese de que existan sistemas para ayudar a los m�dicos a recopilar e informar datos sobre los resultados y la seguridad de todas las personas que se someten a este procedimiento. -Revisar peri�dicamente los datos sobre los resultados y la seguridad de este procedimiento. La investigaci�n adicional debe informar la selecci�n de pacientes, incluido el sitio y el tama�o del da�o del cart�lago, y los resultados a largo plazo, incluida la incidencia de procedimientos de revisi�n y reemplazos articulares. La selecci�n de pacientes debe ser realizada por un equipo multidisciplinario con experiencia en el manejo de la condici�n. El procedimiento solo debe ser realizado por cirujanos con experiencia en el rejuvenecimiento focal del cart�lago articular.";2022;;;"Low value";Treatment;"Link to the recomendation on the website of the initiative" 6835;6;"Less Is More Collection - JAMA Network";"Chen et al.";English;"Intensive blood pressure therapy is not recommended in hypertensive patients 60 years of age or older who have less than 1 year of life expectancy.";"Recent guidelines recommend a systolic blood pressure goal of less than 150mmHg or even 130mmHg for adults aged 60 years or older. However, harms from intensive blood pressure treatments occur immediately (eg, syncope, fall), and benefits for cardiovascular event reduction emerge over time. Therefore, the benefit-risk of intensive blood pressure treatment should be clearer, particularly for those patients with a limited life expectancy. The evidence comes from the analysis of 6 randomized clinical trials consisting of 27.414 individuals with hypertension aged 60 years and older. 19.1 months and 34.4 months were needed to avoid 1 cardiovascular event for 200 and 100 patients, respectively. These results reinforce the importance of individualizing intensive blood pressure control decisions by incorporating each patient?s values and preferences. Some limitations of this study are: the age group older than 80 years has traditionally been excluded or underrepresented in clinical trials, therefore, there may be uncertainties regarding the benefit-risk estimates of intensive blood pressure treatment between this specific population and, although sensitivity analyzes were performed between the included trials, heterogeneity between them may not yet be properly assessed. Finally, it is not clear whether patients with a higher risk of cardiovascular disease might have a shorter time to benefit.";2022;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 6836;6;"Less Is More Collection - JAMA Network";"Breeden et al.";English;"Advice on best practices and communication between doctors is recommended to reduce potentially unnecessary attention in any medical act of the total population.";"Demand for citrate products increased in early 2021 due to a significant increase in the use of this material as a result of increasing COVID-19 infection rates and its use in COVID-19 development of vaccines and therapies. This caused a shortage of 3.2% sodium citrate laboratory tubes used primarily for testing prothrombin time (PT), international normalized ratio (INR), and partial thromboplastin time (PTT) test. The study followed the SQUIRE reporting guideline. The study was carried out from emails that were sent to doctors explaining the lack of this type of tubes. Furthermore, when physicians made a request for aPT, INR, or PTT without other coagulation tests, the electronic medical record (EMR) displayed the message: ""There is a national shortage of sodium citrate laboratory tubes, and we urge restraint in requests for PT/INR/PTT. Does this patient require PT/INR/PTT measurement?? and finally provided guidance on appropriate clinical scenarios for requests for these tests.";2022;;;"Low value";"- ";"Link to the recommendation on the website of the initiative" 6581;1;"NICE ";NICE;English;"Do not use vitamin B12 injections, offer hyperbaric oxygen to treat fatigue or fampridine to treat mobility problems in people with multiple sclerosis. Do not offer omega?3, omega?6 fatty acid compounds, or vitamin D solely for the purpose of treating multiple sclerosis.";"Multiple sclerosis (MS) is an acquired chronic immune-mediated inflammatory condition of the central nervous system, affecting both the brain and spinal cord. It affects approximately 130,000 people in the UK. It is the most common cause of serious physical disability in adults of working age. People with MS typically develop symptoms in their late 20s, experiencing visual and sensory disturbances, limb weakness, gait problems, and bladder and bowel symptoms. They may initially have partial recovery, but over time develop progressive disability. Fampridine is a clinically effective treatment for some people, but it is not cost effective at the current list price. This recommendation does not apply to people who have already started treatment with fampridine in the NHS, who should be able to continue treatment until they and their NHS clinician think it appropriate to stop. To treat an acute relapse of multiple sclerosis, do not prescribe steroids at lower doses than methylprednisolone 0.5 g daily for 5 days, and do not give patients a supply of steroids to self?administer at home for future relapses.";2022;;;"Low value";Manejo;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6837;6;"Less Is More Collection - JAMA Network";"Park et al.";English;"The routine use of gabapentin in the postoperative period of major surgery in patients older than 65 years is not recommended.";"Gabapentin has been increasingly used as part of a multimodal analgesia regimen to reduce the use of opioids in the management of perioperative pain. However, the safety of perioperative use of gabapentin among older patients remains uncertain. This study examines in-hospital adverse clinical events associated with the perioperative use of gabapentin among older patients undergoing major surgery. It is a retrospective cohort study that included patients 65 years of age or older who underwent major surgery at hospitals in the United States and who did not use gabapentin prior to surgery. The effect of using gasbapentin in the 2 days after within 2 days after surgery was examined. The primary outcome was delirium, identified using diagnostic codes, and the secondary outcomes were use of new antipsychotics, pneumonia, and in-hospital death between postoperative day 3 and hospital discharge. In this cohort study, perioperative use of gabapentin was associated with increased risk of delirium, use of newer antipsychotics, and pneumonia among older patients after major surgery. These results suggest a careful evaluation of the risk-benefit ratio before prescribing gabapentin for the treatment of perioperative pain. The diagnostic algorithm for the identification of delirium had a low sensitivity (18%) and high specificity (98%), so that the incidence of delirium in said cohort was lower in relation to the previously reported incidences (3.4% in the present study vs. 15-25% in previous studies); the codes for ""delirium"" and ""pneumonia"" in the databases consulted did not have an onset date, so it is possible that in some patients they presented prior to the use of gabapentin in the postoperative period; Finally, a risk of bias is identified as the patients in whom gabapentin was used were generally healthier and therefore more likely to be assigned to elective surgery.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6582;1;"NICE ";NICE;English;"The use of mesh external aortic root is recommended to prevent aortic root expansion and aortic dissection in people with Marfan syndrome, nevertheless, evidence on long-term outcomes is limited.";"These are evidence-based recommendations on personalized external aortic root support with mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome. This involves opening the chest through the breastbone and wrapping mesh around the outside of the aorta closest to the heart. Some doctors recommend this technique when the aortic diameter is 45 mm or more. One of the positive points of the technique is that since the aortic valve is left intact, there is no need to anticoagulate the patient. Evidence is adequate on the short-term safety and efficacy of personalised external aortic root support (PEARS) using mesh to prevent aortic root expansion and aortic dissection in people with Marfan syndrome. Evidence on long-term outcomes is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or research. ";2022;;;"High value";Prevention;"Link to the recomandation on the webside of the initiative" 6838;6;"Less Is More Collection - JAMA Network";"Upadhayay et al.";English;"The use of additional complementary tests to the clinical history for the eligibility of women for medical abortion is not recommended.";"Evaluation for medical abortion eligibility usually includes an ultrasound or pelvic exam. To reduce physical contact during the COVID-19 pandemic, many doctors stopped ordering tests before medical abortion and instead examined patients for length of pregnancy and risk of ectopic pregnancy based on medical history alone. . However, few studies have been conducted on the outcomes and safety of this new model of care. The aim of the study was to evaluate the outcomes and safety of a chart-based screening method, without tests, for medical abortion care. This retrospective cohort study included patients who obtained a medical abortion without a preabortion ultrasound or pelvic exam between February 1, 2020, and January 31, 2021, at 14 independent, Planned Parenthood, academic affiliated, and only clinics. line. throughout the US The results to be analyzed are the effectiveness, defined as the complete abortion after the administration of 200 ?g of mifepristone and up to 1600 ?g of misoprostol without additional intervention; and abortion-related major adverse events, defined as hospital admission, major surgery, or blood transfusion. In this cohort study, screening for medical abortion eligibility by medical history alone was effective and safe, with results similar to published rates for models involving ultrasonography or pelvic examination. This approach can facilitate more equitable access to this essential service by increasing the types of physicians and locations that offer abortion services.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6583;1;"NICE ";NICE;English;"It is not recommended the use of neuromuscular electrical stimulation in the treatment of urinary incontinence, only with special arrangements for clinical governance, consent, and audit or research.";"The procedure uses non-implanted electrodes connected to an external neuromuscular electrical stimulator device to stimulate muscles and nerves, to make the pelvic floor muscles contract. The device is typically used in sessions. The number and frequency of advised sessions varies, but the treatment period is typically 6 to 12 weeks. Evidence on the safety of transcutaneous electrical neuromuscular stimulation for urinary incontinence raises no major safety concerns. Evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wanting to do transcutaneous electrical neuromuscular stimulation for urinary incontinence should: -Inform the clinical governance leads in their healthcare organisation. -Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Ensure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure. -Regularly review data on outcomes and safety for this procedure.";2022;;;"Low value";"Neuromuscular estimulation, Urinary incontience";"Link to the recommendation on the website of the initiative" 6839;6;"Less Is More Collection - JAMA Network";"Piette et al.";English;"Artificial intelligence-adjusted cognitive behavioral therapy for chronic pain is recommended for the treatment of patients with chronic pain";"Cognitive behavioral therapy for chronic pain (CBT-CP) is a safe and effective method that is an alternative to opioid analgesics. Because CBT-CP requires multiple sessions and therapists are in short supply, many patients have limited access or do not complete treatment. This study was a randomized non-inferiority comparative effectiveness trial that included 278 patients with chronic back pain from the Department of Veterans Affairs Health System (recruitment and data collection from July 11, 2017 to April 9, 2020). ). More patients were randomized to the AI-CBT-CP group than to the control (1.4:1) to maximize the system's ability to learn from patient interactions.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6584;1;"NICE ";NICE;English;"It is not recommended to perform synthetic cartilage implant insertion in people with first metatarsophalangeal joint osteoarthritis (hallux rigidus), only with special arrangements for clinical governance, consent, and audit or research.";"For people with advanced disease for whom arthrodesis is indicated, evidence on the safety of synthetic cartilage implant insertion for first metatarsophalangeal joint osteoarthritis (hallux rigidus) shows no major safety concerns in the short term. But evidence on efficacy is limited in quantity and quality. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wanting to do synthetic cartilage implant insertion for hallux rigidus for people with advanced disease for whom arthrodesis is otherwise indicated should: -Inform the clinical governance leads in their healthcare organisation. -Give people (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Make sure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Enter details about all people having synthetic cartilage implant insertion for first metatarsophalangeal joint osteoarthritis (hallux rigidus) onto the British Orthopaedic Foot & Ankle Society (BOFAS) Registry and review local clinical outcomes. -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every person having this procedure. -Regularly review data on outcomes and safety for this procedure.";2022;;;"Low value";Tratamiento;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6840;6;"Less Is More Collection - JAMA Network";"Bell et al.";English;"It is not recommended to add coronary artery calcium scores into cardiovascular disease risk calculators in adults in the general population without detected cardiovascular disease.";"Coronary artery calcium scores are used to help assess patients? cardiovascular status and risk. However, their best use in risk assessment beyond traditional cardiovascular factors in primary prevention is uncertain. Coronary artery calcium score appears to add some further discriminations to the traditional cardiovascular disease risk assessment equations. However, the modest gain may often be outweighed by costs, rates of incidental findings, and radiation risks. Evidence comes from 6 cohort studies of primary prevention populations that used one of the cardiovascular disease risk calculators recommended by national guidelines (Framingham, QRISK, pooled cohort equation, NZ PREDICT, NORRISK, or SCORE) and reported the incremental discrimination provided by the calcium score in coronary arteries to estimate the risk of a future cardiovascular event.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6585;1;"NICE ";NICE;English;"Vaccination is recommended in the general population.";"This guideline is intended to increase the acceptance of all vaccines provided in the immunization schedule by all eligible individuals. Supports actions to improve immunization coverage by GPs and reduce health inequalities. The recommendation reviews the population eligible for vaccination and the opportunity to be vaccinated, as well as the groups of children and pregnant women. The main objective of the recommendation is to increase the acceptance of vaccination in populations with low acceptance. For more information, visit the link with the complete guideline.";2022;;;"High value";Vaccination;"Link to the recommendation on the initiative" 6841;6;"Less Is More Collection - JAMA Network";"Groenendyk et al.";English;"The addition of polygenic risk scores to traditional risk scoring to aid clinical decision-making in the general population without prior cardiovascular disease or risk factors such as diabetes, HIV, and cancer is not recommended.";"Prediction of coronary heart disease (CHD) risk is the cornerstone of prevention strategies. Polygenic risk scores (PRS) have emerged as a new approach to predict risk in asymptomatic people. Polygenic risk scores for CHD have been studied in various populations, but there is disagreement about the incremental value of PRS beyond traditional risk factor scores in the primary prevention of CHD. This study is a narrative review critically appraised the 5 most cited studies published up to 2021 that also included a large number (>45,000) of single nucleotide variations (formerly single nucleotide polymorphisms) and evaluated the incremental value of PRS in predicting of CHD risk according to published PRS reporting standards. Cohorts studied included the Atherosclerosis Risk in Communities Study, FINRISK, the Framingham Heart Study, the Multi-Ethnic Atherosclerosis Study, and the UK Biobank. all studies focused predominantly on populations of European descent.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6586;1;"NICE ";NICE;English;"It is not recommended the use of endoanchoring systems is recommended in patients who need endovascular aortic aneurysm repair when unfavourable aneurysm morphology, only with special arrangements for clinical governance, consent, and audit or in the context of research";"For people with unfavourable aneurysm morphology needing an endovascular aortic aneurysm repair (EVAR) as a primary procedure, or for people with an existing EVAR who need a secondary procedure, evidence on the safety of using endoanchoring systems is adequate. Evidence on efficacy is limited in quantity and quality. Therefore, for these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or in the context of research. Clinicians wanting to use endoanchoring systems for people with unfavourable aneurysm morphology needing an EVAR as a primary procedure, or for people with an existing EVAR who need a secondary procedure should: -Inform the clinical governance leads in their healthcare organisation. -Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Enter details about everyone having endoanchoring systems in endovascular aortic aneurysm repair into the National Vascular Registry and review local clinical outcomes. -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. -Regularly review data on outcomes and safety for this procedure.";2022;;;"Low value";"Aneurisma aortico";"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6587;1;"NICE ";NICE;English;"Superficial venous arterialization is not recommended for chronic limb-threatening ischemia as it has well-recognized complications.";"This procedure arterializes the venous arch of the foot, keeping the GSV in situ and without compromising the existing collateral circulation. The goal is to improve symptoms and save the affected lower extremity. The evidence on the safety of superficial venous arterialization for chronic limb-threatening ischemia shows well-recognized complications. The evidence on its efficacy is inadequate in quantity and quality. However, in people who have no other revascularization option, this procedure can be used. Efficacy outcomes are limb salvage, pain relief and improvement in quality of life and safety outcomes are mortality, need for major amputation, pain, bleeding and infection.";2022;;;"Low value";"Superficial venous arterialization, chronic ischemia.";"https://www.nice.org.uk/guidance/ipg736/chapter/3-Committee-considerations" 6588;1;"NICE ";NICE;English;"Selumetinib is recommended for the treatment of symptomatic and inoperable plexiform neurofibromas associated with neurofibromatosis type 1 in children 3 years of age and older.";"Selumetinib is recommended for the treatment of symptomatic and inoperable plexiform neurofibromas associated with neurofibromatosis type 1 in children 3 years of age and older. Evidence from clinical trials suggests that selumetinib is effective in reducing the volume and size of plexiform neurofibromas";2022;;;"High value";Treatment;"Link to the recommendation on the webside of the initiative" 6589;1;"NICE ";NICE;English;"Liposuction is recommended for chronic lymphedema in adults.";"These are evidence-based recommendations on liposuction for chronic lymphedema in adults. This procedure involves the use of suction to remove fluid and fat through punctures in the skin. Evidence on the efficacy and safety of liposuction for chronic lymphedema is adequate, showing potential risks including venous thromboembolism, fat embolism, and fluid overload. It is important to note that the procedure should only be performed in specialized centers by physicians with training and experience in liposuction for lymphedema following agreed perioperative protocols.";2022;;;"High value";"Chronic lymphedema";"Link to the recommendation on the webside of the initiative" 6591;1;"NICE ";NICE;English;"It is recommended to follow the recommendations inclueded in this guideline about the diagnosis of type 1 and type 2 diabetes in young patients(<18 years), their families and carers.";"Type 1 Diabetes Mellitus: Offer children and young people with type 1 diabetes and their families or carers a continuing programme of education from diagnosis about the importance of good oral hygiene and regular oral health reviews, for preventing periodontitis. Offer real-time continuous glucose monitoring (rtCGM) to all children and young people with type 1 diabetes, alongside education to support children and young people and their families and carers to use it. Offer intermittently scanned continuous glucose monitoring (isCGM, commonly referred to as 'flash') to children and young people with type 1 diabetes aged 4 years and over who are unable to use rtCGM or who express a clear preference for isCGM. When choosing a glucose monitoring device, if multiple devices meet their needs and preferences, offer the device with the lowest cost. Advise children and young people with type 1 diabetes who are using CGM (and their families or carers) that they will still need to take capillary blood glucose measurements (although they can do this less often). Advise children and young people with type 1 diabetes who are using capillary blood glucose monitoring (and their families or carers) to routinely perform at least 5 capillary blood glucose tests per day. Advise children and young people with type 1 diabetes who are using capillary blood glucose monitoring (and their families or carers) that more frequent testing is often needed (for example with physical activity and during intercurrent illness). Ensure they have enough test strips for this. Offer children and young people with type 1 diabetes who are using capillary blood glucose monitoring (and their families or carers) a choice of equipment for monitoring, so they can optimise their blood glucose management in response to changes in their insulin, diet and exercise. Periodontitis: Advise children and young people with type 1 and type 2 diabetes and their families and carers at their regular diabetes reviews that: -they are at higher risk of periodontitis -if they get periodontitis, managing it can improve their blood glucose control and can reduce their risk of hyperglycaemia. Advise children and young people with type 1 and type 2 diabetes to have regular oral health reviews.";2022;;;"High value";"""Blood glucose""; ""plasma glucose""; ""Diabetes""";"Link to the recommendation on the website of the initiative" 6595;1;"NICE ";NICE;English;"Targeted support for social, emotional, and mental well-being is recommended for primary and secondary school students.";"A series of recommendations are made such as: 1. Have clear guidance on how to identify individual children and young people and groups of people for targeted support based on their specific needs (see the section on identifying children and young people at risk of poor social, emotional and mental wellbeing). 2. Offer targeted individual or group support to children and young people who have been identified as needing additional social, emotional or mental health support. Use trained, experienced practitioners who are competent to provide the support. Any support should be culturally sensitive and take into account possible neurodiversity, communication needs and other needs of the child or young person. 3. Actively involve the parents or carers of the child or young person when deciding whether to offer targeted support (but think about whether the young person is competent to give their consent or there are reasons not to involve the parents or carers). Discuss with them any support that is being proposed and make sure that they understand it and agree with it. 4. Explain the targeted support to the child or young person and involve them in decisions about the support offered to them, including when and where it is offered. Where appropriate and possible, obtain their agreement before starting the support. 5. Take into account the range of individual needs and risks when putting together a group for targeted group support, including the developmental age and cultural background of the pupils it is being delivered to. 6. Promote a range of targeted support, including peer-to-peer support, that allows children and young people to express difficult feelings and talk about their experiences. 7. Aim to minimise the risk of any unintended adverse consequences and stigma and proactively normalise seeking support. Take care not to reinforce bullying by singling people out for support. 8. Ensure that all targeted support is delivered collaboratively with any other external agencies or services, the professional network around the child or young person and any support that the child or young person is already receiving.";2022;;;"High value";"Wellbeing; support; targeted support; Child; young ";"?Link to the recommendation on the website of the initiative""" 6851;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely � : Things we do for no reason";English;"It is not recommended P2Y12 inhibitor in patients with NSTE-ACS";"Guidelines recommend that high?risk, stabilized patients receive an early invasive management strategy (defined as ICA within 24 h of admission). If ICA leads to a percutaneous coronary intervention (PCI) with stent placement, then dual?antiplatelet therapy (DAPT) is indicated, typically with aspirin and an oral P2Y12 inhibitor, such as clopidogrel, ticagrelor, or prasugrel. For patients with an NSTE?ACS, providers typically start oral P2Y12 inhibitor with a loading dose in one of two time periods: a ?pretreatment? or ?upstream? strategy in which the P2Y12 inhibitor is administered before ICA or a ?downstream? strategy in which the P2Y12 inhibitor is administered after ICA is complete and a PCI is planned or completed. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6852;33;"Choosing Wisely � : Things we do for no reason";"Rebeca Gomez et al.";English;"It is not recommended the routine repeat electrocardiogram for low?to?intermediate risk chest pain in adults.";"Chest pain is the second most common presenting complaint in emergency departments in the United States. Although traditionally repeated ECGs increase the likelihood of identifying significant changes, advances in cardiac enzyme tests have resulted in more accurate ways to identify acute cardiac problems and ischemia. In addition, routine ECGs at prespecified time intervals regardless of symptoms may lead to necessary tests and treatment without improving outcomes. It is only recommended to obtain an initial ECG immediately when a patient presents with chest pain, and repeat an ECG for unstable patients and patients with chest pain that changes in quality or recurs. It is recommended to rely primarily on serial troponins, risk scores such as HEART score, and ADP to stratify the risk of patients with chest pain who have normal or non-diagnostic initial ECG findings.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6853;22;"The Canadian Task Force for Preventive Health Care Guidelines";"College of Family Physicians of Canada";English;"It is not recommended instrument-based screening for depression for everyone during pregnancy and the postpartum period (up to 1 year postpartum)";"A systematic review was carried out. The available evidence on screening is very uncertain, due to a lack of high-quality studies on the benefits and harms of screening. The recommendation extends to individuals who may be at an elevated risk of depression (e.g., trauma in early life, family history of depression). This recommendation does not extend to individuals with a personal history or current diagnosis of depression or another mental health disorder, those currently receiving assessment or treatment for mental health disorders or those seeking services due to symptoms of depression.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6854;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire;English;"It is not recommended the use of flenfuramine as an antiepileptic in Dravet syndrome in children.";"Fenfluramine is an amphetamine licensed in combination with antiepileptic therapy in Dravet syndrome, a rare and severe form of childhood epilepsy. Fenfluramine increases the incidence of convulsive status epilepticus, despite a decrease in the incidence of seizures overall. The long-term impact on psychomotor development and mortality in children by the end of 2021 is unknown. Fenfluramine can cause heart valve disease and pulmonary arterial hypertension, so its use as an appetite suppressant has been discontinued. It can also cause neuropsychiatric disorders and other cardiovascular disorders. The analyzes show that the harm-benefit balance of the use of fenfluramine is unfavorable in all its authorized indications. The drug is more dangerous than beneficial. There is no valid reason why you should retain your marketing authorization.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6599;1;"NICE ";NICE;English;"Do not use individual-level approaches to replace organisational strategies for reducing work stressors, or for the main purpose of increasing productivity.";"The use of tiered approaches to support mental wellness at work reflects best practice and improves employee wellness. Its aim is to promote a supportive and inclusive work environment, including training and support for managers and helping people who have or are at risk of mental health problems. There is evidence that better mental well-being and job satisfaction are associated with higher performance and productivity in the workplace. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6855;33;"Choosing Wisely � : Things we do for no reason";"Larsen et al.";English;"The routine use of isolated incentive spirometry is not recommended in operated patients with low risk of postoperative pulmonary complications.";"Postoperative pulmonary complications (PPCs) are one of the leading causes of morbidity and mortality after surgery and have a wide range in reported incidence from 1% to >80%. CPPs include conditions of varying severity, such as atelectasis, pneumonia, pleural effusions, respiratory failure, and acute respiratory distress syndrome. Bartlett introduced the incentive spirometer in the 1970s to reverse or prevent atelectasis by promoting alveolar recruitment through maximal inspiration. Incentive spirometry (IS) soon replaced intermittent positive pressure breathing (IPPB), in which a mechanical ventilator intermittently delivers a controlled pressure of gas to aid lung expansion, as the dominant form of postoperative lung hygiene. Despite 50 years of widespread use, no high-quality studies demonstrate the benefits of IS in reducing CPPs compared to other methods or no intervention. Furthermore, there is no agreement on the standard prescription for the optimal IS frequency, target volumes, or duration of apneas. Although initial studies showed benefits with IS compared with IPPB, subsequent randomized controlled trials (RCTs) found that IS did not prevent atelectasis any better than other modalities, such as physical therapy and breathing exercises. deep, in which the patient breathes slowly and deeply with a slow inspiration. Given the collective cost of ISs, poor patient compliance, and the lack of strong evidence to support their use, clinicians should abandon the low-value practice of routine use of ISs alone to prevent CPPs in low-risk patients. .";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6600;1;"NICE ";NICE;English;"It is not recommended percutaneous insertion of a cystic duct stent after cholecystostomy for acute calculous cholecystitis, only if special arrangements for clinical governance, consent, and audit or research are in place.";"The evidence included 3 case series (including 1 abstract reporting safety events) and 2 case reports. Most of the evidence considered was for patients with acute calculous cholecystitis who needed persistent external drainage and were unable to have biliary surgery. The procedure involves inserting a tube called a stent into or across the cystic duct to allow bile to flow through the tube, bypassing the blockage and preventing further obstruction. Treatments for acute calculous cholecystitis include intravenous fluids, medicines (analgesics and antibiotics), endoscopic or percutaneous biliary drainage, and surgery (laparoscopic or open cholecystectomy). Evidence on the safety and efficacy of percutaneous insertion of a cystic duct stent after cholecystostomy for acute calculous cholecystitis is inadequate in quality and quantity. But because patients would otherwise need permanent external drainage, the procedure can be considered for this condition, as long as special arrangements for clinical governance, consent, and audit or research are in place. Clinicians wanting to do percutaneous insertion of a cystic duct stent after cholecystostomy for acute calculous cholecystitis should: -Inform the clinical governance leads in their healthcare organisation. -Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. -Regularly review data on outcomes and safety for this procedure. Patient selection should be done by a multidisciplinary team. This procedure should only be done in specialist centres by clinicians with specific training and experience in this procedure. Further research should report details of patient selection, the procedure undertaken, the type of stent used and whether the patient is later able to have definitive surgery.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6601;1;"NICE ";NICE;English;"It is not recommended liposuction for chronic lipoedema, this procedure should only be used in the context of research";"Lipoedema is characterised by an abnormal, usually symmetrical, accumulation of fat in the legs, hips, buttocks, and occasionally arms. It is a different condition from obesity and from lymphoedema. Treatment typically involves healthy lifestyle changes, conservative therapy and, in severe cases, surgery. Evidence on the safety of liposuction for chronic lipoedema is inadequate but raises concerns of major adverse events such as fluid imbalance, fat embolism, deep vein thrombosis, and toxicity from local anaesthetic agents. Evidence on the efficacy is also inadequate, based mainly on retrospective studies with methodological limitations. Therefore, this procedure should only be used in the context of research. Evidence on the safety of liposuction for chronic lipoedema is inadequate but raises concerns of major adverse events such as fluid imbalance, fat embolism, deep vein thrombosis, and toxicity from local anaesthetic agents. Evidence on the efficacy is also inadequate, based mainly on retrospective studies with methodological limitations. Therefore, this procedure should only be used in the context of research. Further research should report: -patient selection, including age, effects of hormonal changes (which should include effects seen during puberty and menopause) and the severity and site of disease -details of the number and duration of procedures, the liposuction technique used (including the type of anaesthesia and fluid balance during the procedure), and any procedure-related complications -long-term outcomes, including weight and body mass index changes -patient-reported outcomes, including quality of life. Patient selection should be done by a multidisciplinary team, including clinicians with expertise in managing lipoedema. The procedure should only be done in specialist centres by surgeons experienced in this procedure.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6857;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire;English;"It is not recommended the use of ulipristal 5mg as a treatment for uterine fibroids in women.";"The use of ulipristal 5 mg is authorized for the treatment of uterine fibroids, it has an unfavorable harm-benefit balance because it can cause serious liver damage, sometimes even requiring a liver transplant. When its use seems necessary while waiting for the menopause or when surgery is not an option, there are other less risky options: the insertion of a levonorgestrel intrauterine device as a first option, or the taking of an oral progestogen for a time limited by its uncertain balance of harm-benefit. As an exception, in postcoital contraception, ulipristal is taken with a single dose of 30 mg. Although there is no evidence of a risk of hepatitis when used in this way, taking levonorgestrel would be a more cautious option in this situation, especially since interactions between ulipristal and hormonal contraceptives may reduce the effectiveness of ulipristal or the contraceptive. When the short-term prognosis is poor, some health professionals feel justified in proposing ""last chance"" treatments. In this case, the patient must be informed so that they know the benefits and risks and accept or not the treatment and, if necessary, participate in a study.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6602;1;"NICE ";NICE;English;"Elosulfase alfa is recommended for the treatment of mucopolysaccharidosis type 4A for people of all ages";"MPS 4A is rare and progressive, and has a significant effect on the quality of life of people with the condition, and their families and carers. It causes abnormalities in the joints and bones, respiratory symptoms, pain, fatigue and increasing dependence on a wheelchair. Current treatment options are limited. The company used the same limited economic model structure for the review as for the original guidance. This was despite encouragement to improve the structure to better reflect the characteristics of MPS 4A, target population and treatment benefits of elosulfase alfa. There is uncertainty around the model because it: relies on wheelchair use, which does not represent well enough how the condition progresses; uses several uncertain assumptions to capture the long-term benefit of elosulfase alfa; includes some analyses of the managed access data with missing information; uses utility values based on managed access data that includes only a small number of people. Clinical trial evidence, data from the managed access agreement, and feedback from patient and carer experience were collected. These suggest that MPS 4A is likely to progress more slowly when treated with elosulfase alfa compared with standard care. The health and quality-of-life benefits of elosulfase alfa are considered to be substantial. Also, data from younger people who may benefit more from elosulfase alfa is not specifically included, and additional skeletal benefits may not be fully captured. Taking these factors into account, the cost-effectiveness estimates are within the range that NICE considers acceptable for highly specialised technologies. So, elosulfase alfa is recommended for people with MPS 4A. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiativ" 6858;1;"NICE ";NICE;English;"It is not recommended 360� SLT treatment for patients with suspected COAG and IOP less than 24 mmHg unless they are at risk of lifetime visual impairment.";"The cost-effectiveness evidence showed that first-line treatment with 360� SLT was more effective and less costly compared with eye drops, with at least 90% probability of being the more cost-effective option. For costs, this result was driven by treatment involving 360� SLT costing less overall compared with eye drops alone. This is because the additional upfront costs of 360� SLT were outweighed by the accumulating costs of eye drops over time. For quality of life, 360� SLT resulted in a longer period without eye drops, or with fewer eye drops, and slightly slower estimated progression rates for glaucoma. Although no statistically significant direct benefit on quality of life was found in the trial, additional data on the natural history of glaucoma, which was incorporated into the cost-effectiveness analysis, suggests that quality of life was likely to be improved. The cost-effectiveness analysis included the costs and benefits of a second 360� SLT if the clinicians deemed it necessary. Even if 360� SLT was assumed to have the same clinical effectiveness as eye drops, it would still be a highly cost-effective treatment, because of the estimated reduction in overall costs. Based on this evidence and their clinical experience, the committee recommended 360� SLT as first-line treatment for people with newly diagnosed OHT or newly diagnosed COAG. The recommendation excludes cases associated with pigment dispersion syndrome. This was because there was no evidence on the use of 360� SLT in people with pigment dispersion syndrome and the committee agreed that eye drop treatment is more suitable for those people. The recommendation lists information to give to people to help them make a decision on having SLT as first-line treatment, including telling them about 360� SLT-specific side effects and complications and how long they are likely to last.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6603;1;"NICE ";NICE;English;"The use of the PredictSURE IBD and IBDX tests to predict the course of severe disease and guide treatment in people with Crohn's disease is not recommended.";"Crohn's disease is a chronic condition that causes inflammation of the gastrointestinal tract. This condition is characterised by recurring periods of active symptoms. At other times health is generally good (remission). Some people are at a higher risk of more frequent flares and relapses that do not respond to standard drug treatment. In the long term, they may be at a higher risk of developing complications and may need surgery.Crohn's disease has no cure. The goal of treatment is to induce remission by controlling symptoms and maintain remission to prevent relapse. PredictSURE IBD is a whole blood-based biomarker prognostic laboratory-based test combined with a proprietary algorithm to categorise people into a high or low risk of a severe course of Crohn's disease IBDX is a panel of 6 indirect solid-phase enzyme-linked immunosorbent assay (ELISA) kits, each of which detects serum levels of specific antiglycan antibodies. Antiglycan antibodies are serological biomarkers thought to be highly specific for Crohn's disease and associated with a severe disease course. There is not enough evidence to recommend the use of the PredictSURE IBD and IBDX tests. They should only be used in the context of research to help identify people at high risk of a severe course of Crohn's disease and guide treatment.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6859;33;"Choosing Wisely � : Things we do for no reason";" Benjamin Kinnear et al.";English;"It is recommended examine motivations for question-asking during clinical teaching and it is recommended eliminate strategies aimed at reinforcing hierarchy, creating fear, or humiliating learners.";"Despite constant change in medical education, traditional practices such as ?pimping? during teaching rounds have persevered and remain in widespread use. ?Pimping? is often described as the practice of asking trainees questions in a manner that establishes and reinforces a dominant intellectual hierarchy and stresses the trainee. Pimping aims to induce shame, humiliation, or distress, and often involves asking difficult questions about recall of facts rather than clinical reasoning. As a complex social phenomenon, most studies of pimping are qualitative in nature. The search method is not specified, but the article was based on the review of several sources in addition to the observation of a case. The paper describes creating little educational value by humiliating students with weird medical eponymous questions or hierarchy-reinforcing interactions. The attending should first clarify that questioning on rounds is for learning. This frames knowledge gaps as opportunities for growth rather than something that triggers shame. Then, they could ask questions that stimulate critical thinking and curiosity. Within the hierarchy of learning, the goal of the teacher should be to bring the learner to their level or beyond, not to keep the hierarchy intact.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6604;1;"NICE ";NICE;English;"It is not recommended endoscopic full thickness removal of gastrointestinal stromal tumours of the stomach, only in the context of research";"This procedure involves removing a gastrointestinal stromal tumour using an endoscope and f�rceps, it uses a full thickness resection device, which allows endoscopic resection with a single step, clip and cut technique. . The aim is to remove the tumour without the need for open surgery. The evidence included 1 case series and 2 case reports. Evidence on the safety and efficacy of endoscopic full thickness removal of gastrointestinal stromal tumours of the stomach is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. This procedure should only be done in specialist centres by interventional upper gastrointestinal endoscopists with specific training in this procedure.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6605;1;"NICE ";NICE;English;"Atidarsagene autotemcel is recommended as an option for the treatment of metachromatic leukodystrophy with switches in the arylsulfatase gene in children who have late infantile or early juvenile types, without clinical signs or symptoms, or in children who have early juvenile types, with signs or early clinical symptoms, and who can still walk independently and not tied down";"Metachromatic leukodystrophy is a genetic condition that affects the central nervous system. It has a significant effect on the quality of life of children with the condition, and their families and carers. It progresses rapidly, with loss of mobility and cognitive function, and causes early death. Treatment options are limited to managing symptoms and supportive care. Clinical evidence suggests that the gene therapy atidarsagene autotemcel improves mobility and cognitive function and could correct the enzyme deficiency caused by the condition. But how well atidarsagene autotemcel works in the long term is uncertain. Atidarsagene autotemcel is recommended, within its marketing authorisation, as an option for treating metachromatic leukodystrophy with mutations in the arylsulphatase A gene: -for children who have late infantile or early juvenile types, with no clinical signs or symptoms -for children who have the early juvenile type, with early clinical signs or symptoms, and who can still walk independently and have no cognitive decline. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6861;1;"NICE ";NICE;English;"Do not recommended denying aerobic exercise programs to older people after a traumatic injury, nor it is not recommended to wait for your prostheses to be fitted to begin rehabilitation after limb loss or amputation. ";"Physical crises for people with complex rehabilitation needs after traumatic injury have B.1 evidence in the review. Specific programs and packages in amputation for people with complex rehabilitation needs after a traumatic injury in the review have a C.1 evidence.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6606;1;"NICE ";NICE;English;"Intramedullary distraction for upper limb lengthening is not recommended for unequal limb lengths in children, youth, and adults, but as this is a rare condition with limited alternative treatments, the procedure may be considered provided special arrangements are made for clinical management. , consent and audit or investigation.";"People may have different limb lengths caused by trauma or infection or, more rarely, hypoplasia or dysplasia (congenital conditions such as achondroplasia, Ollier's disease, and brachial plexus palsy). The condition can be unilateral or bilateral. Unequal limb lengths can lead to disability and limit functional ability. Intramedullary distraction systems are intramedullary devices that are similar to intramedullary nails used for managing fractures. Once inserted and fixed, they can be mechanically lengthened over time using different techniques, resulting in a controlled lengthening of the bone. The device can be inserted into the humerus from the top (antegrade), though this may cause damage to the shoulder muscles, or the lower end (retrograde). Evidence on the safety and efficacy of intramedullary distraction for upper limb lengthening is inadequate in quantity and quality. But because this is a rare condition with limited alternative treatments, the procedure can be considered as long as special arrangements for clinical governance, consent, and audit or research are in place. Clinicians wanting to use intramedullary distraction for upper limb lengthening should: -Inform the clinical governance leads in their healthcare organization. -Give people (and their families and careers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Make sure that people (and their families and caregivers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Audit and review clinical outcomes of everyone having the procedure. The main effectiveness and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organizations should: -Make sure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure. -Regularly review data on outcomes and safety for this procedure. This technically challenging procedure should only be done in specialist centers by surgeons with specific training and experience in upper limb lengthening techniques, using a multidisciplinary approach.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6862;33;"Choosing Wisely � : Things we do for no reason";"O'Malley et al.";English;"Do not recommended routinely administer an oral P2Y12 inhibitor in patients with an NSTE?ACS prior to early?invasive ICA.";"Risk stratification with a validated score (such as GRACE or TIMI) can guide the appropriateness and timing of invasive coronary angiography (ICA). Guidelines recommend that high?risk, stabilized patients receive an early invasive management strategy (defined as ICA within 24 h of admission). If ICA leads to a percutaneous coronary intervention (PCI) with stent placement, then dual?antiplatelet therapy (DAPT) is indicated, typically with aspirin and an oral P2Y12 inhibitor, such as clopidogrel, ticagrelor, or prasugrel. It is not specified how was the search method but the article was based on the review of several sources as well as on the observation of a case. With the latter, we illustrate why a pretreatment strategy should not be used for patients with NSTE-ACS who will receive early invasive coronary angiography.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6607;1;"NICE ";NICE;English;"Intramedullary distraction for lengthening the lower limbs in children, young people and adults is not recommended in terms of safety and efficacy, only with special arrangements for clinical governance, consent, and audit or research";"People may have different limb lengths because of trauma or infection (acquired) or, because of hypoplasia or dysplasia of the femur or tibial (congenital). Unequal leg length can cause a limp, limit functional ability and have effect on other joints. This procedure involves surgically inserting a metal lengthening device in the shorter leg. The aim is to lengthen the bone in a controlled manner. This procedure should only be used with special arrangements for clinical governance, consent, and audit or research. The evidence included 5 systematic reviews, 2 retrospective cohort studies, 2 case series, 1 retrospective matched case series, 1 cross-sectional study and 1 case report. Clinicians wanting to do intramedullary distraction for lower limb lengthening should: -Inform the clinical governance leads in their healthcare organisation. -Give patients (and their families and carers as appropriate) clear information to support shared decision making, including NICE's information for the public. -Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Audit and review clinical outcomes of all patients having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion). -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. -Regularly review data on outcomes and safety for this procedure. Patient selection should be done by a multidisciplinary team that ideally includes physiotherapy and psychological support. This technically challenging procedure should only be done in specialist centres by surgeons with training and specific experience in limb lengthening techniques.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6608;1;"NICE ";NICE;English;"EarlyCDT Lung is not routinely recommended for use in assessing lung cancer risk in patients with solid lung nodules.";"EarlyCDT lung is a blood test to assess the risk of malignancy of solid lung nodules found by CT scan or chest X-ray. It measures the presence of autoantibodies against a panel of 7 acute ones associated with lung cancer. EarlyCDT Lung is used to assess the risk of lung cancer in solid lung nodules. Accurate risk assessment can prevent delayed treatment of malignant nodules or unnecessary biopsies of benign nodules. However, the evidence on how well EarlyCDT Lung works is limited and uncertain. Because of the limited clinical evidence, the cost effectiveness of EarlyCDT Lung was not assessed and so it has not been recommended. Further research is needed on both the EarlyCDT Lung test and on the impact of current lung nodule management.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative " 6609;1;"NICE ";NICE;English;"Endoscopic balloon dilation is not recommended for subglottic or tracheal stenosis in adults, only with special arrangements for clinical governance, consent, and audit or research.";"Subglottic or tracheal stenosis is a narrowing of the airways. It can be congenital, traumatic, or more commonly iatrogenic after prolonged endotracheal intubation. The aim of endoscopic balloon dilation is to dilate airway strictures with minimal mucosal trauma by applying pressure to an area of ??stricture. Endoscopic balloon dilation is not recommended for subglottic or tracheal stenosis in adults, but it is recommended in infants, children, and young people. The evidence included 1 registry study, 1 systematic review and meta-analysis, 1 systematic review, 1 cohort study, 5 case series, 3 case reports, and 1 database analysis.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6610;1;"NICE ";NICE;English;"It is not recommended to stop a a dependence-forming medicine or antidepressant abruptly (complete cessation with immediate effect) unless there are exceptional medical circumstances";"Exceptional medical circumstances include the occurrence of serious side effects (for example, upper gastrointestinal bleeding from an antidepressant, respiratory depression from an opioid or severe ataxia from a gabapentinoid). In these circumstances, consider: -scheduling more frequent reviews -short-term use of medicines to treat the physical symptoms of withdrawal (for example, abdominal cramps and diarrhoea during withdrawal of an opioid). Medicines associated with dependence include benzodiazepines, Z?drugs (such as zopiclone and zolpidem), opioids, gabapentin and pregabalin. Antidepressants, although historically not classified as dependence-forming medicines, can nevertheless cause withdrawal symptoms when they are stopped. This guideline focuses on medicines that are usually used for conditions that are chronic, complex and difficult to treat, such as anxiety and insomnia, chronic pain including neuropathic pain, depression and generalised anxiety disorder. It also covers medicines that were initially prescribed for acute pain but continue to be prescribed over a longer term.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6866;1;"NICE ";NICE;English;"It is not recommended the removal, preservation and subsequent reimplantation of ovarian tissue to prevent symptoms from the menopause";"Menopause occurs with the final menstrual period and is usually diagnosed clinically after 12 months of amenorrhoea. It usually happens when someone is between 45 and 55, although around 1% of women have early (premature) menopause before 40. As oestrogen levels reduce, most people have some symptoms, which can affect quality of life. Most commonly, these are hot flushes and night sweats. Other symptoms are mood changes, memory and concentration loss, vaginal dryness, a lack of interest in sex, headaches, and joint and muscle stiffness. Menopause can also increase the risk of osteoporosis and cardiovascular disease. The therapy involves removing a small piece of ovarian tissue through eye surgery, freezing it, and storing it. Once menopause begins, the tissue is thawed and transplanted under the skin of the armpit, abdomen or forearm, with the aim of producing estrogen. NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This rapid review did not identify any relevant studies. The committee was informed that the same procedure can be used to preserve fertility or to prevent menopausal symptoms or premature menopause from iatrogenic (such as cancer treatment) or non-iatrogenic (such as hereditary or disease) causes. The committee was informed that although published evidence for the use of this procedure for fertility preservation for medical reasons exists, there was no published evidence for its use in otherwise healthy people who wanted to prevent menopause symptoms. There is a small risk of significant complications associated with laparoscopy.";2022;;;"Low value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6611;1;"NICE ";NICE;English;"It is recommended Odevixibat for the treatment of progressive familial intrahepatic cholestasis in people 6 months of age and older.";"Progressive familial intrahepatic cholestasis is a rare and serious genetic condition that reduces or stops the flow of bile acids from the liver. This can cause severe itching, poor growth, and liver damage. Progressive familial intrahepatic cholestasis severely affects the quality of life of people with the condition and their families and caregivers. It is fatal if left untreated. There is evidence that in progressive familial intrahepatic cholestasis types 1 and 2, odevixibat reduces blood bile acid levels and pruritus compared with placebo. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6867;1;"NICE ";NICE;English;"It is not recommended prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia in men aged over 50";"Lower urinary tract symptoms caused by benign prostatic hyperplasia commonly affect men aged over 50. Benign prostatic hyperplasia results from an increased number of stromal and epithelial cells. Symptoms include hesitancy during micturition, interrupted or decreased urine stream (volume and flow rate), nocturia, incomplete voiding and urinary retention. NICE's guideline on lower urinary tract symptoms in men describes current treatment options. Mild symptoms are usually managed conservatively. Medicines such as alpha blockers and 5?alpha?reductase inhibitors may also be used. If other treatments have not worked, there are several possible surgical options, including transurethral resection of the prostate, transurethral vaporisation, holmium laser enucleation, prostatic urethral lift implant insertion, prostatic artery embolisation and prostatectomy. Potential complications of some of these surgical procedures include bleeding, infection, urethral strictures, incontinence and sexual dysfunction. This article propose positioning a temporary implant in the urethra to increase the flow of urine to avoid complications from an implant left in place long term. Evidence on the safety and efficacy of prostatic urethral temporary implant insertion for lower urinary tract symptoms caused by benign prostatic hyperplasia is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6868;1;"NICE ";NICE;English;"It is not recommended YAG laser vitreolysis for symptomatic vitreous floaters";"Vitreous floaters are microscopic clumps of collagen fibres in the vitreous that cast shadows on the retina, appearing as floaters. The most common cause of vitreous floaters is posterior vitreous detachment, when the posterior hyaloid face separates from the retina. Vitreous floaters do not usually threaten vision and can be managed conservatively. When they do affect vision, treatment options include vitrectomy and vitreolysis with YAG laser. This article propose a procedure that aims to improve vision and reduce symptoms by removing or reducing the size of floaters. This involves a special type of laser (YAG) firing short pulses of energy into the floaters, to break them up (vitreolysis) and reduce sight disturbances. Nontheless, evidence on the safety and efficacy of YAG laser vitreolysis for symptomatic vitreous floaters is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6613;1;"NICE ";NICE;English;"It is recommended to consider rapid blood pressure lowering for people in over 16 years with acute intracerebral haemorrhage who present within 6 hours of symptom onset and have a systolic blood pressure of between 150 and 220 mmHg.";"Taking into account the risk of harm, consider rapid blood pressure lowering on a case-by-case basis for people with acute intracerebral haemorrhage who present beyond 6 hours of symptom onset or have a systolic blood pressure greater than 220 mmHg. When rapidly lowering blood pressure in people with acute intracerebral haemorrhage, aim to reach a systolic blood pressure of 140 mmHg or lower while ensuring that the magnitude drop does not exceed 60 mmHg within 1 hour of starting treatment. When considering blood pressure lowering in young people aged 16 or 17 with acute intracerebral haemorrhage, seek advice from a paediatric specialist.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6869;1;"NICE ";NICE;English;"It is not recommended the neurostimulation of lumbar muscles for chronic refractory nonspecific low back pain";"Chronic, severe, long-term refractory low back pain can present in several ways, including as neuropathic pain (associated with damage to the nervous system) or nociceptive pain (associated with physical damage to joints, muscles, and ligaments). In some people, it is associated with dysfunction of the lumbar multifidus (large muscles that support the lower back) and inhibition of arthrogenic muscles. This treatment is not intended for neuropathic pain. It involves implanting a pulse generator under the skin of the upper buttocks or lower back, which the person can use to control pain. Treatments for low back pain are described in NICE's guideline on low back pain and sciatica in over 16s: assessment and management. Conservative pain management includes pharmacological treatments (such as oral non-steroidal anti-inflammatory drugs, and weak opioids with or without paracetamol) and non-interventional treatments (such as self-management advice and education, exercise...). People with severe chronic low back pain that is refractory to conservative treatments may be offered interventional procedures (such as radiofrequency denervation and epidural injections) or surgery (such as spinal fusion procedures). Evidence on the efficacy and safety of neurostimulation of lumbar muscles for refractory non-specific chronic low back pain is limited in quantity and quality. The devices are not compatible with magnetic resonance imaging. Most research is done in younger patients with a body mass index less than 35.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6614;1;"NICE ";NICE;English;"Microwave ablation is not recommended for improvement in survival, long-term outcomes, and quality of life in patients with primary or metastatic lung cancer, only with special arrangements for clinical governance, consent, and audit or research.";"Lung cancer is one of the most common types of cancer. There are 2 main types of primary lung cancer: small cell lung cancer and non-small cell lung cancer. Cancer that starts in one part of the body and spreads through the bloodstream to the lungs is known as metastatic lung cancer. Common tumors that metastasize to the lungs include breast cancer, colon cancer, prostate cancer, sarcoma, bladder cancer, neuroblastoma, and Wilm's tumor. The evidence on the safety of microwave ablation for treating primary lung cancer and lung metastases is adequate, but shows that it can cause rare serious complications. Evidence on its effectiveness shows that it reduces tumor size. But the evidence on improved survival, long-term outcomes, and quality of life is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical management, consent, and audit or investigation. The evidence included 3 systematic reviews and/or meta-analyses, 6 non-randomised comparative studies, 2 case series, 1 case report and 1 review of lung microwave ablation database. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6870;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"The administration of an alternating regimen of antipyretics is not recommended in boys and girls with fever.";"Fever is a physiological defense mechanism against infections. That is why most experts support the use of antipyretics with the aim of relieving discomfort in boys and girls, if there is any, instead of waiting for the temperature to return to normal levels. Treatment of fever in the pediatric population with an alternating regimen of antipyretics, usually ibuprofen and paracetamol. Most clinical practice guidelines do not recommend the alternating regimen of antipyretics in the management of fever in children. Two systematic reviews conclude that the evidence is not robust enough to recommend the alternating regimen over monotherapy, because the small improvements observed in the reduction of fever and discomfort in children are not clinically relevant. The evidence is not robust enough to favor the alternating regimen of antipyretics over monotherapy, given that the reduction in temperature is modest, the results on childhood discomfort are not conclusive and the risk of boys and girls receiving doses higher than those indicated that can cause toxicity. Similar rates of adverse events are observed between monotherapy and the alternating antipyretic regimen, such as gastrointestinal disorders, a slight elevation of pancreatic enzymes or an alteration in renal function. The alternating regimen of antipyretics could be considered appropriate when discomfort persists with monotherapy.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6615;1;"NICE ";NICE;English;"Penalizing homeless people for missing appointments is not recommended, for example, by terminating people from the service. Consider seeking help from specialists, such as peer support or independent advocates, to help the person keep appointments and re-engage in care after missing appointments";"Underlying causes of homelessness include structural, societal and economic factors, and inequalities, such as poverty and deprivation, unaffordable housing, unemployment, exclusion and discrimination. People experiencing homelessness often experience severe and multiple disadvantage and unmet health and social care needs that may be contributing factors for becoming homeless as well as consequences of homelessness. Experience of psychological trauma and adverse childhood events are common in people experiencing homelessness, and the prevalence of people who are neuroatypical or have a brain injury is higher than in the general population. Homelessness and access to appropriate housing is a public health issue. Ensure that people can access help when needed, including through emergency care, and avoid policies that withdraw support and close cases after a standard duration, unless a safe transfer of care to another service has been agreed with the person or the person agrees that they no longer need the service.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6871;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Generalitat de Catalunya";Spanish;"The concomitant use of opioids, especially strong ones, and benzodiazepines is not recommended in patients with chronic non-cancer pain.";"Opioids, especially strong ones, and benzodiazepines are drugs that cause depression in the central nervous system, can cause a reduction in respiratory rate and contribute to oxygen desaturation. This combination may enhance complications and put the patient at greater risk of respiratory depression and potentially fatal overdose. It can also affect the ability to drive a vehicle or other machinery safely, and is related to problems associated with the risk of dependency. The concomitant use of opioids, especially strong ones, and benzodiazepines is considered a clinical practice of little value because it may put the patient at risk for respiratory depression or a fatal overdose. This combination is not recommended in patients with chronic non-cancer pain, since it may cause more harm than good and, furthermore, there is no evidence to support the long-term use of this combination. Clinical practice guidelines recommend not prescribing opioids and benzodiazepines together in patients with chronic non-cancer pain, or avoiding this concomitant use if possible and restricting it only to exceptional cases. A 2020 systematic review shows that three cohort studies found an association between the concomitant use of benzodiazepines and opioids and increased risk of overdose, versus the use of opioids alone.";2022;;;"Not applicable";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6872;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial: Salud";Spanish;"It is not recommended the routine use of the combination of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in patients with heart failure";"Both angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists act on the renin-angiotensin-aldosterone system and are used in the routine treatment of heart failure. Angiotensin-converting enzyme inhibitors are the first-line treatment and angiotensin II receptor antagonists are reserved for patients who do not tolerate angiotensin-converting enzyme inhibitors or in whom their administration is contraindicated. Since their mechanism of action is complementary, they have sometimes been administered in combination. However, no mortality benefits have been observed in patients with heart failure treated with angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists simultaneously. Furthermore, although the combination may reduce hospital admissions associated with heart failure, it has also not demonstrated any effect on total hospital admissions. Combination therapy, angiotensin-converting enzyme inhibitors + angiotensin II receptor antagonists, is associated with an increased risk of an adverse event, especially worsening renal function and hyperkalemia. For this reason, the routine use of the combination of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists is not recommended in patients with heart failure.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6617;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"Antidepressants increase the risk of suicidality in children and adolescents";"After the review carried out on the safety of the use of antidepressants in children and adolescents, it is concluded that, in general, in this population, antidepressants are associated with a greater risk of suicidal tendencies, especially suicidal ideation, and of serious adverse events.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6873;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"It is recommended the screening for syphilis infection in persons who are at increased risk for infection";"After reaching a record low in 2000, rates of syphilis have been increasing over the past 20 years. Without treatment, syphilis can damage the brain, nerves, eyes, and cardiovascular system. Screening and follow-up treatment can cure syphilis and prevent complications. This recommendation applies to adolescents and adults who have ever been sexually active and are at increased risk for syphilis infection. Although it does not apply to pregnant persons nor to persons who have signs or symptoms of syphilis. The screening consist in: ? Traditional screening algorithm: Screen with an initial nontreponemal test (eg, Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR] test). If positive, confirm with a treponemal antibody detection test (eg, T pallidum particle agglutination [TP-PA] test). ? Reverse sequence algorithm: Screen with an initial automated treponemal test (eg, enzyme-linked or chemiluminescence immunoassay). If positive, confirm with a nontreponemal test. ? Screening interval: although evidence on optimal screening intervals is limited for the general population, men who have sex with men or persons with HIV infection may benefit from screening at least annually or more frequently (eg, every 3 to 6 months) if they continue to be at high risk. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6618;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"Diagnostic tests for the detection of Helicobacter pylori. Both the breath test and the rapid stool antigen test are valid for the initial diagnosis of Helicobacter pylori infection and also for confirmation of eradication after treatment.";"Both for the initial diagnosis of Helicobacter pylori infection and for confirmation of eradication after treatment, the 13C breath test or the rapid stool antigen test may be used. Whenever the rapid stool antigen test is carried out and it shows a positive result, it is recommended to carry out a breath test to confirm the positivity, both if it is the initial diagnosis and especially after the eradication treatment. In this situation, the result obtained through the breath test will prevail as valid. In all cases, a treatment-free period must be completed before carrying out the diagnostic tests, which will be at least 2 weeks in the case of proton pump inhibitors and at least 4 weeks in the case of antibacterial treatment.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6874;1;"NICE ";NICE;English;"It is recommended ultrasound-guided percutaneous microwave ablation for symptomatic benign thyroid nodules due to its safety compared to other procedures.";"This involves inserting a thin wire into the nodule under local anaesthetic and guiding it into position using ultrasound. Microwaves from the wire heat the nodule to destroy it (ablation). The aim is to make the nodule smaller, relieve symptoms and improve appearance There are known complications, including pain, bleeding and damage to other parts of the neck or throat. There?s also a chance cancerous nodules could be treated, which risks cancer going undetected.";2022;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 6875;1;"NICE ";NICE;English;"It is recommended the use of transcutaneous electrical stimulation of the supraorbital nerve for treating and preventing migraine";"Migraines are moderate to severe headaches that can last for hours, days, or longer. Clinical: nausea, photophobia, phonophobia and perception of unpleasant odors. In some people, they may be accompanied by an aura, characterized by focal neurological symptoms that usually precede or sometimes accompany the headache. For acute migraine attacks, these include pain relievers, triptans, and antiemetics. Treatments to stop or reduce the frequency of migraine attacks include beta-blockers, calcium channel blockers, tricyclic antidepressants, antiepileptics, and calcitonin gene-related peptide inhibitors. Transcutaneous electrical supraorbital nerve stimulation uses small electrical currents to stimulate the supraorbital nerves to relieve headache pain and, when used regularly, reduce the severity and frequency of migraine attacks. A quick review of the published literature on the efficacy and safety of this procedure was done. They noted that several people reported a negative experience with the procedure, including unpleasant side effects.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6620;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"The recommendations and proposals only refer to adult patients (?18 years) who are going to undergo a radiological test prior to which the administration of iodinated contrast is required by INTRAVENOUS WAY. In all cases, the following should always be assessed: ? The need to perform a radiological test (mainly CT); ? Analyze whether there are other alternative imaging tests that do not require co";"Antithrombotic prophylaxis after hip/knee arthroplasty: All three types of drugs [direct-acting oral anticoagulants (DOACs), heparins and ASA] are considered valid alternatives. In the case of using anticoagulants, issues such as the cost of treatment, the need for interconsultation and the associated cost, differences in the method of administration, the possibility of requiring urgent reoperation, prior anticoagulation should be considered when choosing the drug. , drug interactions or contraindications. Considering economic issues, the option with the lowest cost would be the use of DOACs if consultation is not required, and heparin derivatives if consultation is required for the prescription of DOACs. ? The use of ASA may be considered, especially in patients who, due to their characteristics or circumstances, present a greater risk of bleeding. Antithrombotic prophylaxis after hip fracture surgery: ? Heparin derivatives are the option of choice. ? The use of ASA may be considered, especially in patients who, due to their characteristics or circumstances, present a greater risk of bleeding.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6876;1;"NICE ";NICE;English;"It is recommended ab interno canaloplasty for open angle glaucoma in people who suffer from this disease.";"Open-angle glaucoma is a progressive condition that causes increased pressure in the eye. This damages the nerve that connects the eye to the brain and may lead to permanent sight loss. This procedure involves making a small cut in the eye (ab interno) and inserting a tiny tube into the channel that drains fluid from the eye. The tube widens the drainage channel (canaloplasty), then gel is injected into it and the tube is removed. The gel keeps the channel wider for a few days then dissolves, leaving the channel permanently wider, allowing excess fluid to drain away. The aim is to reduce pressure in the eye. It is based on a rapid review of the medical literature and professional opinion. It should not be regarded as a definitive assessment of the procedure. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6877;1;"NICE ";NICE;English;"Unclear evidence on the use of extracorporeal therapy Extracorporeal shockwave therapy for calcific tendinopathy in the shoulder in adults.";"Calcific tendinopathy is a shoulder disorder characterized by the formation of calcium crystal deposits in one or more of the rotator cuff tendons. It can cause symptoms such as upper arm and shoulder pain, reduced range of motion, stiffness, and weakness. The exact cause is unknown. Most cases of calcific tendinopathy resolve over time without treatment Extracorporeal shock wave therapy is a non-invasive treatment that uses a device to pass short-duration, controlled acoustic shock waves through the skin to the affected area. This produces transient pressure disturbances that break down calcium deposits. A quick review of the published literature on the effectiveness and safety of this procedure was done with 11 sources, Evidence on the safety of the therapy does not show significant short-term safety concerns. The evidence on effectiveness is inadequate (it comes from a heterogeneous group of patients, which made it difficult to determine whether there was a group that could benefit from the treatment). Therefore, this procedure should only be used in the context of research";2022;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6622;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"Imaging tests are not recommended in adults over 50 years of age with chronic non-traumatic knee pain and typical symptoms of osteoarthritis.";"It is considered that the initial diagnosis in patients over 50 years of age who present chronic knee pain of non-traumatic cause and typical symptoms of osteoarthritis should be established routinely through review of the medical history and physical examination. In those specific cases in which it is considered necessary to have an imaging test for the initial diagnosis, simple radiography is the test of choice, and routine magnetic resonance imaging is not justified in this situation. Performing an MRI of the knee would be justified in the case of patients with chronic pain that persists despite established treatment, in whom the X-ray shows no abnormalities or whose symptoms are not explained by the X-ray findings, provided that it is suspected that the The origin of the pain may be a lesion other than osteoarthritis and the choice of therapeutic approach necessarily requires more precise images. There is no justification for performing a magnetic resonance imaging of the knee in patients with signs of osteoarthritis in order to identify a meniscus tear, nor prior to the placement of a prosthesis. The routine performance of follow-up imaging tests in patients with osteoarthritis is also not justified.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6879;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"Exclusively pharmacological treatment is not recommended for chronic non-cancer pain in adults. ";"Chronic non-cancer pain is one of the main reasons for seeking health care and includes various conditions (prevalence of 11-17% in the Spanish population). Treating these people solely with drugs, without including a multimodal approach, is considered a clinical practice of little value since the combination of medication and non-pharmacological strategies provides a greater benefit in reducing pain, improving functionality, emotional discomfort and quality. of life. Clinical practice guidelines recommend non-pharmacological strategies in the approach. There is a wide range of interventions with proven effectiveness: physical exercise, cognitive-behavioral therapy, health education, mindfulness and acceptance, self-management strategies or acupuncture. Non-pharmacological interventions have been proven to be safe in terms of morbidity or mortality.";2022;;;"High value";-;"

Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 6625;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"It is recommended to routinely assess activity levels and recommend appropriate physical activity to your patients. ";"Studies have shown a decrease in all-cause mortality associated with increasing levels of energy expenditure. It has also been shown to decrease risk of coronary artery disease, diabetes, hypertension, many types of cancers, and a host of other medical conditions with strong, consistent epidemiologic evidence and moderately strong supporting evidence from clinical trials. Benefits on bone health and mental health have also been demonstrated. Practitioners should routinely assess physical activity levels and recommend safe and appropriate activity to patients. Some studies have also shown that exercise prescriptions increase physical activity levels and quality of life. The potential risks associated with a well-designed exercise program that accounts for age, baseline fitness level and medical history are low. ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative." 6881;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force A and B recommendations";English;"It is recommended anxiety screening for children and teenagers ages 8 to 18. ";"Anxiety disorder, a common mental health condition, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms A systematic review was conducted to evaluate the benefits and harms of screening for anxiety disorders in children and adolescents. Between ages 8-18 the grade of evidence obtained was B.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6626;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"It is not recommended to use tests of ovarian reserve (oocyte quantity measures such as AMH or FSH levels) to judge a woman?s reproductive potential (whether someone is likely or unlikely to become pregnant).";"Markers of ovarian reserve, such as early follicular phase FSH or antim�llerian hormone (AMH) levels, have been shown to be poor independent predictors of reproductive potential. Therefore, they should not be used as a ?fertility test? for women who are not infertile or who have untested fertility.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6882;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"The use of antibiotics as a treatment for mild acute otitis in children over 2 years of age is not recommended.";"Acute otitis media is one of the most common infections in children 1?4 and, in parallel, one of the most common causes of antibiotic therapy. It is a generally self-limiting infection, and most children and young people improve within 3 days without the need for antibiotics. Likewise, acute complications are rare regardless of whether they are treated with antibiotics or not. For all these reasons, it is considered that expectant management for 48-72 hours is the most appropriate in the management of uncomplicated acute otitis media in children over 2 years of age without associated risk factors. In any case, analgesic and/or anti-inflammatory treatment is recommended to relieve pain. Antibiotic therapy is associated with adverse events such as diarrhea, nausea or skin rashes, in addition to promoting the selection of antibiotic resistance.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6627;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"It is not recommended ordering segmental pressures of the lower extremities without toe pressures in patients with diabetes and foot ulceration.";"Systolic ankle pressures can lack predictive validity for wound healing due to calcification of the ankle arteries. This is especially true of patients with diabetes and advanced complications where vessel calcifications are observed in 53?66% of patients. Compared to ankle pressures, toe pressures appear to be more predictive of distal arterial perfusion and wound healing potential in patients with diabetes. If toe pressures are requested at the time of the initial order, repeat studies performed solely for the purpose of obtaining toe pressures can be avoided.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6883;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services";English;"Unclear evidence on screening for major depressive disorder in adolescents aged 12 to 18 years.";"Depression is a leading cause of disability in the U.S. Children and adolescents with depression often have functional impairments in their performance at school or work, their interactions with their families and peers, their development, and are at increased risk. of suicides. The US Preventive Services Task Force concludes that there is insufficient evidence on screening for major depressive disorder and suicide in children aged 11 years and younger as evidence is lacking and the balance between benefits and harms cannot be determined. .";2022;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6628;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Imaging is not recommended to establish the diagnosis of cryptorchidism in children.";"Cryptorchidism is an affectation of one or both testicles that prevents them from moving from the abdomen to the scrotum. As there is no test that is accurate, safe and accessible enough to confirm testicular absence, a surgical exploration such as diagnostic laparoscopy or open exploration is the gold standard for both diagnostic and therapeutic purposes for non-palpable testicles.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6629;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"It is not recommended to order ankle or midfoot X-rays for patients older than 6 years old without positive criteria per the Ottawa ankle rules.";"Both children and adults commonly present to healthcare settings with ankle and foot injuries. Multiple randomized control studies and meta-analyses have shown the high sensitivity of the Ottawa Ankle Rules to rule out fractures when criteria are not met and thus avoid the need for imaging in the acute setting. There is much less data for application of the Ottawa Ankle Rules for pediatric patients under the age of 6 due to less ankle and midfoot injuries in this patient population as well as difficulty of children in this age group to walk independently.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative." 6885;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial Salud";Spanish;"It is not recommended starting treatment with antibiotics without certain diagnostic guidance in children with symptoms suggestive of a urinary tract infection";"Urinary tract infection is a pathology that can affect pediatric patients of any age. The clinical presentation depends on age: in children in the preverbal phase the symptoms are very nonspecific (fever, vomiting, lethargy, irritability). On the other hand, children over 2 years of age usually report dysuria, altered urination frequency, or abdominal or flank pain. It should be noted that the morbidity of urinary tract infection in pediatric age is variable: in the short term it depends on the degree of kidney involvement due to the infection itself and the presence of bacteremia; In the long term it depends on the possibility of renal scarring which, if significant, can lead to renal dysfunction, high blood pressure and chronic kidney damage, depending on the presence of risk factors such as bladder dysfunction or congenital renal and urinary tract anomalies, including vesicoureteral reflux. The definitive diagnosis of urinary tract infection in children to initiate antibiotic treatment is based on the presence of compatible symptoms, together with the correct interpretation of the urinalysis result (test strips and urine sediment: leukocyte esterase / leukocyturia and /or positive nitrites). Additionally, it is important to send a urine sample for a urine culture. Confirmation will be obtained with a positive urine culture with a count ? 105 CFU/ mL in samples collected by spontaneous urination, or between CFU ? 104 2,3,8 or ? 5 x 104 CFU/ mL 13 in samples obtained by bladder catheterization, a single microorganism. In samples obtained by suprapubic puncture in newborns and young infants, any bacterial count will be accepted as positive. The empirical use of antibiotics without certainty diagnostic guidance is not justified and contributes to the appearance of adverse events and an increase in antimicrobial resistance. For example, in Catalonia, between June 2021 and May 2022, a diagnostic test such as a urine sediment and/or a urine culture is performed in 50.4% of cases of urinary tract infection in pediatrics. Therefore, it is important to have a certain diagnosis of urinary tract infection in children before prescribing antibiotics, to prevent healthy children from receiving unnecessary treatment. The most common adverse events are associated with the use of antibiotics, especially if they are used without a certain diagnostic basis of bacterial infection. This is the case of exanthematic, allergic-type skin reactions and gastrointestinal symptoms, mainly diarrhea. Apart from these reactions, the most important aspect is the contribution to the increase in antimicrobial resistance.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6630;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to use opioids for treatment of mild, acute pain. For moderate to severe acute pain, if opioids are used, it should be in conjunction with non-opioid methods with the lowest effective dose for the shortest required duration.";"Opioids have serious risks including opioid use disorder and overdose. If opioid therapy is required, pain management with short acting opioids should be the lowest effective dose for the shortest required duration, often no more than 1 week. A trial of non-opioid and non-pharmacological alternatives is recommended for opioid na�ve patients. If opioids are used, they may be used in conjunction with non-opioid methods, when clinically appropriate. For patients already on opioids for chronic pain, it is not recommended to abruptly stop or taper opioid therapy to avoid withdrawal, mental health crisis, and overdose. Individualized treatment plans should be made with the patient and outpatient clinicians, whenever possible. It is important for the clinician to assess potential biases that may affect treatment of pain.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6886;1;"NICE ";NICE;English;"There is not enough evidence about the insertion of a tunneled peritoneal drainage catheter to treat refractory ascites in patients with cirrhosis.";"Refractory ascites is a common complication of cirrhosis of the liver. Build-up of fluid causes difficulty in breathing, fatigue, nausea, poor appetite, acid reflux, abdominal pain and infection. The committee was informed that the procedure has the potential to increase the pre-existing risk of bacterial peritonitis in people with refractory ascites in cirrhosis. Evidence on the safety of long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis is limited but shows well-recognised complications. Evidence on the efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. NICE encourages further research into long-term tunnelled peritoneal drainage catheter insertion for refractory ascites in cirrhosis.";2022;;;"Low value";"Refractory ascites, cirrhosis, peritoneal drainage catheter";"Link to the recomendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6631;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Screening for urinary tract infection is not recommended in asymptomatic patients undergoing clean intermittent catheterization";"Children who perform clean intermittent catheterization may have colonization of the urinary tract by bacteria that are sometimes considered pathogenic. Typical UTI symptoms include fever, chills, and/or pain. Guidelines have been published that discourage both detection and treatment of asymptomatic bacteriuria in non-pregnant patients, including children.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6632;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"It is not recommended the prescription of neuropathic pain agents for painless neuropathy in patients with diabetic peripheral neuropathy.";"Diabetic peripheral neuropathy is a progressive condition that may be painful or painless. Neuropathic pain agents (for example: anticonvulsants or antidepressants) have been studied to reduce painful symptoms in those with neuropathy; however, they have no effect on painless neuropathy and their many side effects can cause unnecessary harm (for example: unwanted drug interactions, increased fall risk, etc.)";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6633;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to maintain a peripheral capillary oxygen saturation (SpO2) of higher than 96% when using supplemental oxygen, unless for carbon monoxide poisoning, cluster headaches, sickle cell crisis, or pneumothorax.";"Ideal oxygen saturation levels for patients getting supplemental oxygen therapy is at or below 96%. The overuse of supplemental oxygen has been shown to increase mortality in numerous studies of patients with a variety of critical illnesses, including cardiac arrest, stroke, and trauma, as well as following emergency surgery. Higher oxygen levels may be needed for those with certain medical conditions such as carbon monoxide poisoning, special types of headaches like cluster headaches, sickle cell crisis, or pneumothorax. An important caveat to this recommendation is the higher incidence of occult hypoxemia, defined as an arterial oxygen saturation of less than 88% with a pulse oximetry measurement of 92 to 96%, in black patients compared to white patients.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6634;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"It is recommended to evaluate with ultrasound rotator cuff tears before ordering an MRI.";"Rotator cuff tears are one of the most common causes of shoulder pain. Determining rotator cuff integrity is pivotal in deciding between surgical and non-surgical management. Given its comparable diagnostic accuracy, low cost and convenience, high-frequency ultrasound may be considered prior to MRI, based on clinical determination via medical history, physical examination and review of relevant imaging, for the evaluation of rotator cuff tears. Furthermore, the cost of MRI and some contraindications, like the presence of metal-mounted devices, could make ultrasound a better, more accessible option in certain clinical scenarios. Ultrasound of the rotator cuff should be done by an experienced provider at a center with appropriate diagnostic ultrasound equipment.";2022;;;"High value";-;"Link to the recommendation on the website of the initiative." 6635;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Newborn clamp circumcision is not recommended in boys with penile abnormalities without first consulting urology.";"In 2012, hypospadias, congenital chordee, and deficient shaft skin, were listed as contraindications to newborn circumcision. For patients with hypospadias, preservation of the prepuce is important for use in future reconstruction. Additionally, abnormal urethral anatomy may predispose to urethral injury during clamp circumcision. As such, best practice dictates consulting a urologist to help assess these anatomic penile anomalies prior to initiation of circumcision.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6636;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to wake patients at night for routine care.";"It is recommended to redesign workflow to promote sleep at night. Inadequate sleep in hospitalized patients has been associated with poor outcomes including high blood pressure, hyperglycemia, immune dysfunction, and delirium. Environmental factors (noise, light disruptions), care-related factors (blood draws, vital signs), and patient factors (illness, pain) all contribute to sleep disruption. It is generally recommended that non-pharmacologic interventions be the first line of prevention. Although data are limited, multifaceted interventions targeting modifiable factors including nighttime interventions to decrease noise and light, group care activities and minimize unnecessary patient contact (i.e. decreasing vital sign frequency, blood draws) may improve sleep quality and duration. Non-pharmacologic sleep aids including earplugs, eye masks and relaxation techniques can be easily adopted and may provide some benefit.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6637;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"It is not recommended a major reconstructive surgical intervention on children with clubfoot without prior Ponseti casting therapy.";"The Ponseti method has become the standard of care worldwide for treatment of pediatric clubfoot deformity. The success rates for clubfoot treatment with the Ponseti method, when properly administered, is 95%. In cases where rigid or neglected deformities are encountered, the Ponseti method can reduce the complexity of the deformity, thereby reducing complexity of surgical intervention and potential complications. Failure to consider Ponseti therapy first, may subject patients to unnecessary surgery and/or more complicated reconstruction attempts that might have otherwise been avoided.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6638;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Collecting a urine culture bag urine sample to confirm a urinary tract infection in a toilet-trained child is not recommended.";"Prospective studies of the use of a bag applied to the perineum for urine collection have shown a high incidence of false-positive culture results, ranging from 85 to 99%. In children under 2 years of age, urethral catheterization with sterile technique is recommended. Alternatively, suprapubic bladder aspiration has been shown to have the highest sensitivity, but requires trained providers, often with ultrasound guidance, and is thus often impractical. In older children with sphincter control, collection of clean midstream samples is possible and reliable. The guidelines of the AAP, the American Academy of Family Physicians and the European Association of Urology issue this recommendation with the support of quality A evidence.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6639;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"It is not recommended to cast or perform follow-up X-rays for isolated, non-displaced/non-angulated distal radius buckle fractures that do not involve the physis and which have an intact cortex in children.";"Distal radius buckle fractures are one of the most common wrist fractures in children. These fractures are inherently stable and have an excellent prognosis. As long as the following conditions are met, radius buckle fractures can be safely treated with a Velcro removable wrist splint for 3-4 weeks as long as: cortex is intact, there are no fracture lines extending to the physis on any view, there is no angulation/displacement of the fracture, there are 2 or 3 inflection points seen in the cortex on either view which best represents the fracture and the parent can do a symptom check with instructions. Treating in a cast and repeating X-rays increases healthcare costs as well as radiation exposure for the patient. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative." 6640;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to order creatine kinase (CK) or Creatine Kinase-Myocardial Band (CK-MB) in suspected Acute Coronary Syndrome or Acute Myocardial Infarction.";"According to published guidelines, cardiac troponin is the lab test of choice to diagnose acute coronary syndrome or acute myocardial infarction. Troponin is highly sensitive for acute myocardial infarction and more specific than Creatine Kinase-Myocardial Band (CK-MB); CK-MB yields no incremental diagnostic value even in patients with chronic kidney disease. Guidelines also support the use of cardiac troponin over CK-MB for diagnosing reinfarction";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6641;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"It is not recommended to delay initiation of early sub-threshold, symptom-limited aerobic exercise as rehabilitation for adolescents who have sustained an acute sport-related concussion.";"Concussions represent 70?90% of all traumatic brain injuries. The historic standard for treatment of sport-related concussions consists of physical and cognitive rest until symptoms resolve, followed by a stepwise gradual return to activity. However, the current consensus among experts is that there is insufficient evidence for prescribing complete physical and cognitive rest until asymptomatic after acute SRC. Moreover, unnecessary delays in activity initiation for athletes may have detrimental effects on physical fitness and mental health. Thus, we recommend initiating early sub-threshold, symptom-limited aerobic exercise as rehabilitation for adolescents who have sustained an acute sport-related concussions, especially given the overwhelming amount of recent high-quality, data-driven evidence sufficiently demonstrating symptomatic improvement and decreased recovery time with this strategy.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6642;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"It is not recommended to treat urinary incontinence in a child with pharmacotherapy before first evaluating and treating constipation.";"The association of lower urinary tract dysfunction and constipation is termed bladder-bowel dysfunction. From 25-30% of children with functional constipation have daytime urinary incontinence. Treatment of constipation alone can eliminate daytime urinary incontinence in many patients and also has been shown to reduce recurrent urinary tract infection. The clinical diagnosis of constipation can be made using the Rome IV criteria. Treatment strategies involve education, fecal disimpaction in many, prevention of re-accumulation with maintenance regimens and close follow-up. If a child is started on anti-cholinergic medications, the bowel regimen must be continued to obviate worsening constipation.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6643;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"It is not recommended using expensive fixation in hammertoe surgery without first engaging in shared decision making to evaluate alternatives.";"From an efficacy standpoint, there is no clear benefit to using commercially available hammertoe implants over conventional K-wire fixation, and the cost of commercial devices, when used routinely, may be prohibitive. Since some patients may prefer the idea of not having implantable hardware retained for life, while others may not want hardware exiting the toe during the immediate postoperative period, selection of hammertoe fixation represents an opportunity for shared decision making.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6644;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"It is not recommended the prophylactically use of compounded antibiotic soaks for aftercare, following office-based procedures.";"The marked increase of prescribing and dispensing of compounded antibiotic powders for soaking after non-complicated office-based procedures has shown no more effectiveness than the current standard (i.e., over-the-counter Betadine, white vinegar, astringent soaks and Epsom salts) while having the obvious downside of adding significant overall cost to in-office procedures. The hundreds of dollars being spent on these expensive substitutes represents medical waste.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6646;1;"NICE ";NICE;English;"It is not recommended the use of liposuctyion in patients with chronic lipoedema due to a lack of security and efficacy. This procedure should only be used in the context of research.";"Lipoedema is characterised by an abnormal, usually symmetrical, accumulation of fat in the legs, hips, buttocks, and occasionally arms. It is considerably more prevalent in women. It can have a profoundly negative effect on quality of life, and physical and mental health. Lipoedema is common, under-recognised and extremely debilitating. Evidence on the safety of liposuction for chronic lipoedema is inadequate but raises concerns of major adverse events such as fluid imbalance, fat embolism, deep vein thrombosis, and toxicity from local anaesthetic agents. Evidence on the efficacy is also inadequate, based mainly on retrospective studies with methodological limitations. Treatment typically involves healthy lifestyle changes, conservative therapy and, in severe cases, surgery. The fat associated with lipoedema is usually resistant to diet modification and exercise. Conservative therapy, including compression and manual lymphatic drainage is sometimes used to treat lipoedema, but is ineffective at removing abnormal fat. The main surgical treatment for lipoedema is liposuction. In people who also have obesity, there is emerging evidence that bariatric surgery may help reduce fat from both lipoedema-affected and unaffected areas of the body. The aim of liposuction for lipoedema is to reduce limb bulk, reduce pain, and to improve mobility and functioning. Liposuction is done around and all the way along the limb. Liposuction is often a multi-stage procedure, depending on the extent of fat deposition. Furthermore, it may not be a curative procedure and multiple procedures may be needed. NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 8 before-and-after studies. The committee also considered safety data from a coroner's regulation 28 letter. Key efficacy outcomes were considered to be: patient-reported outcomes including quality of life and lipedema volume reduction, while safety outcomes were: pain, bleeding, infection, fat embolism, deep vein thrombosis, imbalance of fluids and toxicity of local anesthesia. There were 29 commentaries from patients who have had this procedure that were discussed by the committee. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6647;1;"NICE ";NICE;English;"It is recommended to follow the NICE Guideline for stroke and transient ischaemic attack in over people over sixteen years old. ";"A stroke occurs when the blood supply to a part of the brain is severely compromised. Most strokes (85%) are caused by a blockage in an artery that supplies blood to the brain. A transient ischemic attack has the same clinical presentation as a stroke except that symptoms resolve within 24 hours. It is recommended that people over 16 years of age presenting with neurological symptoms suggestive of stroke undergo rapid recognition of symptoms and diagnosis. In addition, imaging tests should be performed if TIA is suspected. In any case, specialized care must be offered and pharmacological treatments or surgery should be adapted to the patient and the clinical situation. Treatments include: - Thrombectomy for people with acute ischemic stroke - Maintenance or restoration of homeostasis, including control of blood pressure in people who have had acute intracerebral haemorrhage - Nutrition and hydration - Optimal positioning and early mobilization for people with acute stroke - Decompressive hemicraniectomy for people with acute stroke ";2022;;;"High value";-;"Link to the recommendation on the website of the initiative" 6649;1;"NICE ";NICE;English;"It is not recommended the use of Freelite assays for diagnosing multiple myeloma and related conditions.";"NICE no longer plans to develop guidance on Freelite assays for diagnosing multiple myeloma and related conditions in primary care. This is because data on the use of the assays in primary care has not been received. The assays are already recommended for use in NICE's guideline on myeloma: diagnosis and management.";2022;;;"Low value";-;"https://www.nice.org.uk/guidance/dg47" 6650;1;"NICE ";NICE;English;"Intramedullary distraction is not recommended for lengthening of the upper limb. However, the procedure may be considered for clinical monitoring, consent, and audit or research.";"Clinicians wanting to use intramedullary distraction for upper limb lengthening should: Inform the clinical governance leaders in their healthcare organization, give people (and their families and carers as appropriate) written information to support shared decision-making, including NICE information for the public. They make sure that people understand the safety and efficacy of the procedure, and any uncertainties about it. They must audit and review clinical outcomes of everyone having the procedure. Finally, the results of the procedure should be discussed during their annual evaluation to reflect, learn and improve. Healthcare organizations should make sure systems are in place to help clinicians collect and report data on the outcomes and safety of everyone who undergoes this procedure. This technically challenging procedure should only be done in specialist centres by surgeons with specific training and experience in upper limb lengthening techniques, using a multidisciplinary approach. Any problem with a medical device must be reported using the Yellow Card System of the Medicines and Health Products Regulatory Agency. Additional investigations, which could be registry data, should report details on patient selection, device selection, technique used, procedural results, long-term outcomes including quality of life, need for repeat interventions or surgery and complication rates.";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6653;2;"Choosing Wisely�";"Society of Hospital Medicine";English;"It is not recommended to order daily chest radiographs in hospitalized patients unless there are specific clinical indications.";"Patients in intensive care units have historically had daily chest x-rays as part of routine management. Evidence suggests that this does not lead to change in management, unless there are specific clinical indications to obtain a chest x-ray. The use of routine daily chest x-rays leads to unnecessary test utilization, unwarranted exposure to radiation, and downstream testing";2022;;;"Low value";Diagnostic;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6654;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Blood Transfusion";English;"It is not recommended to order a blood group and crossmatch when the appropiate woukd be a blood group and antibody screen.";"Modern on-site laboratories can issue compatible blood within minutes if the patient has a valid group and screen and no clinically significant red cell antibodies. Cross-matching blood unnecessarily increases total inventory levels, increases the average age at which units are transfused, increases blood wastage and creates additional work and costs associated with transfusion. If an on-site laboratory is not available, then cross-matching should be guided by a Maximum Surgical Blood Ordering Schedule to minimise wastage. For patients with antibodies laboratories should have a policy related to cross matching blood for those patients who have difficult to match antibodies.";2022;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6655;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"It is not recommended to use neuromuscular ultrasound to evaluate the severity of carpal tunnel syndrome.";"Although neuromuscular ustrasound can be used as a reasonable alternative to electrodiagnostic evaluation (nerve conduction studies and electromyography) for the diagnosis of carpal tunnel syndrome in some patients, its ability to determine severity is uncertain. Carpal tunnel syndrome is due to pressure on the median nerve. The carpal tunnel is a narrow passage surrounded by bones and ligaments located in the palm of the hand. When the median nerve is compressed, symptoms can include numbness, tingling, and weakness in the hand and arm. Wrist anatomy, health problems, and possible repetitive hand movements can all contribute to carpal tunnel syndrome. Early detection and treatment are important to prevent permanent nerve damage. The way to diagnose it is through a physical exam and specific tests of the nerves. ";2022;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6144;1;"NICE ";NICE;English;"Is recommended the use of Leukomed Sorbact for closed surgical wounds after caesarean section and vascular surgery.";"Leukomed Sorbact is an interactive dressing that binds to the microbes that cause surgical site infection so they are removed when the dressing is changed. Leukomed Sorbact should be considered as an option for people with wounds that are expected to have low to moderate exudate after caesarean section and vascular surgery. It should be used as part of usual measures to help reduce the risk of surgical site infection. More evidence is needed on the use of Leukomed Sorbact on wounds after other types of surgery. The relevant clinical evidence consists of 5 studies, including 3 randomised trials";2021;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web" 6145;1;"NICE ";NICE;English;"Brolucizumab is recommended as an option for treating wet age-related macular degeneration in adults";"Usual treatment for age-related macular degeneration is aflibercept and ranibizumab. The evidence that brolucizumab provides similar overall health benefits to these drugs, and is similarly safe, has been drawn from clinical trials and network meta-analyses. Brolucizumab will be recommended, only in cases where the eye to be treated has the best-corrected visual acuity between 6/12 and 6/96, there is no permanent structural damage to the central fovea, the lesion size is less than or equal to 12 disc areas in greatest linear dimension, and there is recent presumed disease progression (for example, blood vessel growth, as shown by fluorescein angiography, or recent visual acuity changes).";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6401;15;"U.S. Preventive Services Task Force A and B recommendations";"US Preventive Services Task Force";English;"It is not recommended screening for hearing loss in asymptomatic adults with 50 years or older. ";"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for hearing loss in older adults. This recommendation applies to asymptomatic older adults (age >50 years) with age-related, sensorineural hearing loss. This recommendation is for persons who have not noticed any issues with their hearing. It does not apply to adults with conductive hearing loss, congenital hearing loss, sudden hearing loss, or hearing loss caused by recent noise exposure, or those reporting signs and symptoms of hearing loss. Clinicians should use their clinical judgement about hearing testing for patients who have symptoms of hearing loss or who have raised concerns about their hearing. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6146;1;"NICE ";NICE;English;"It is recommended niraparib as an option for maintenance treatment for advanced (FIGO stages 3 and 4) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer after response to first-line platinum-based chemotherapy in adults";"There are no maintenance treatments routinely available for advanced ovarian, fallopian tube or peritoneal cancer that has responded to first-line platinum-based chemotherapy. Clinical evidence comes from PRIMA, an ongoing clinical trial, which shows that niraparib delays disease progression. But it has not shown whether people having niraparib live longer because they have not been followed up for long enough. ";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6402;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Obstetricia y Ginecolog�a ";Spanish;"Is not recommended absolute therapeutic bed rest in pregnant women with chronic hypertension or in the fetus.";"In the clinical practice guidelines that have assessed the prescription of absolute bed rest in pregnant women with chronic hypertension, it has been found that the quality of the evidence was low. There is no evidence to support that absolute therapeutic bed rest has beneficial effects in pregnant women with chronic hypertension or in the fetus. By consensus, the experts suggest not prescribing absolute bed rest, since the risk-benefit balance would be unfavorable due to the fact that prolonged absolute bed rest can increase the risk of venous thromboembolic events.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6147;32;"Otros art�culos/Other articles on this topic";"American Diabetes association";English;"It is recommended the use of sodium-glucose cotransporter 2 inhibitors as part of treatment to lower blood sugar levels in patients with type 2 diabetes, with atherosclerotic cardiovascular disease, kidney disease, or heart failure.";"Among patients with type 2 diabetes who have established atherosclerotic cardio- vascular disease or established kidney disease, a sodium?glucose cotransporter 2 inhibitor with proven benefit in this patient population is recommended to reduce the risk of major adverse cardiovascular events and/or heart failure hospitalization, reducing the risk of worsening heart failure and cardiovascular death.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6403;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Obstetricia y Ginecolog�a";Spanish;"Breast ultrasound is not recommended in women with a normal physical examination and no history of risk who present with premenstrual mastalgia";"Premenstrual mastalgia presents as bilateral and diffuse pain. It is a clinical diagnosis that is based on the medical history and complete physical examination. In women with premenstrual mastalgia without other associated symptoms, routine breast ultrasound is not recommended, since it is a very common symptom that by itself is not related to malignancy and performing this test will not change its management or clinical course. The most recent clinical practice guidelines, based on the limited number of available studies and mainly on expert consensus, do not recommend imaging tests in women with premenstrual mastalgia without suspicious findings, since in principle the risk of malignancy is low. Despite this recommendation, breast ultrasounds are still often requested that justify premenstrual mastalgia as a reason for consultation. Premenstrual mastalgia is related to the menstrual cycle and is not associated with a specific underlying disease, and rarely is mastalgia the only symptom of breast cancer. In the absence of other clinical findings, studies have not identified a relationship between premenstrual mastalgia and breast cancer.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6148;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t order specific IgG testing to panels of foods.";"The presence of IgG to a specific food indicates previous exposure not hypersensitivity. The use of methods other than serum-specific IgE evaluation or skin prick testing in diagnosing allergies is not proven and can result in inappropriate diagnosis and treatment.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6404;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria ";Spanish;"It is not recommended the routine use of acetylsalicylic acid as primary cardiovascular prevention in patients with high, moderate or low cardiovascular risk (including elderly adults with hypertension, dyslipidemia and diabetes).";"Acetylsalicylic acid or aspirin (ASA) is an established treatment for secondary prevention of cardiovascular disease. In contrast, its indication in primary prevention is controversial and is not recorded in the technical data sheet. The use of acetylsalicylic acid in patients at high, moderate or low cardiovascular risk generally has an unfavorable clinical balance, since it increases the risk of serious adverse events (gastrointestinal or intracranial bleeding) and does not reduce mortality. According to the CPGs and meta-analyses, there is no evidence that ASA in primary prevention reduces mortality (total and cardiovascular) or major cardiovascular events (myocardial infarction, stroke) without increasing the complications or major adverse effects of the drug, especially serious bleeding (gastrointestinal or intracranial). Evidence-based CPGs advise focusing primary prevention of cardiovascular disease on lifestyle modification, adequate physical activity, smoking cessation, weight control, and treatment of hypertension, diabetes, and elevated cholesterol levels. In conclusion, ASA should be used infrequently in the primary prevention of cardiovascular disease because of the lack of relevant net benefit (reduction in mortality) and the unnecessary increased risk of major bleeding in patients.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6405;31;"Smarter medicine";"La Sociedad Cient�fica para el Cuidado Gerontol�gico";English;"It is not recommended to leave the elderly in bed or just sitting in a chair. ";"Nearly 65% ??of older people who were previously able to move independently find it difficult to do so while hospitalized. Staying in bed or sitting in a chair during a hospital stay lead to loss of strength and are important factors in reduced walking ability in the elderly. The part of Marcher's capacity prolongs his stay in the hospital environment, increases the need for subsequent rehabilitation or may lead to admission to a medico-social establishment. Added to this is the increased risk of falls and mortality, both during and after hospitalization. It is crucial to entertain the walker's ability to maintain people's functional ability and avoid increasing the load on helpers. The negative consequences of immobility also apply to people who are in a medico-social establishment or at home. The objectives of mobilization and promotion of the march must be centered on the person and adapted to the environment, the life project and the personal situation of the person concerned.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative/" 6151;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t order specific immunoglobin E (IgE) tests (skin or serum) unless indicated by the patient?s history specific to that food.";"Specific IgE to foods may be detectable when the patient is clinically tolerant. Frequent false positives lead to incorrect diagnosis of food allergies and unnecessary dietary restrictions. Appropriate diagnosis and treatment of allergies requires specific IgE testing (either skin or blood tests) based on the patient?s clinical history of signs and symptoms to optimize both cost effectiveness and patient care.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6153;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t use antihistamines as first-line treatment in anaphylaxis";"Epinephrine is the drug of choice to treat anaphylaxis. Overuse of antihistamines in anaphylaxis is associated with increased morbidity. H1 antagonists serve as second-line treatment for cutaneous non-life-threatening symptoms such as urticaria but should not be used in place of epinephrine. They do not alleviate or prevent cardiovascular or respiratory symptoms of anaphylaxis and can delay the administration of epinephrine, increasing the risk of potential consequences such as disability or fatality. Prompt use of epinephrine is important for the emergency treatment of anaphylaxis.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6409;31;"Smarter medicine";"Sociedad Suiza de Pediatr�a";English;"It is not recommended to use intravenous fluids in children with mild to moderate dehydration before beginning well-performed oral rehydration.";"Enteral rehydration (oral or by nasogastric tube) with oral rehydration solution is as effective as intravenous rehydration and is associated with fewer adverse effects. In many developed countries, the use of diluted apple juice and preferred fluids (such as breast milk) may be a suitable alternative to oral rehydration solution in children with mild dehydration. In addition, the installation of an intravenous line is often difficult in dehydrated children, which further delays their rehydration. The risk of failure of enteral rehydration therapy in children with diarrhea and vomiting is 5% in systematic reviews and even lower in patients with diarrhea only.";2021;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6410;31;"Smarter medicine";"La Sociedad Cient�fica para el Cuidado Gerontol�gico";English;"Means that limit the freedom of movement of older people are not recommended.";"Measures that restrict freedom of movement are rarely a solution and often cause problems such as increased disturbance and serious complications, which can even, in the worst case, lead to the death of the affected person. Measures are often taken that limit freedom of movement in the face of risky and/or dangerous behavior. This case requires immediate attention and a specific assessment of the situation. Therefore, it is very important to develop a clear strategy to avoid and manage risky and/or dangerous behaviors, as well as to coordinate actions with loved ones. Person-centered safety without measures that limit freedom of movement is supported by an interprofessional team and/or a care expert who is available to advise on anticipation, identification, and pursuit of a problem-solving strategy. An organization that opts for such an approach that favors accommodation without measures that limit freedom of movement, with ad hoc structures even if the educational offer remains indispensable.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6157;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t diagnose or manage current or chronic or persistent asthma without objective testing such as spirometry or a methacholine challenge in patients >6 years of age ";"Findings on a patient?s history and physical exam such as cough, wheeze and dyspnea may be caused by many conditions, including asthma. When the diagnosis of current or persistent asthma is suspected it must be confirmed with objective testing, as up to one third of patients with suspected asthma show no objective evidence when later tested and may have went into sustained clinical remission or never had asthma. Misdiagnosis leads to delayed treatment of the underlying condition and unnecessary exposure to medication side effects. Objective methods of confirming the diagnosis of asthma in patients in whom asthma is suspected should be used such as spirometry, methacholine challenge, exercise challenge or peak flow variability. These tests may be normal when on treatment.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6413;31;"Smarter medicine";"La Sociedad Cient�fica para el Cuidado Gerontol�gico";English;"Waking up at night for care is not recommended as long as neither your health condition nor your care needs really require it for the elderly.";"Physiologically, nocturnal sleep changes with age. Older people take longer to fall asleep, sleep less deeply, and wake up multiple times. In addition, health problems such as pain, shortness of breath, or frequent nighttime urination disrupt the entire sleep-wake cycle. Regular rounds to see if everything is in order also cause unnecessary noise and light, which can disrupt sleep and ultimately lead to sleep disturbance. Sleep disorders have a negative impact on health and well-being, impede physical activity and can lead to delirium, depression or other mental disorders. Caregivers should, particularly in the elderly, promote a restful, nightly sleep. The description of the sleep of the elderly in question reveals habits and rituals that favor nocturnal sleep. In care services, unnecessary disruptive factors should be identified and eliminated as far as possible.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6414;31;"Smarter medicine";" Sociedad Suiza de Pediatr�a";English;"It is not recommended to immediately treat acute otitis media with antibiotics.";"It is not recommended to avoid the routine use of antibiotics for uncomplicated acute otitis media in children older than 6 months, since it is due to a viral infection of the upper respiratory tract. A clinical reassessment is recommended 24-48 hours after the prescription of an analgesic treatment. In most cases there is a spontaneous improvement of symptoms. The use of antibiotics favors the development of bacterial resistance, which can cause adverse effects without preventing the appearance of rare serious complications.";2021;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6415;31;"Smarter medicine";"Sociedad Profesional Suiza de Geriatr�a";English;"Benzodiazepines or other sedative-hypnotics are not recommended for use as first-line treatment for insomnia, restlessness, or delirium in the elderly.";"Large-scale studies consistently show that the risk of motor vehicle accidents, falls, and hip fractures resulting in patient hospitalization or death can more than double in older people taking benzodiazepines and other sedative-hypnotics. Elderly patients, their caregivers, and providers must recognize this potential harm when choosing treatment strategies for insomnia, agitation, or delirium. Benzodiazepine use should be reserved for alcohol withdrawal symptoms, delirium tremens, or severe generalized anxiety disorder unresponsive to other treatments.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6160;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t prescribe antibiotics for uncomplicated acute rhinosinusitis.";"Viral infections are the primary cause of acute rhinosinusitis, whereby only 0.5% to 2% develop into bacterial infections. Most cases of clinically diagnosed acute rhinosinusitis improve without treatment within two weeks. For those with uncomplicated acute rhinosinusitis, who have a mild illness, observation without use of antibiotics is recommended. If a decision is made to treat, clinicians should prescribe amoxicillin as first-line antibiotic therapy for most cases of acute rhinosinusitis.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6416;31;"Smarter medicine";"Sociedad Suiza de Medicina Interna General";English;"Screening or new management of dyslipidemia is not recommended for patients over 75 years of age in primary prevention.";"Because of their likely low benefit and possible side effects, the SSMIG recommends not starting statin therapy and therefore measuring blood lipids for people older than 75 years without cardiovascular disease. In the case of patients with cardiovascular diseases and, in particular, those who have suffered a myocardial infarction, the decision as to whether the use of statins is justified should be made in consultation with the patient on the basis of detailed prior information from the latter. . For people older than 75 years without a cardiovascular history, it is unclear whether newly started lipid-lowering statin therapy prevents cardiovascular events or death. Consequently, lipid measurements can be dispensed with for this group of patients.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6417;31;"Smarter medicine";"La Sociedad Cient�fica para el Cuidado Gerontol�gico";English;"It is not recommended to place or leave a urinary catheter without specific information in the elderly.";"Urinary tract infection associated with a urinary catheter is undoubtedly the most frequent nosocomial infection. This type of infection prolongs the length of hospital stay and increases morbidity and mortality, as well as costs. Among the most effective preventive measures are refraining from unnecessary catheterization and targeted interventions to maintain an optimal urinary excretion pattern. In cases where urinary catheterization is unavoidable, the medical indication should be checked daily and the duration of maintenance should be kept to a minimum. When assessing the situation, particular account will be taken of how the elderly people concerned feel about the constraints and the quality of life.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6162;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t order sinus computed tomography (CT) for uncomplicated acute rhinosinusitis.";"Abnormal images of the sinuses cannot stand alone as diagnostic evidence of bacterial rhinosinusitis. Radiologic changes such as mucosal thickening are present in most cases of acute viral infections of the upper respiratory tract when sensitive detection methods such as CT scanning are used. Incidental findings of mucosal thickening can also be seen in a high percentage of asymptomatic individuals.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6418;31;"Smarter medicine";"Sociedad Suiza de Pediatr�a";English;"The routine use of glucocorticoids or bronchodilators in infants with bronchiolitis is not recommended.";"Current research shows no clinically relevant and lasting impact of systemic or inhaled glucocorticoids on admissions or length of hospitalization for infants with bronchiolitis. Scientific evidence shows that bronchodilators like salbutamol do not improve oxygen saturation, reduce hospital admissions, or shorten length of stay and time to resolution of symptoms in infants with bronchiolitis. Salbutamol is associated with side effects such as tachycardia, oxygen desaturation and tremors.";2021;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6419;31;"Smarter medicine";"Sociedad Profesional Suiza de Geriatr�a";English;"It is not recommended to diagnose pelvic congestion syndrome in elderly patients with computed tomography or magnetic resonance imaging alone; It should only be diagnosed if patients meet the clinical and imaging criteria.";"Dilated pelvic veins on computed tomography or magnetic resonance imaging sections may be an incidental finding of no clinical relevance. Ovarian vein reflux, ovarian vein dilatation, and parauterine vein dilatation can occur in asymptomatic patients. In order to diagnose pelvic congestion syndrome, the clinical symptoms must be taken into account when interpreting the images.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6164;19;"Choosing Wisely Canada";"Canadian Society of Allergy and Clinical Immunology";English;"Don?t order non-beta lactam antibiotics without an appropriate evaluation in patients with a history of penicillin allergy.";"While a history of penicillin allergy is self-reported by approximately 6-25% of patients, most are able to tolerate penicillin. In those with penicillin allergy, it may remit over time. Patients deemed ?penicillin-allergic? are more likely to: be treated with broad-spectrum alternative antibiotics (such as vancomycin, quinolones and clindamycin); experience longer hospital stays; and develop complications such as infections with methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridium difficile. IgE-mediated penicillin allergy can be evaluated through skin testing or graded oral challenge.";2021;;;"Low value";-;"https://choosingwiselycanada.org/allergy-clinical-immunology/" 6420;31;"Smarter medicine";" Sociedad Suiza de Medicina Interna General";English;"MRI of the knee is not recommended in patients with anterior pain, without limitation of movement or joint effusion, and without prior adequate conservative treatment.";"The few studies available for patients with anterior knee pain do not show differences in the evolution of pain and mobility depending on whether or not an MRI was performed. On the other hand, MRIs often lead to false-positive results, which can subsequently trigger costly, risky, and unnecessary interventions.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6166;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology Canadian IBD Network for Research and Growth in Quality Imp";English;"Avoid performing an endoscopy for dyspepsia without alarm symptoms for patients under the age of 60 years.";"Endoscopy is an accurate test for diagnosing dyspepsia, but organic pathology that does not respond to acid suppression or Helicobacter pylori eradication therapy is rare under the age of 60. Most guidelines therefore recommend as the first line approach for managing dyspepsia either empirical proton pump inhibitor therapy or a non-invasive test for Helicobacter pylori and then offering therapy if the patient is positive. If the patient has alarm features such as progressive dysphagia, anemia or weight loss, endoscopy may be appropriate.";2021;;;"Low value";-;"https://choosingwiselycanada.org/gastroenterology/" 6422;31;"Smarter medicine";"La Sociedad Cient�fica para el Cuidado Gerontol�gico";English;"It is not recommended to administer reserve medications such as sedatives, antipsychotics, or hypnotics during delirium unannounced, eliminating or treating underlying causes in older patients.";" Primarily use non-pharmacological approaches to prevent and treat delirium. The main step in treating delirium is identifying, eliminating, or treating the underlying causes. Delirium is often a direct physiological consequence of another illness, intoxication, withdrawal, exposure to a toxin, or multiple causes. This would require a detailed history, physical examination, ordering laboratory tests and issuing specific diagnoses as well as thoroughly checking whether certain medications could induce delirium and interrupt it. Since many drugs or groups of drugs are related to the development of delirium (for example, benzodiazepines, anticholinergics, some antihistamines, sedatives/sleeping pills), their administration as a standby drug should be avoided whenever possible. possible. In addition, antipsychotics should only be given at the lowest effective dose, for the shortest possible duration, and only to elderly people who exhibit severe agitation and/or who may pose a danger to others or to themselves. same. These drugs have significant side effects and there is insufficient evidence for their application. is safe and effective in delirium. It is therefore recommended, in terms of preventing delirium, to implement various non-pharmacological interventions and to carry them out in a systematic and interprofessional manner throughout the duration of hospitalization.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative/" 6678;29;"Choosing Wisely Australia";"The Australian and New Zealand Society of Nephrology";English;"Do not use oral acetylcysteine ??before giving radiocontrast to patients at increased risk for contrast-induced acute kidney injury.";"Is not recommended the use of acetylcysteine ??in patients undergoing angiography. Patients at high risk of renal complications who underwent an angiography showing that oral acetylcysteine ??had no benefit over placebo for preventing contrast-induced acute kidney The evidence of the recommendation is due to an extensive review process that involved key College societies with an interest or professional engagement with nephrology as well as health equity. It was then further consulted with other medical colleges through Choosing Wisely Australia. The option of administering acetylcysteine ??to patients undergoing angiography was raised because it was thought that it would have a protective effect in preventing acute tubular damage . The list of recommendations was then subject to an extensive review process that involved key College societies with an interest or professional engagement with nephrology as well as health equity. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6423;31;"Smarter medicine";"Sociedad Suiza de Medicina Interna General";English;"Iron replacement is not recommended in asymptomatic non-anemic patients or iron infusion without prior oral replacement (except in cases of malabsorption).";"Decreased performance and fatigue are not necessarily caused by a lack of iron. When hemoglobin is present in sufficient quantity and the body's iron stores (in the liver, spleen, and bone marrow) are full, fatigue often has other causes. So far, no clear indication has been found that iron intake reduces fatigue in this situation. For asymptomatic patients without anemia whose iron stores are sufficiently replenished (ferritin ? 15 ?g/L), there is no clear scientific evidence of the benefit of iron replacement, regardless of the form of administration. In non-anemic women with relatively high ferritin levels and increased fatigue, two RCTs revealed a weak subjective benefit of oral iron replacement in terms of fatigue. A placebo effect cannot be excluded and the quality of the scientific evidence was judged to be moderate to very low. If iron substitution is indicated, oral substitution should be tried first given the potential risks of the infusion, except in special situations (poor absorption).";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6424;31;"Smarter medicine";"Sociedad Suiza de Pediatr�a";English;"It is not recommended to use an acid inhibitor for the treatment of gastroesophageal reflux disease in babies.";"Medications that reduce stomach acid do not improve crying or spitting up in babies. These symptoms, so common in pediatrics, usually disappear on their own as the child grows. In the face of a physiological process, acid-inhibiting drugs are not necessary. Inappropriate use of proton pump inhibitors or H2 receptor antagonists can cause adverse effects, such as lower respiratory tract infections, changes in the intestinal microbiota, delayed gastric emptying; it is also associated with reduced bone mineralization. The few cases of infants with symptomatic gastroesophageal reflux disease (growth retardation, recurrent respiratory infections, bleeding, etc.) require careful evaluation. Trial treatment with proton pump inhibitors is not recommended.";2021;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6169;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"Don?t offer therapies on the basis of survival benefit without establishing your patient?s prognosis, preferences, and goals of care.";"It is often the path of least resistance to follow medical care algorithms and escalate care as patient?s require it. However, it has been consistently shown that patients value goals of care discussions to better understand prognosis and possible next therapeutic steps. These discussions enhance patient care and help avoid unnecessary interventions.";2021;;;"Low value";-;"https://choosingwiselycanada.org/cardiology/" 6425;31;"Smarter medicine";"Sociedad Suiza de Enfermedades Infecciosas";English;"Performing a Borrelia serology to detect disease activity without presenting specific symptoms is not recommended.";"Borrelia serology does not allow confirming a possible activity of the disease. Patients should understand the risk of overdiagnosis and overtreatment before undergoing any tests.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6426;31;"Smarter medicine";"Sociedad Suiza de Medicina Interna General";English;"Routine measurement of vitamin D 25 (OH) is not recommended in people without risk factors for vitamin D deficiency.";"It is seldom useful to measure vitamin D 25(OH), because the result has little bearing on the recommended procedure.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6682;29;"Choosing Wisely Australia";"The Australian and New Zealand Society of Nephrology";English;"It is not recommended to give routine prophylactic antibiotics to a child after the first urinary tract infection if at low risk of recurrent urinary tract infections";"A conservative approach to the management of urinary tract infection (UTI) is warranted for most children. The existing evidence indicates that antimicrobial prophylaxis is not associated with decreased risk of recurrent UTI but is associated with an increased risk of resistant infections. Accordingly, the routine use of prophylactic antibiotics for children after a first UTI is not recommended. The list of recommendations was then subject to an extensive review process that involved key College societies with an interest or professional engagement with nephrology as well as health equity";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6427;31;"Smarter medicine";"La Sociedad Suiza de Dermatolog�a y Venerolog�a";English;"Systemic antifungal therapy for suspected nail fungus is recommended only if fungus is detected in the general population.";"Onychomycosis is usually caused by dermatophytes (often Trichophyton rubrum and Trichophyton interdigital). They are generally sensitive to standard treatments with azole and terbinafine derivatives, but resistance to terbinafine has already been described. In addition, nail fungus can also be caused by non-dermatophytes such as yeast (Candida spp.) And mold (for example, Fusarium spp. And Aspergillus spp.). While yeast mycoses respond only to azole derivatives, molds are not accessible to standard systemic antifungal treatments. Finally, many other causes (for example, psoriasis, lichen planus, vascular insufficiency, mechanical and chemical irritations, and son on) can lead to nail dystrophy. In order to reduce unnecessary therapies and the risk of drug-related side effects, the diagnosis of fungus should be confirmed microbiologically prior to antifungal therapy";2021;;;"High value";-;"?Link to the recommendation on the website of the initiative/" 6684;29;"Choosing Wisely Australia";"The Australian and New Zealand Society of Nephrology";English;"It is not recommended to prescribe aspirin therapy for primary prevention of cardiovascular disease in patients with stage 1-3 chronic kidney disease";"Chronic kidney disease is a well?known independent cardiovascular risk factor. Evidence for anti?platelet therapy indicates that low?dose aspirin reduces the risk of cardiovascular disease (CVD) by 25?33%, especially in patients with established CVD or those at high risk. In patients with cronic kidney disease (CKD) potential benefits of low-dose aspirin therapy need to be carefully weighed against an increased risk of bleeding. A meta-analysis of serious vascular events and major bleeds in 22 primary and secondary prevention trials involving a combined 120,000 individuals has found that in primary prevention without previous disease, aspirin is of uncertain net value. Moreover, high cumulative exposure to nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk for rapid CKD progression in the community-based elderly.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 6430;31;"Smarter medicine";"Sociedad Suiza de Medicina Interna General";English;"Periodic in-depth medical check-ups are not recommended for asymptomatic people.";"For asymptomatic people, there is no scientific evidence of the benefit of periodic health check-ups in terms of cardiovascular events as well as mortality, either due to cancer or general mortality. On the other hand, these tests carry a risk of overdiagnosis and, in particular, further investigation after false-positive results from blood tests, imaging, or ECGs. The exception is screening tests based on scientific evidence (for example, screening for specific cancers based on age and sex, blood pressure, cholesterol), as well as lifestyle consultations, the benefit of which is clearly scientifically proven.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6431;31;"Smarter medicine";"Sociedad Suiza de Enfermedades Infecciosas";English;"The use of urinary catheters for incontinence disorders or for the sole purpose of measuring urine output is not recommended in patients who are not critically ill.";"The need for and benefit of urinary catheters should be regularly discussed with patients and questioned by health professionals. Institutions must have guidelines on the indications and strategies for weaning and changing urinary catheters.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6432;31;"Smarter medicine";"La Sociedad Suiza de Dermatolog�a y Venerolog�a";English;"It is recommended to treat dermatosis with topical corticosteroids instead of systemic ones in the general population.";"In principle, short-term application of systemic corticosteroids can relieve severe symptoms, but after discontinuation, it often threatens a rapid recurrence or even worsening (the so-called rebound effect). Long-term treatment with systemic corticosteroids may, under certain circumstances, cause serious short- and long-term side effects. Exceptions to this rule of preferring topical treatment may be severe, drug and anaphylactic reactions, as well as generalized or treatment-resistant dermatoses.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6178;1;"NICE ";NICE;English;"Transvaginal laser therapy is not recommended in patients with stress urinary incontinence in the short term, only in the investigational setting.";"Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements, such as coughing, sneezing and laughing. In women, it is most commonly associated with previous pregnancy, with or without recognized obstetric trauma. Previous urogynecological surgery may also result in stress urinary incontinence. Transvaginal laser therapy for stress urinary incontinence is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes a controlled thermal injury, which is claimed to promote tissue remodelling and the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to improve the support to the bladder and reduce the symptoms of stress urinary incontinence. There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury. The evidence on transvaginal laser therapy for stress urinary incontinence does not show any short-term safety concerns. Evidence on long-term safety and efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg696/chapter/2-The-condition-current-treatments-and-procedure" 6179;1;"NICE ";NICE;English;"Transvaginal laser therapy is not recommended for stress urinary incontinence, only in the context of research.";"Stress urinary incontinence is the involuntary leakage of urine during exercise or certain movements, such as coughing, sneezing and laughing. In women, it is most commonly associated with previous pregnancy, with or without recognised obstetric trauma. Previous urogynaecological surgery may also result in stress urinary incontinence. Transvaginal laser therapy for stress urinary incontinence is done as an outpatient procedure and can be done without anaesthetic. A laser-probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes a controlled thermal injury, which is claimed to promote tissue remodelling and the production of new collagen. Treatment typically consists of 3 sessions at 4 to 6 weeks apart. The aim is to improve the support to the bladder and reduce the symptoms of stress urinary incontinence.There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminium garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury. The evidence on transvaginal laser therapy for stress urinary incontinence does not show any short-term safety concerns. Evidence on long-term safety and efficacy is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg696/chapter/1-Recommendations" 6180;1;"NICE ";NICE;English;"Transvaginal laser therapy for urogenital atrophy is not recommended, only in the investigational setting.";"Urogenital atrophy most often occurs during or after menopause. The lack of the hormone estrogen causes thinning of the tissues around the vaginal area and a reduction in the number of mucus-producing glands. The most common symptoms of the vulva and vagina, including sequelae, pain during intercourse, itching and vaginal discharge. There is an increased vulnerability to inflammation, trauma, and infection. Urogenital atrophy can also cause urinary symptoms, such as urgency to urinate and urinary tract infections. Transvaginal laser therapy for urogenital atrophy is performed as an outpatient procedure and can be performed without anesthesia. A laser probe device is inserted into the vagina to apply laser energy to the vaginal wall. The laser causes a controlled thermal injury, which is claimed to remodel tissue, improve tissue elasticity, and stimulate new collagen production. Treatment generally consists of 3 sessions 4 to 6 weeks apart. The goal is to reduce the symptoms of urogenital atrophy. There are different types of lasers used for this procedure, including CO2 and erbium-doped yttrium aluminum garnet (Er:YAG) lasers. The type of laser and the energy level used have different tissue penetration and can cause different types of thermal injury. The evidence on transvaginal laser therapy for urogenital atrophy does not show any short-term safety concerns. Evidence on long-term safety and efficacy is inadequate in quality and quantity. This procedure should only be used in the context of research.";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg697/chapter/1-Recommendations" 6181;1;"NICE ";NICE;English;"Metreleptin is recommended for the treatment of complications of leptin deficiency in lipodystrophy for persons 2 years of age and older with generalized lipodystrophy and for persons 12 years of age and older with partial lipodystrophy.";"Lipodystrophy is a rare and heterogeneous group of syndromes characterized by total or partial loss, or absence, of subcutaneous adipose tissue. This results in the accumulation of lipids in abnormal sites such as the liver and muscle. Currently, the condition is managed with lifestyle modifications, cosmetic surgery, and medications to control metabolic disorders, including lipid-lowering medications and antidiabetic therapy. Metreleptin is an analogue of the human hormone leptin, which is secreted into the circulation from adipocytes. Metreleptin has a marketing authorization in the UK in ""exceptional circumstances"" as ""a dietary supplement as replacement therapy to treat complications of leptin deficiency in patients with lipodystrophy (LD). It is administered subcutaneously. This recommendation is not intended to affect metreleptin treatment that was initiated on the NHS before this guideline was published. People receiving treatment outside this recommendation can continue without change until they and their NHS doctor deem it appropriate to stop.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/hst14/chapter/3-The-technology" 6437;31;"Smarter medicine";"La Sociedad Suiza de Dermatolog�a y Venerolog�a";English;"Serologic testing is not recommended for the diagnosis of herpes simplex virus skin infections in the general population.";"Positive serological reactions are usually the expression of a chronic infection, as occurs in a large part of the population. However, in the case of an acute primary infection, the antibody titer may still be false negative. In the case of local recurrences, neither IgM antibodies nor significant increases in IgG antibodies are usually detected";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6182;1;"NICE ";NICE;English;"Whole liver extracorporeal perfusion is not recommended for acute liver failure, only in the context of research.";"Acute liver failure is characterised by a rapid (typically in less than 4 weeks) decline in liver function. Causes include poisoning because of alcohol, pharmaceutical or recreational drugs, and viral infection. Less common causes are metabolic disease and acute fatty liver of pregnancy. In this procedure a veno-venous circuit is usually used to perfuse the patient's blood through an extracorporeal whole liver. The aim is to provide metabolic support and prolong survival, to allow time for the patient's liver function to recover or to find a suitable donor liver for transplantation. Blood is pumped from a catheter inserted into the femoral vein through an oxygenator and the hepatic artery and portal vein of an extracorporeal whole liver. The liver may be a human liver not suitable for transplantation or a xenogeneic liver (typically a pig liver). Effluent blood from the extracorporeal liver, which is maintained at a normal temperature with a normal pH and electrolytes, is returned to the patient through a subclavian or jugular venous cannula. The literature describes modifications to the technique, such as isolating the patient's immune system from the extracorporeal liver and using different sites for venous access. Extracorporeal perfusion is continued for up to 5 days until either the patient has a liver transplant or their liver function recovers. Evidence on the safety of extracorporeal whole liver perfusion for acute liver failure shows serious, well-recognised complications. Evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. Clinicians and centres doing this procedure must follow the relevant regulatory and legal requirements of the Human Tissue Authority and the procedure should only be done in accordance with the policies of the NHS Blood and Transplant (NHSBT) Organ Donation and Transplantation Liver Advisory Group. Details of any patient who has a liver transplant after extracorporeal whole liver perfusion for acute liver failure should be entered into the NHSBT UK transplant registry, and clinical outcomes should be reviewed locally. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg690/chapter/1-Recommendations" 6438;31;"Smarter medicine";"Sociedad Suiza de Oftalmolog�a";English;"The routine use of local antibiotics as prophylaxis for intravitreal injection is not recommended.";"Studies have shown that prophylactic administration of local antibiotics does not influence the risk of endophthalmitis in case of intravitreal injections. Adequate preoperative disinfection according to international guidelines is sufficient. Reducing the use of antibiotics reduces the selection of resistant germs.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6183;1;"NICE ";NICE;English;"Se recomienda la litotricia electrohidr�ulica para los c�lculos de las v�as biliares en contexto de investigaci�n y auditor�a s�lo con arreglos especiales para la gesti�n cl�nica, el consentimiento y la auditor�a o la investigaci�n.";"Evidence on the efficacy of electrohydraulic lithotripsy for difficult-to-treat bile duct stones is adequate. However, evidence on its safety is limited in quantity. Therefore, it should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wishing to do electrohydraulic lithotripsy for difficult-to-treat bile duct stones should: - Inform the clinical governance leads in their healthcare organisation. - Give patients (and their families and carers as appropriate) clear written information to support shared decision making. - Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. - Audit and review clinical outcomes of all patients having the procedure. - Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: - Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. - Regularly review data on outcomes and safety for this procedure. The procedure should only be done in specialised centres with experience of managing difficult-to-treat bile duct stones.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg698" 6695;29;"Choosing Wisely Australia";"The Australian and New Zealand Society of Nephrology";English;"Do not give multiple daily doses of aminoglycoside antibiotics to patients with normal and stable kidney function as the risk of toxicity is less with a single daily dose";"Acute kidney injury is a well-known complication of aminoglycosides. Because efficacy of these antibiotics is concentration-dependent rather than time-dependent frequent doses should be avoided. For instance, once- and three-times daily aminoglycoside antibiotics appear to be equally effective in the treatment of pulmonary exacerbations of cystic fibrosis and to be less toxic to children?s kidneys. The use of extended-interval (once daily) dosing for aminoglycosides is also effective and safe for immunocompromised patients with febrile neutropenia.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6184;1;"NICE ";NICE;English;"Onasemnogene abeparvovec is recommended for the treatment of spinal muscular atrophy (SMA) 5q with a biallelic mutation in the SMN1 gene and a clinical diagnosis of SMA type 1 in infants and children. Its use is also recommended in babies with up to 3 copies of the SMN2 gene.";"Onasemnogene abeparvovec is recommended as an option for treating 5q spinal muscular atrophy (SMA) with a bi-allelic mutation in the SMN1 gene and a clinical diagnosis of type 1 SMA in babies, only if: they are 6 months or younger, or they are aged 7 to 12 months, and their treatment is agreed by the national multidisciplinary team. It is only recommended for these groups if: permanent ventilation for more than 16 hours per day or a tracheostomy is not needed For babies aged 7 to 12 months, the national multidisciplinary team should develop auditable criteria to enable onasemnogene abeparvovec to be allocated to babies in whom treatment will give them at least a 70% chance of being able to sit independently. In 5q SMA with a bi-allelic mutation in the SMN1 gene and up to 3 copies of the SMN2 gene in babies it is recommended only if the conditions in the managed access agreement are followed.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/hst15/chapter/1-Recommendations" 6440;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"It is recommended to limit deep sedation using sedation levels evaluated by validated scales, and allowing daily awakenings, even partial, in patients on mechanical ventilation.";"The expected positive effects are a decrease in the total duration of mechanical ventilation, a decrease in the incidence of complications related to mechanical ventilation (intensive care-acquired paralysis, delirium, ventilator-acquired infections), and facilitation of early mobilization of patients. the patients. The evidence supporting the measure is intervention studies, observational studies, meta-analyses, and recommendations from professional societies.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6185;1;"NICE ";NICE;English;"Laser lithotripsy is recommended in patients with biliary tract stones, only with special arrangements for clinical governance, consent, and audit or research. ";"Evidence on the efficacy of laser lithotripsy for difficult-to-treat bile duct stones is adequate. However, evidence on its long-term safety is limited in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wishing to do laser lithotripsy for difficult-to-treat bile duct stones should: - Inform the clinical governance leads in their healthcare organisation. - Give patients (and their families and carers, as appropriate) clear written information to support shared decision making. - Ensure that patients (and their families and carers, as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. - Audit and review clinical outcomes of all patients having the procedure. - Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: - Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. - Regularly review data on outcomes and safety for this procedure. The procedure should only be done in specialised centres with experience of managing difficult-to-treat bile duct stones, and by clinicians with specific training in bile duct stone visualisation and the safe use of laser therapy.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg699" 6186;1;"NICE ";NICE;English;"Melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation is recommended for patients with liver metastases from an ocular melanoma.";"Evidence on the safety of melphalan chemosaturation with percutaneous hepatic artery perfusion and hepatic vein isolation for cancer or metastases in the liver shows there are serious, well?recognised complications. For patients with metastases in the liver from ocular melanoma, there is some evidence of short?term tumour response. For these patients, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. For patients with primary liver cancer or metastases in the liver that are not from ocular melanoma, evidence of efficacy is inadequate in quality and quantity. For these patients, this procedure should only be used in the context of research. Clinicians wishing to do cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis should: - Inform the clinical governance leads in their healthcare organisation. - Give patients (and their families and carers as appropriate) clear written information to support shared decision making - Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. - Audit and review clinical outcomes of all patients having the procedure. - Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg691" 6442;31;"Smarter medicine";"Sociedad Suiza de Oftalmolog�a";English;"It is not recommended to stop antiplatelet or anticoagulant therapy before intravitreal injections or cataract operations performed under general anesthesia.";"In the context of the interventions mentioned above, the perioperative bleeding risk is very low and is not significantly increased by taking antiplatelet agents or anticoagulants. On the other hand, discontinuation of these treatments increases the risk of thromboembolic complications in patients and is not justifiable for the mentioned interventions.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6187;1;"NICE ";NICE;English;"The use of Givosiran is recommended for the treatment of acute hepatic porphyria (AHP) in adults and children from 12 years of age, under conditions";"Givosiran is recommended as an option for treating acute hepatic porphyria (AHP) in adults and young people aged 12 and older, only if: they have clinically confirmed severe recurrent attacks (4 attacks or more within 12 months) and the company provides it according to the commercial arrangement. Acute hepatic porphyria (AHP) is a rare inherited metabolic disorder caused by a deficiency of the enzymes needed to make haem. It is characterised by high levels of porphyrin precursors, including delta?aminolevulinic acid and porphobilinogen, in the liver and other tissues. High levels of these substances damage nerve cells and can provoke acute attacks of physical pain. There are 4 types of AHP: acute intermittent porphyria, hereditary coproporphyria, variegate porphyria and aminolevulinate dehydratase porphyria. I'ts progressive, with attack frequency and severity increasing over time. ";2021;;;"High value";-;"https://www.nice.org.uk/guidance/hst16/chapter/1-Recommendations" 6188;1;"NICE ";NICE;English;"The use of repetitive short-pulse transscleral cyclophotocoagulation for glaucoma is not recommended, only in the context of research.";"Glaucoma is usually a chronic condition associated with raised intraocular pressure that leads to progressive damage to the optic nerve. Early stages are usually asymptomatic. As the condition progresses, it causes visual impairment and, if untreated, blindness. Repetitive short-pulse transscleral cyclophotocoagulation (commonly known as micropulse transscleral cytophotocoagulation) uses a laser to target the same tissue as conventional cyclodiode laser treatment but it is delivered in pulses lasting microseconds. This allows the tissue to cool between pulses, with the aim of reducing collateral damage. The procedure is normally done under local or general anaesthesia and usually takes 10 to 20 minutes. A probe is applied to the surface of the eye with firm pressure and moved in a continuous sliding motion over the upper or lower limbus of the eye, or both. To prevent ciliary neurovascular injury, the 3 and 9 o'clock positions are avoided. The device is set to deliver repetitive short-pulse (micropulse) laser energy with specified 'on' and 'off' times. Lower laser settings are used for patients with higher pigments to avoid overtreatment and inflammation. The laser treatment usually lasts between 100 seconds and 360 seconds per session. After the procedure, patients may need to wear an eye patch over the treated eye for about 24 hours and may be prescribed topical corticosteroids and antibiotics. Evidence on the safety of repetitive short-pulse transscleral cyclophotocoagulation for glaucoma shows no major safety concerns. Evidence on efficacy is inadequate in quality. Therefore, this procedure should only be used in the context of research. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg692" 6189;1;"NICE ";NICE;English;"Percutaneous insertion of a closure device is recommended to repair a paravalvular leak around a replaced mitral or aortic valve, provided that standard provisions for clinical management, consent and audit are established.";"Evidence on the safety of percutaneous insertion of a closure device to repair a paravalvular leak around a replaced mitral or aortic valve shows that this procedure can cause potentially serious but well-recognised complications. Evidence on its efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. Clinicians wishing to do percutaneous insertion of a closure device to repair a paravalvular leak around a replaced mitral or aortic valve should: - Inform the clinical governance leads in their healthcare organisation. - Give patients (and their families and carers as appropriate) clear written information to support shared decision making. - Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. - Review local clinical outcomes and enter details about all patients having percutaneous insertion of a closure device to repair a paravalvular leak around a replaced mitral or aortic valve into the British Cardiovascular Intervention Society database managed by the National Institute for Cardiovascular Outcomes Research. Contact bartshealth.nicor-generalenquiries@nhs.net for details. - Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: - Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. - Regularly review data on outcomes and safety for this procedure. Patient selection should be done by a multidisciplinary team experienced in managing the condition including interventional cardiologists with specific training in the procedure, cardiac surgeons, specialists in cardiovascular imaging and cardiac anaesthetists. This is a technically challenging procedure and it should only be done in specialised centres by a multidisciplinary team including clinicians with training and experience in this procedure. Clinicians should only do their initial procedures with an experienced mentor.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg700" 6445;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"It is recommended to limit the transfusion of red blood cells with a transfusion threshold of 70 g/l of hemoglobin in stable patients without bleeding.";"The expected positive effects are the saving of blood products, the reduction of costs and the reduction of complications associated with transfusion (transfusion reactions, circulatory overload associated with transfusion TACO (circulatory overload, transfusion-associated lung injury TRALI). The evidence that supports the measure is intervention studies, observational studies and recommendations of professional societies.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6190;1;"NICE ";NICE;English;"Deep brain stimulation is not recommended for chronic, severe, refractory obsessive-compulsive disorder (OCD) in adults, only in the context of research.";"Obsessive-compulsive disorder (OCD) is a mental health condition in which a person has obsessive thoughts (repeated, unwanted and unpleasant thoughts, images or urges). The person feels compelled to carry out compulsive (repetitive) behaviours to try to relieve the unpleasant feelings brought on by the obsessive thoughts. Deep brain stimulation for OCD is done under general or local anaesthesia. A stereotactic frame may be used. MRI or CT imaging, or both, are used to identify the target area of the brain (commonly, the anterior limb of the internal capsule). Two small holes are drilled in the skull and electrodes are implanted into the target area. The electrodes are connected to an implantable neurostimulator by leads, which are tunnelled under the skin of the neck and scalp. The neurostimulator is surgically placed into a subcutaneous pocket below the clavicle. Postoperative imaging is usually used to confirm the location of the electrodes. A handheld remote-control programming unit is used to turn the neurostimulator on or off and adjust stimulation parameters to find the right level of stimulation. Although the mechanisms of action of deep brain stimulation are not fully understood, the aim of the procedure is to reduce the obsessive-compulsive thoughts and behaviours. A potential advantage of the procedure is that the stimulation can be adjusted according to the clinical effect and if necessary, stopped completely. It can be used as an adjunct to medication and as an alternative to neurosurgery for treatment-resistant OCD. Evidence on the safety and efficacy of deep brain stimulation for chronic, severe, treatment-resistant obsessive-compulsive disorder (OCD) in adults is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg693/chapter/1-Recommendations" 6446;31;"Smarter medicine";"Sociedad Suiza de Oftalmolog�a";English;"The routine use of imaging techniques is not recommended in asymptomatic patients, in the absence of clinical signs suggestive of ocular disease and in the absence of sequelae.";"The use of imaging techniques (eg, optical coherence tomography, fundus photography) is not indicated in the absence of symptoms, clinical signs, or therapeutic consequences. Appropriate use of modern imaging modalities helps reduce costs and conserve resources in healthcare.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6191;1;"NICE ";NICE;English;"Permanent implementation of a His bundle pacemaker is not recommended for the treatment of heart failure, only in the context of research.";"Heart failure is a complex clinical syndrome of symptoms and signs that happen when the heart is not working well enough. It leads to reduced blood flow to body tissues and can cause oedema in the lungs (causing breathlessness) and swelling of the legs. Other symptoms include reduced ability to exercise, fatigue and malaise. Heart failure can be caused by structural or functional abnormalities of the heart. The aim of implanting a permanent pacemaker at the His bundle is to produce normal physiological ventricular activation via the His-Purkinje system. The procedure is usually done under local anaesthesia, with or without sedation, in a cardiac catheterisation laboratory. A pacemaker generator is implanted under the skin near the collarbone, usually on the left side of the chest (although the right side is possible). A standard or dedicated pacing lead is inserted through the subclavian, cephalic or axillary vein into the heart. This is done under fluoroscopic guidance and continuous electrocardiogram monitoring or mapping, and using a standard or specially designed His-delivery sheath. It is then positioned and secured to the His bundle, where it can directly stimulate the His-bundle fibres. An electrogram from the tip of the lead is used to ensure a His signal and that the pacing lead is correctly placed. The pacemaker generator is securely connected to the His-bundle lead. The generator can be adjusted transcutaneously to ensure optimum His-bundle pacing. Evidence on the safety and efficacy of permanent His-bundle pacemaker implantation for treating heart failure is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. This is a technically challenging procedure and experience in cardiac electrophysiology is needed. It should only be done in specialist centres with experience of cardiac pacing.";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg694" 6192;1;"NICE ";NICE;English;"The use of self-expanding implants in the intersphincteric space is not recommended, their use is only recommended in the research context.";"Fecal incontinence is an inability to control bowel movements, resulting in the involuntary passage of stool. The defecation process and its control is complex. Causes of incontinence include problems with the colon and rectum, problems with the sphincter muscles, or nerve damage. Fecal incontinence can also be caused by loss of higher-level brain control in conditions such as dementia or severe learning disability. The initial management of faecal incontinence includes interventions related to diet, bowel habit, bathroom access, and medication. Specialized management options depend on the underlying cause and include pelvic floor muscle training, bowel retraining, specialized dietary assessment and management, biofeedback, electrical stimulation, and rectal irrigation. The main surgical treatment is repair of the anal sphincter. Sacral nerve stimulation may be offered to people for whom sphincter surgery is not appropriate. If a sacral nerve stimulation trial is unsuccessful, a neosphincter (stimulated graciloplasty or an artificial anal sphincter) may be considered. This technique is performed under local or general anesthesia, with ultrasound guidance. About 6 to 10 small (2 mm) incisions are made in the perianal skin, equidistant to each other, about 2 cm from the anal margin. An introducer is inserted into each incision in turn, pushed through a short subcutaneous tunnel and into the intersphincteric space. The implant is deployed in the desired position within the intersphincteric space. This is repeated around the entire circumference of the internal anal sphincter. Evidence on the safety and efficacy of self-expanding implant insertion into the intersphincteric space for faecal incontinence is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg685/chapter/1-Recommendations" 6448;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"It is not recommended to carry out advanced life support maneuvers without first discussing the therapeutic objectives with the patient or relatives who represent him and taking into account his personal values and preferences in patients who present a significant risk of death or serious sequelae.";"The positive effects hoped for are diminishing the inadequate tratamientos in its duration and/or intensity, promoting communication and information for the patient and familiar, and the harmonization of the decision-making processes in intensive care. The evidence that shows the medida its intervention studies, observational studies and recommendations of professional societies.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6193;1;"NICE ";NICE;English;"Normothermia using temperature modulation devices is not recommended to improve outcomes after stroke or subarachnoid hemorrhage in the research setting, only in context of research.";"Evidence on the safety and efficacy of inducing and maintaining normothermia using temperature modulation devices to improve outcomes after stroke or subarachnoid haemorrhage is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg701" 6194;1;"NICE ";NICE;English;"The use of the ex situ perfusion machine is recommended for extracorporeal conservation of lungs for transplantation.";"Lung transplant is usually done in patients with non-malignant advanced or end-stage pulmonary diseases (such as severe pulmonary fibrosis, cystic fibrosis, pulmonary hypertension and obliterative bronchiolitis) that is minimally responsive or unresponsive to treatment and who have a life expectancy of less than a year. This improves patients' quality of life and prolongs survival. Ex-situ machine perfusion for extracorporeal preservation of lungs (ex-vivo lung perfusion, EVLP) is a technique of lung preservation that may allow donor lungs to be preserved for longer in better physiologic conditions, and may allow marginal donor lungs or pulmonary grafts which are working poorly to be improved and reconditioned so that they can be used in lung transplant. Ex-situ machine perfusion for extracorporeal preservation of lungs is done once the lungs have been removed from the donor after cold pulmonary flush using surgical techniques. An adequate donor left atrial cuff and pulmonary artery are preserved to allow anastomosis to the recipients' organs. After being transferred in cold solution and being ischemic for a period of time, the lungs are placed in a specially designed organ chamber and connected to a modified heart?lung bypass machine, a ventilator and filtration or EVLP system. A specialised nutrient solution (perfusate) is pumped from the filtration or EVLP system through a perfusion circuit (gas exchange membrane, heat exchanger and leukocyte filter) under optimal colloid pressure through the pulmonary artery to the lungs. Pulmonary effluent from the pulmonary veins drains back to the EVLP system and is recirculated. Perfusion flow is then gradually increased, pulmonary artery pressure is carefully monitored, and protective controlled mechanical lung ventilation with low tidal volume and positive end expiratory pressure is started. The lungs are gradually rewarmed to body temperature while reaching a targeted flow. EVLP is possible for a number of hours after removal from the donor. During this period, the lungs can be assessed and, if necessary, treated to remove unwanted fluid, and to re?expand areas of lung that have collapsed (atelectatic areas). If EVLP-treated lungs recover well enough, they may be considered suitable for transplant in the conventional way.Ex-situ machine perfusion can be done using different devices or machines and protocols. The perfusate composition, perfusion and ventilation settings (target flow, temperature, pressure) may vary.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg695" 6450;31;"Smarter medicine";"Sociedad Suiza de Oftalmolog�a";English;"Establishing the indication for cataract surgery on the sole basis of obvious lens opacification is not recommended.";"Cataract surgery is a relative indication, which must be performed taking into account both the wishes of the patient and the individual operative risk. Only in rare cases is the operation absolutely necessary. This may be the case where lack of intervention could result in permanent visual impairment, e.g. in the context of an intumescent cataract with altered intraocular pressure.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6195;1;"NICE ";NICE;English;"Magnetic resonance imaging therapy is not recommended in patients with knee osteoarthritis, only in investigational setting.";"Evidence on the safety of magnetic resonance therapy for knee osteoarthritis shows no major safety concerns. Evidence on efficacy is inadequate in quality and quantity and shows no benefit over placebo. Therefore, this procedure should not be used unless it is part of a research study. ";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg702" 6196;1;"NICE ";NICE;English;"Minimally invasive radical hysterectomy is recommended for use in cervical cancer only in the research setting.";"Evidence on efficacy for tumors 2 cm or larger shows that minimally invasive radical hysterectomy has shorter overall and disease-free survival compared with open hysterectomy surgery. Therefore, this procedure should not be used for tumors that are 2 cm or larger. Evidence on efficacy for tumors smaller than 2 cm is inconclusive for disease-free and overall survival compared to open hysterectomy surgery. Therefore, for tumors smaller than 2 cm, this procedure should only be used in the research setting. Radical hysterectomy is the most common surgical treatment for cervical cancer. It is conventionally done through an incision in the abdomen or through the vagina. It includes removing the uterus and supporting ligaments, cervix, upper vagina, the pelvic lymph nodes and sometimes the para-aortic lymph nodes. Further research, preferably in the form of randomized controlled trials, should describe details of patient selection, tumor histology and size, and surgical technique, and report on overall survival, disease-free survival, tumor recurrence and patient-reported outcome measures. Radiotherapy may be used, with or without surgery, and is usually combined with chemotherapy.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg686/chapter/1-Recommendations" 6452;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"It is not recommended to administer broad-spectrum antibiotics without an initial assessment of the adequacy of treatment and with daily assessment of the possibility of de-escalation.";"The expected positive effects are a decrease in the overall consumption of broad-spectrum antibiotics, a reduction in associated complications (allergies, kidney failure, liver failure, secondary infections with resistant germs) and a decrease in selection pressure and resistance development.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6197;1;"NICE ";NICE;English;"The use of free-functioning gracilis transfer to restore upper limb function in brachial plexus injury is recommended provided that standard agreements for clinical management, consent, and auditing are in place.";"The evidence on the safety of the free-functioning gracilis transfer to restore upper limb function in brachial plexus injury shows well-recognized complications. Evidence on its efficacy is adequate to support the use of this procedure, provided that standard agreements for clinical management, consent and audit are in place. Find out what standard arrangements mean on the NICE website. The brachial plexus is a network of nerves that carries signals from the spinal cord to the shoulder, arm, and hand. These nerves can be damaged by being stretched, compressed, or torn from the spinal cord. The most serious injuries of the brachial plexus are usually the result of traffic accidents. Severe nerve damage can lead to paralysis of an upper extremity, with loss of function and sensation, and severe pain. This procedure should only be performed in a specialized brachial plexus unit by a multidisciplinary team that includes specialized physical therapists, with input from microvascular surgeons.";2021;;;"High value";-;"https://www.nice.org.uk/guidance/ipg687" 6198;1;"NICE ";NICE;English;"The use of debulking surgery with hyperthermic intraoperative peritoneal chemotherapy is not recommended for peritoneal carcinomatosis.";"Peritoneal carcinomatosis is an advanced form of cancer resulting from the regional spread of gastrointestinal, gynaecological and other malignancies. It is associated with short survival and poor quality of life. It may lead to bowel obstruction, ascites and pain. Cytoreduction surgery is done to remove all macroscopic tumours within the abdominal cavity. Hyperthermic intraoperative peritoneal chemotherapy is then used to distribute a chemotherapeutic drug uniformly to all surfaces within the abdominal cavity and to increase drug penetration. This is done to treat any remaining microscopic traces of the cancer. The aim is to reduce symptoms, extend survival and improve quality of life. Using general anaesthesia, a laparotomy is done and all macroscopic tumour is removed, with resection of involved organs and stripping of the tumour from the surface of some organs and peritoneum. The surgery is extensive and complex. It is followed by perfusion of the abdominal cavity with a heated (between 40 and 48�degrees Celsius) chemotherapy solution for 30 to 120 minutes, with the abdomen open or closed. The fluid is drained from the abdominal cavity before closure. A further course of systemic or early postoperative intraperitoneal chemotherapy may be administered. The application of this procedure will have to be carried out in a specialized center and with a multidisciplinary team of experts. Evidence on the safety of cytoreduction surgery with hyperthermic intraoperative peritoneal chemotherapy for peritoneal carcinomatosis shows frequent and serious but well-recognised complications. Evidence on its efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";2021;;;"Low value";-;"https://www.nice.org.uk/guidance/ipg688" 6455;31;"Smarter medicine";"La Sociedad Suiza de Gastroenterolog�a ";English;"Repeat colonoscopy is not recommended for at least 5 years in patients with one or two small adenomatous lesions (<1 centimeter), without high-grade dysplasia, completely removed by total colonoscopy.";"The date of a follow-up colonoscopy should be determined based on the results of a prior total colonoscopy. There are (published) evidence-based recommendations that patients with one or their small tubular adenomas with low-grade dysplasia should be monitored by follow-up colonoscopy within five to ten years after the initial polypectomy. The specific date within this range should be based on other clinical factors, such as previous colonoscopy results, family history and patient preferences, and physician judgment.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6200;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order labs for drug toxicity monitoring (i.e. CBC, liver enzymes, creatinine) more often than every 12 weeks for patients on a stable dose of non-biologic disease-modifying antirheumatic drugs (DMARDs).";"It is not recommended to order labs for drug toxicity monitoring (i.e. CBC, liver enzymes, creatinine) more often than every 12 weeks for patients on a stable dose of non-biologic DMARDsPediatric patients on stable doses of non-biologic disease modifying anti-rheumatic drugs (DMARDs) (e.g. methotrexate, sulfasalazine) without specific risk factors (e.g. obesity, diabetes mellitus, renal disease, alcohol use, concomitant use of hepatotoxic or myelosuppressive medications) are at a low overall risk of toxicity. More frequent blood draws pose an unnecessary burden to pediatric patients and the health-care system. Patients new to treatment, on escalating doses, or with abnormal baseline labs typically require more frequent monitoring.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6201;19;"Choosing Wisely Canada";"Canadian Nurses Association, Canadian Association of Critical Care Nurses";English;"It is not recommended to administer benzodiazepines to treat symptoms of delirium.";"The treatment of delirium is multifactorial, including environmental stimulation, ongoing mobilization and family presence. Guidelines recommend against using benzodiazepines for sedation, unless otherwise indicated (e.g., withdrawal related to alcohol or benzodiazepine use). The inappropriate administration of benzodiazepines may harm a critically ill patient by inadvertently increasing the incidence of delirium or the length of stay in an ICU. Nonpharmacologic strategies should be used, along with monitoring, assessing and treating pain. Preliminary research has shown that implementing nurse-driven daily awakening protocols and best practice bundles such as ABCDE may improve outcomes, including decreases in length of overall hospital stay, ventilator days and risk of ICU-acquired delirium.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6457;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva ";English;"Routine or periodic complementary examinations are not recommended if they are not performed for the purpose of answering a specific clinical question relevant to the patient.";"The expected positive effects are a reduction in the general consumption of examinations and associated costs, a reduction in the negative consequences (irradiation, anemia) and a reduction in the risk of unnecessary or unsuitable treatments. The evidence that shows the medida its intervention studies, observational studies, metan�lisis and recommendations of professional societies.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6203;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order HLA-B27 unless spondyloarthropathy is suspected based on clinical signs or symptoms.";"Back pain is a common symptom relative to the incidence of spondyloarthropathy (SpA) in children. In addition, the prevalence of HLA-B27 is 2-8% in the general population, and individuals with a positive HLA-B27 have a low probability of developing SpA. As such, HLA-B27 testing is not useful as a single diagnostic test in a patient with low back pain without specific signs or symptoms of SpA (e.g., inflammatory back pain, peripheral arthritis, enthesitis, or acute anterior uveitis) or suggestive findings on MRI. Of note, patients with confirmed Juvenile Idiopathic Arthritis (JIA) may have HLA-B27 testing in order to classify their JIA subtype.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6205;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order rheumatoid factor or anti-citrullinated protein antibodies in patients with arthralgia but no arthritis on exam.";"In children, the vast majority of musculoskeletal (MSK) pain is non-inflammatory (97%) and is rarely secondary to a rheumatic disease. For patients with arthralgia (joint pain) but no arthritis on physical exam (defined as presence of joint effusion or ?2 of warmth, tenderness, stress pain, reduced range of motion), testing rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) is not clinically useful and has low diagnostic utility. For example, a positive RF may result from various infections. Performing such tests without clinical relevance may result in unnecessary additional testing and anxiety.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6461;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"It is not recommended to administer parenteral nutrition in the first 4 to 6 days of intensive care stay in a patient without nutritional deficit.";"The expected positive effects are a reduction in parenteral nutrition and associated costs and a reduction in associated complications (infections, liver or metabolic complications). The evidence supporting the measure is intervention studies and recommendations from professional societies.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative/" 6206;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"It is not recommended to initiate therapy with opioids for patients with chronic non-cancer pain unless non-opioid pharmacotherapy and other non-pharmacological options have been optimized.";"Several non-opioid therapies (including both drug and non-drug alternatives) may achieve a similar magnitude of improvement in pain and function more safely without the potentially serious side effects of opioid therapy (e.g. harms related to dependence, addiction and overdose).";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6207;19;"Choosing Wisely Canada";"Canadian Nurses Association, Canadian Association of Critical Care Nurses";English;"It is not recommended the use of physical restraints as the first choice to prevent self-extubation or removal of lines or tubes with critically ill patients.";"The intention to use physical restraints to prevent self-extubation or accidental removal of lines or tubes is often misguided. In fact, some research has found restraints have the potential to cause harm to critically ill patients, including complications but not limited to unplanned extubation, increased risk for delirium, and prolonged recovery. The use of physical restraints in ICU patients in Canada is common and significantly higher comparable to some European countries. Guidelines recognize the paucity of evidence to substantiate the use of physical restraints as an effective strategy. The use of physical restraints can be minimized by maintaining direct visual observation of patients, permitting the presence of family care partners, initiating spontaneous awakening and breathing trials (to support removal of endotracheal tube and thus reduce need for restraints), and assessing delirium and the need for mobilization. Decreased use of physical restraints is an important indicator of quality nursing care.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6208;2;"Choosing Wisely�";"Society for the Advancement of Patient Blood Management (SABM) ";English;"It is not recommended to depend on standard laboratory values for transfusion decisions; consideration of the patient?s clinical status is requisite";"Laboratory studies may not accurately portray the individual?s hemostatic status, bleeding risk or need for transfusion; laboratory studies must be assessed in the context of the patient?s overall clinical status. Additional platelet function and viscoelastic testing should be performed to guide blood product transfusions in children with (or at risk for) moderate to severe bleeding. Pharmacologic modalities (i.e. antifibrinolytics, topical hemostatic agents) should be utilized as appropriate. Hemoglobin levels should be assessed in the context of the patient?s fluid status, hemodynamics, and degree of cardiopulmonary reserve; with the goal of restrictive RBC transfusion practices.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6464;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"Administration of intravenous fluids without prior assessment of fluid response based on dynamic testing is not recommended during circulatory failure.";"The expected positive effects are a reduction in the administration of intravenous fluids and associated costs and a reduction in associated complications (fluid overload, renal failure, metabolic complications). The evidence supporting the measure is observational studies, expert advice and best practices, and recommendations from professional societies.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6209;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order Lyme disease serology as an explanation for musculoskeletal symptoms without an exposure history and exam findings.";"Lyme disease is most likely to occur if an individual resides in or visits an endemic area. The most common musculoskeletal (MSK) manifestation of Lyme disease is persistent or intermittent arthritis in at least one joint (typically the knee) which develops within weeks to months after a tick bite. Chronic diffuse arthralgias, myalgias or fibromyalgia alone are not criteria for MSK Lyme disease. Testing for Lyme disease should be limited to children with characteristic clinical signs and risk of exposure to Lyme to avoid false positive tests and unnecessary treatment.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6210;19;"Choosing Wisely Canada";"Canadian Society for Long Term Care Medicine";English;"It is recommended to use virtual care to complement in-person visits in order to meet the needs of residents in long-term care during the COVID-19 pandemic.";"To reduce the potential of serious outbreaks in long-term care during COVID-19, physicians are encouraged to practice virtual medicine, where appropriate. To be effective, physicians and senior leadership, must strive for excellent communications and timely access to physicians. Studies have shown that the use of telemedicine in caring for nursing home residents can facilitate better patient care and overall cost savings through reducing unnecessary hospital transfers to the emergency department and subsequent hospitalizations. If the home needs to be physically attended to, physicians are encouraged to do targeted on-site visits and consider charting remotely. Telemedicine in long-term care can contribute to the delivery of high-quality medical care reducing avoidable hospitalizations. Utilizing virtual care where appropriate can ensure protection of health care workers while still maintaining effective communication with staff and residents? families. Appropriate systems level optimization can be created so that physicians can effectively advocate for older residents who are especially vulnerable to contracting COVID-19. The pandemic has further illustrated the need to provide timely access to care to assess acute change in status including respiratory complaints and hypoactive delirium.";2021;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 6467;31;"Smarter medicine";"Sociedad Suiza de Pediatr�a";English;"The use of cough medicine in children is not recommended";"Coughing is usually a normal defense mechanism of the body. Research shows that prescription cough medicines for viral respiratory tract infections, whether chemical or herbal, are not effective and can have potentially serious side effects. Many products contain more than one active ingredient, which increases the risk of accidental poisoning, especially when combined with other drugs.";2021;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 6212;2;"Choosing Wisely�";"Society for the Advancement of patient blood management";English;"It is not recommended to transfuse older RBC units (>7 days) in infants <10 kg or < 1 year of age requiring massive transfusions to prevent hyperkalemic cardiac arrest.";"Transfusion-associated hyperkalemia resulting in cardiac arrest (TAHCA) has been recognized as a complication of massive RBC transfusion in children. During storage, potassium in the extracellular fluid of RBC units stored in additive solutions increases linearly over time. Transfusion of older RBC units (?7 days) should be avoided when large volume/ massive transfusions are expected in neonates and children, such as in craniosynostosis and spinal surgeries, neonatal CPB prime, and cannulation for ECMO or trauma. Although potentially limited in supply, the use of fresh RBC units (<7 days) should be used in large volume/ massive transfusions in neonates and children to prevent hyperkalemic cardiac arrest.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6213;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to use intra-articular corticosteroid injections as a treatment approach for a large number of joints or joints that have been injected multiple times.";"Pediatric patients with juvenile idiopathic arthritis (JIA) often benefit from treatment with intra-articular corticosteroid injections, especially when arthritis is impacting activities of daily living. However, in patients with polyarticular JIA (?5 affected joints) the probability of a short-lived or poor response to corticosteroid injections is increased when compared to those with oligoarticular JIA (?4 affected joints). Lack of concomitant initiation of a disease modifying anti-rheumatic drug (DMARD) in polyarticular disease is also a risk factor for suboptimal response to joint injections. In addition, repeating joint injections in the same joint (e.g. >2-3 times/year) has a lower probability of achieving disease control compared to initiating a DMARD and may be a risk factor for the development of osteochondritis dissecans. Multiple or recurrent intra-articular corticosteroid injections may be considered as an adjunctive therapy while awaiting the effect of an escalation in systemic therapy.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6469;6;"Less Is More Collection - JAMA Network";"Judith J. de Jong. JAMA Intern Med.";English;"An informative web-based educational intervention on dyspepsia is recommended to reduce the need for upper gastrointestinal endoscopy in patients with uninvestigated dyspepsia.";"Education based on a self-managed web-based educational program on gastric function, dyspepsia, and upper GI endoscopy has been shown to be an effective tool in reducing the need for upper GI endoscopy in uninvestigated dyspepsia.";2021;;;"High value";-;"Link to the recommendation on the website of the iniciative" 6214;19;"Choosing Wisely Canada";"Canadian Nurses Association, Canadian Association of Critical Care Nurses";English;"It is not recommended to repeatedly attempt intravenous access during a life-threatening event when intraosseous access is available is not recommended. ";"In emergency situations, intravenous (IV) access can be difficult to obtain. Nurses often lose time trying to insert peripheral IVs, and insertion of central venous catheters may be initiated. However, intraosseous (IO) access is a faster and safer option, with less chance of complications, when inserted by trained personnel.";2021;;;"Low value";"- ";"Link to the recommendation on the website of the initiative" 6470;6;"Less Is More Collection - JAMA Network";"Lindsey C. Yourman. JAMA Intern Med. ";English;"Statins are recommended to prevent a first major adverse cardiovascular event in adults aged 50 to 75 years if they have a life expectancy of at least 2.5 years.";"The American Heart Association, the American College of Cardiology, and the US Preventive Services Task Force recommend hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) for the primary prevention of cardiovascular events in adults aged 40 to 75 years who are at high risk (older than often defined as ?7.5% risk of major adverse cardiovascular events in 10 years). These guidelines also emphasize the importance of individualizing statin decisions through physician-patient discussions, due to the enormous heterogeneity in cardiovascular risk, comorbidity burden, and life expectancy in this population. In this meta-analysis, only 1 of 8 randomized trials found that statins reduced all-cause mortality when used for primary prevention. We found that 100 adults aged 50 to 75 years would need to be treated for 2.5 years to avoid 1 major adverse cardiovascular event. This result suggests that statin therapy is more appropriate for adults aged 50 to 75 years with a life expectancy of more than 2.5 years. For those with a life expectancy of less than 2.5 years, the harms of statins may outweigh the benefits. These results reinforce the importance of individualizing statin treatment decisions, incorporating the values ??and preferences of each patient. One of the main strengths of the study is that this is the first to use quantitative methods to determine the benefit time for primary prevention of cardiovascular events with statins in adults aged 50 to 75 years and fills a critical gap for discussions of risk on statins, especially for those patients with a limited life expectancy. A limitation of our study is a direct result of the age range of study participants in previously published randomized trials of statins used in primary prevention.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6216;2;"Choosing Wisely�";"Society for the Advancement of Patient Blood Management";English;"Is not recommended to practice allogenic transfusion by first using cell salvage for pediatric high blood loss surgery.";"Cell salvage, as a part of a multimodal patient blood management strategy in pediatrics, may reduce unnecessary blood transfusions, improve outcomes and decrease costs. Expert consensus recommendations, observational reports and prospective research suggest that utilizing cell salvage decreases RBC transfusions in infants, children and adolescents undergoing craniosynostosis, spinal and cardiac surgical procedures. While prospective clinical studies are few, the evidence suggests that cell salvage is feasible, effective, and safe. More high-quality trials will further guide optimum use.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6472;6;"Less Is More Collection - JAMA Network";"Dong W. Chang. JAMA Intern Med.";English;"Time-limited trials are recommended to reduce non-beneficial treatments in patients critically ill and with advanced medical illnesses.";"Excessive use of invasive intensive care unit treatments in patients with advanced medical illnesses and poor prognoses can lead to medical care that provides minimal benefit and prolongs suffering. Time-limited trials in these patients have been associated with better quality family meetings and a reduction in the intensity and duration of non-beneficial treatments in the ICU.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6217;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order a periodic fever genetic panel in patients with a classic presentation of PFAPA syndrome without features concerning for other genetic periodic fever syndromes.";"Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome is a clinical diagnosis, and currently, no genetic mutations have been identified for this condition. Periodic fever genetic panel in patients with classic features of PFAPA?without any features of another periodic fever syndrome?rarely yields an alternate diagnosis and as such is costly and has no clinical benefit. However, genetic testing may be warranted if patients have atypical features at presentation, don?t respond to treatment as expected, or develop concerning features over time.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6473;35;"Evidencias COVID-19";"Canadian Society of Otolaryngology?Head & Neck Surgery";Spanish;d;d;2021;;;"High value";d;"https://drive.google.com/file/d/1IlwcRZQYA9Hu8aaIRiL64Uk8dLXi1vBq/view" 6219;19;"Choosing Wisely Canada";"Canadian Nurses Association, Canadian Association of Critical Care Nurses";English;"It is not recommended to prolong use of central venous or peripherally inserted central catheters without daily reassessment";"Central venous or peripherally inserted central catheters require close monitoring for signs of central line-associated bloodstream infections (CLABSI) and should be reviewed daily during multidisciplinary rounds to ensure the appropriateness of the catheter and its intended use. Peripheral intravenous catheters should be assessed daily and removed if they are not part of the continued plan of care or the lumen remains dormant for greater than 24 hours. Unless medically necessary for parenteral nutrition or vasoactive support, the strategies to mitigate CLABSI in central venous access should include considering an access device that is the least invasive with the greatest likelihood of reaching the end of the planned therapy with the lowest rate of replacements and complications.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6220;2;"Choosing Wisely�";"Society for the Advancement of Patient Blood Management";English;"Is not recommended to practice hemodilution and unnecessary blood draws to avoid dilutional coagulopathy and iatrogenic anemia.";"Excessive fluid administration causing hemodilution and unnecessary phlebotomy reduce hemoglobin levels and may unnecessarily trigger red blood cell transfusions based on a numeric threshold despite adequate oxygen carrying capacity. Replacing blood loss with intravenous fluids which do not contain adequate clotting factors (i.e. crystalloids, colloids and packed red blood cells) may lead to dilutional coagulopathy causing a bleeding diathesis. Routine blood draws should be avoided, and if necessary, blood laboratory investigations should be consolidated when appropriate, using minimal volume withdrawal and closed loop collecting systems.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6223;2;"Choosing Wisely�";"Society for the Advancement of Patient Blood Management";English;"Is not recommended to proceed with non-emergent major surgery in neonates, infants and children until anemia is evaluated and treated.";"Anemia is a global health problem with an incidence of up to 25% in neonates, infants and children. An independent association between preoperative anemia and postoperative morbidity and mortality has been reported. Expert consensus guidelines recommend screening 3 to 6 weeks before majo elective surgery. Targeted preventative and therapeutic strategies, which may include iron supplementation, to improve the hematologic status of anemic patients prior to surgery could reduce blood transfusions, improve safety, and decrease costs.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6224;19;"Choosing Wisely Canada";"Society of Obstetricians and Gynaecologists of Canada";English;"It is not recommended to remove ovaries in premenopausal women without strong clinical indications.";"Large US population-based databases have estimated the rate of bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign indications to be 46.4%. When stratified by age, the rates of oophorectomy in women 45-49 years is approximately 60%, and in women >55 years is 65-75%. Studies have shown increase in all-cause mortality, coronary heart disease and cardiovascular death in women with BSO <50 years. These risks may be modified with hormone therapy. BSO has also been shown to increase risk of cognitive impairment and dementia, as well as increase long-term risks of depressive and anxiety symptoms. While BSO has been shown to reduce incidence of ovarian and breast cancer, there are conflicting studies on the impact of BSO on colorectal and lung cancer. Clinical indications for BSO in premenopausal women include women with increased genetic risk for ovarian cancer (BRCA 1, BRCA 2, and Lynch Syndrome) and endometriosis.";2021;;;"Low value";"- ";"Link to the recommendation on the website of the initiative" 6737;36;"Choosing Wisely UK";"Royal College of Emergency Medicine";English;"It is not recommended to put into a plaster cast the fractures of the fifth metatarsal, as they will heal just as quickly in a removable boot.";"Fractures of the base of the fifth metatarsal in association with an inversion injury of the ankle are avulsion fractures that occur at the insertion of the peroneus brevis tendon. They are usually treated symptomatically with a support bandage or cast, with or without crutches (depending on the mobility of the patients). Only one study (of low quality) has adequately compared the cast and the support bandage. This suggests that there is no difference in pain or time to bony union, but that support bandaging significantly shortens the time to full activity and is therefore recommended. Most fractures heal quickly, but sometimes they don't unite. This only needs treatment if it is symptomatic. Fractures of the base of the fifth metatarsal are usually transverse or oblique and in children must be differentiated from the processes, which are longitudinal or even fragmented. These fractures must also be differentiated from those that occur at the base of the shaft of the fifth metatarsal, commonly referred to as Jones fractures. Although they can occur as a result of trauma, Jones fractures are usually stress fractures. Because of the significant incidence of nonunions, they are usually treated with a cast and should be referred for orthopedic follow-up. Other metatarsal shaft fractures are treated symptomatically. There is very little evidence for the treatment of these conditions. There are no current relevant Cochrane reviews, NICE nor SIGN guidelines";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6482;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"Is not recommended the use of convalescent plasma as a treatment in patients hospitalized for COVID-19 to reduce the risk of disease progression or mortality.";"In patients hospitalized for COVID-19, the use of convalescent plasma as part of treatment is not associated with a reduction in mortality. Therefore, it is not considered a recommended therapy. The impact of this intervention as prophylaxis in people at risk or as treatment in patients with mild or asymptomatic forms is unknown. The effect of convalescent plasma for other important clinical outcomes such as ICU admission, mechanical ventilation requirement, hospital stay, rates and time of clinical improvement has not been clarified. All the included studies coincide in reporting a low rate of serious adverse events in the population studied.";2021;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 6227;2;"Choosing Wisely�";"American Society for Clinical Laboratory Science";English;"Is not recommended to use serum cortisol levels as initial screening for adrenal hyperfunction [Cushing syndrome], instead consider superior strategies provided in the justification.";"Serum cortisol levels do not provide high-end diagnostic accuracy or sensitivity when used as an initial diagnostic test. Late night salivary cortisol samples employing an approved collection device, 24-hour urine free cortisol [UFC], or a 1 mg overnight dexamethasone suppression test [DST] should be used as an initial test. These tests have a high diagnostic accuracy for Cushing syndrome [CS]. Multiple screening tests may need to be performed based on the variability of hypercortisolism in CS. Two measurements of abnormal cortisol levels with these tests are recommended for an initial diagnosis, further workup should be referred to an endocrinologist to make the final diagnosis. Each of these tests has different limitations and should be chosen based on the lifestyle and medical history of the patient. Patients with erratic sleep schedules or shift workers would not obtain accurate results from a late-night salivary cortisol test. Women taking oral estrogen, those taking antiepileptic drugs [phenytoin and phenobarbitone], and pregnant women could have falsely elevated cortisol levels as CYP3A4 metabolizes dexamethasone with the DST. UFC tests require rigorous collection management and should not be used on patients experiencing renal failure, or those suspected to have mild CS. Exogenous glucocorticoid use must be excluded before performing these biochemical tests.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6231;19;"Choosing Wisely Canada";"Society of Obstetricians and Gynaecologists of Canada";English;"It is not recommended to perform a cesarean delivery for the sole indication of lack of labor progress in the latent phase of labor for a woman at term with a singleton fetus and cephalic presentation.";"Women who do not make progress in cervical dilatation at less than 4 cm can be managed expectantly, with analgesia and rest as needed. They generally have good outcomes and can often deliver vaginally with no further complications, similar to women who did not have a prolongation of the latent phase of labour. According to the of Obstetricians and Gynaecologists of Canada (SOGC) Clinical Practice Guideline on Management of Labour, ?Dystocia cannot be diagnosed prior to the onset of labour or during the latent phase of labour; caesarean section carried out at this time for an indication of dystocia is inappropriate.? The end of the latent phase is subject to reassessment, the transition to an active phase is easier to diagnose retrospectively. A description of labour curves suggest that the end of the latent phase may be at 6 cm, rather than 4 cm and that overall progress is slower than that originally described. Each obstetrical unit must decide the definition of entry into the active phase of the first stage of labour. Regardless, intervention for a diagnosis of presumed dystocia is inappropriate in whatever may be considered the latent phase. Women should be allowed the opportunity to advance in labour, which many will do if given time, and achieve a vaginal delivery and avoid a caesarean delivery.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6487;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"The use of convalescent plasma is not recommended as a treatment for COVID-19 in patients with moderate to severe forms to reduce disease progression and the risk of death.";"In patients hospitalized for COVID-19, the use of convalescent plasma as part of treatment is not associated with a reduction in mortality. Therefore, it is not considered a recommended therapy. Evidence quality: high (low risk of bias, accurate results, direct information on the clinical question). The impact of this intervention as prophylaxis in people at risk or as treatment in patients with mild or asymptomatic forms is not known. The effect of convalescent plasma for other important clinical outcomes such as ICU admission, mechanical ventilation requirement, hospital stay, rates and time to clinical improvement remains unclear (quality of evidence: low to very low due to serious risk of bias, imprecision). in the results). The levels of IgM and IgG anti-SARS-CoV-2 antibodies are similar in patients with severe COVID-19 (10 days after the onset of symptoms) and in convalescent cases. There is agreement between the studies in terms of reporting a low rate of serious adverse events in the population studied.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6232;2;"Choosing Wisely�";"American Society for Clinical Laboratory Science";English;"Is not recommended to use viscoelastic testing to determine blood product transfusions in trauma patient resuscitation without an established, institutional treatment algorithm in place.";"Currently, many trauma patients presenting to emergency departments are resuscitated through blood product transfusions guided by conventional coagulation tests (CCTs) only. Acute care organizations that utilize viscoelastic testing (VET) in conjunction with CCTs do not commonly have treatment algorithms in place to guide blood transfusions in trauma patients, which can result in the overuse of blood products. When assessing the number of hospitals that have institutional massive transfusion protocols (MTP), one study documented that only 9% of surveyed facilities utilize VET in their MTPs. Several recent studies compared patient outcomes in facilities that incorporate viscoelastic methodologies into their MTPs against those that did not. Mortality and blood product transfusion rates were measured and positive correlations between CCTs in conjunction with VET versus CCTs-only were found. Not only did viscoelastic-guided resuscitation result in higher survival rates and fewer transfused blood products, but also identified those at risk for hyperfibrinolysis, which is a limitation of CCTs. Apart from positive patient outcomes with VET+CCT, another study found that MTP trauma patients guided by VET-only versus CCT-only had no difference in patient outcomes.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6233;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to routinely perform brain imaging after acute seizure in patients with established epilepsy.";"Typically, epilepsy patients have brain imaging at the time of diagnosis to investigate for a structural cause for seizures. Seizures in these patients are unlikely a result of new structural changes. Neuroimaging in can be considered in patients with longstanding epilepsy without prior imaging studies, or in patients who are candidates for neurosurgery with seizures refractory to medical management. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6234;2;"Choosing Wisely�";"American Society for Clinical Laboratory Science";English;"Is not recommended to order a protein S activity assay for measuring protein S function. Instead, order free protein S antigen.";"Thrombophilia has numerous causes, including protein S deficiency, of which there are 3 recognized types. Type I and type III are quantitative defects while type II is a qualitative defect. Type II is extremely rare and is not considered a risk factor for thrombophilia. While functional protein S activity is commonly measured to detect protein S deficiency, there are problems with this test. It is a clot-based assay and has a large coefficient of variation; the test is affected by patients who have factor V Leiden mutation or lupus anticoagulant. On the contrary, free protein S antigen assay is more specific for detecting true deficiencies and only free protein S has anticoagulant activity. Measuring free protein S antigen provides more reliable results, when testing for protein S deficiency is clinically warranted.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6236;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to treat women of childbearing potential with valproic acid if other effective treatments are available";"Valproic acid is teratogenic for a developing fetus and should be avoided. Valproic acid increases the risk of diminished IQ as well as major congenital malformations including neural tube defects and cardiovascular abnormalities for a developing fetus. If valproic acid treatment is deemed necessary, patients should be counselled regarding contraception and the risks of conception. In this case, the lowest effective dose should be used.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6237;19;"Choosing Wisely Canada";"Society of Obstetricians and Gynaecologists of Canada";English;"It is not recommended to give antenatal corticosteroid therapy unless the pregnant woman meets the gestational age criteria and the risk of delivery within the next 7 days is very high.";"The likelihood of preterm delivery and also the gestational age need to be carefully considered when contemplating the use of antenatal corticosteroid therapy among pregnant women. The efficacy of such therapy is highest when the course is given 24 hours to 7 days prior to delivery. Administration more than 7 days before delivery leads to reduced benefit and potentially unnecessary adverse effects . Trials enrolling pregnant women from 24 + 0 to 34 + 6 weeks gestation at high risk of preterm birth show that antenatal corticosteroid therapy significantly reduces perinatal death, respiratory distress syndrome, and intraventricular hemorrhage in the infants who in fact delivered pre-term. Evidence from cohort studies shows a significant reduction in perinatal mortality among infants exposed to antenatal corticosteroid therapy at less than 24 weeks gestation. Women between 22 + 0 weeks and 23 + 6 weeks gestation at high risk of preterm birth within the next 7 days should be provided with a multidisciplinary consultation regarding the high likelihood for severe perinatal morbidity and mortality, and associated maternal morbidity. Steroids should be given if intensive care for the baby is planned.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6238;2;"Choosing Wisely�";"American Society for Clinical Laboratory Science";English;"Is not recommended to order a homocysteine assay as part of the thrombophilia work up.";"For long it was thought that elevated homocysteine was associated with cardiovascular diseases. That in turn could lead to coronary artery disease, heart attacks, strokes, clots in veins causing deep vein thrombosis (DVT) and pulmonary embolism (PE), and pregnancy complications among others. But in 2010 the American Heart Association declared that elevated homocysteine levels were not considered to be a major risk factor for cardiovascular disease. Subsequently, in 2013, the American College of Obstetricians and Gynecologists recommended that fasting homocysteine levels should not be ordered as part of work up for venous thromboembolism. Homocysteine is a breakdown product of methionine that can be recycled by the human body with the help of the enzyme methylene tetrahydrofolate reductase (MTHFR) to reuse in building proteins. A mutation of the MTHFR gene (C677T) impairs its ability to process folate that may lead to elevated homocysteine levels. An elevated homocysteine level is not a clotting disorder and should not be included in thrombophilia testing panels.";2021;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 6239;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to choose opioids or cannabinoids as the first choice of treatment for neuropathic pain.";"Opioids and cannabinoids have weak or inconclusive evidence in effective treatment of neuropathic pain. The well documented risks of opioid and cannabinoids include nausea, sleepiness, impairment, dependence, and development of substance use disorders. With impairment comes further risks to oneself and others in altered judgement in the workplace or while operating a vehicle. Opioids come with an additional risk of decreased respiratory drive and fatality with overdose. Neuropathic pain can be treated effectively using agents with demonstrated efficacy and significantly less risks compared to opioids and cannabinoids.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6496;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";BMJ;English;"It is recommended to review the diagnostic process of cow's milk protein allergy in children with some symptoms.";"Clinical practice guidelines designed to assist non-specialists in diagnosing cow's milk protein allergy in children may be unintentionally medicalizing normal children's symptoms and promoting overdiagnosis of cow's milk protein allergy. cow's milk. The study found that one in four parents reported two or more possible ""mild to moderate"" symptoms in their children each month. The proportion of affected children was higher at 3 months of age, when none of the children drank cow's milk, both in two or more mild to moderate symptoms (37.6%) and in two or more severe symptoms (4.3 %). At the age of 3 to 6 months, half of the babies received six allergenic foods, including cow's milk, along with breastfeeding. The other half were exclusively breastfed until around 6 months. The researchers found that at 6 months of age there was no significant difference between the two groups in the number of children with two or more symptoms. The findings come against a backdrop of increasing rates of prescription of specialized formula for infants with cow's milk allergy, which is completely out of proportion to how common we know the condition to be. Incorrectly attributing these symptoms to cow's milk allergy is not only useless, it can also cause harm by discouraging breastfeeding. ";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6241;2;"Choosing Wisely�";"American Society for Clinical Laboratory Science";English;"Is not recommended to perform routine prothrombin time (PT) and partial thromboplastin time (PTT, APTT) pre-operative screens on asymptomatic patients, use instead a history-based bleeding assessment test.";"The 1989 Medical Necessity Project of the Blue Cross and Blue Shield Association endorsed by the American College of Physicians found that at least 70% of PT and PTT tests were not clinically indicated. Subsequently, nine observational studies, including three prospective trials, reported that PT and PTT positive predictive values for bleeding complications ranged from 0.03 to 0.22, whereas computed 95% confidence intervals for each assay generates a 2.5% false positive rate. A review of 27,737 PT and PTT results over two decades showed that only 8% of PTs and PTTs were clinically indicated based on current or prior patient history of bleeding. A study of general hospital unregulated coagulation screening requests produced few abnormal results with no evidence that they were associated with an increased bleeding risk. In this study, all bleeding cases could be attributed to an underlying condition. The risk of intraoperative bleeding is best predicted from a careful history that includes a questionnaire-based bleeding assessment test (BAT).";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6242;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada";English;"It is not recommended to use a test-based requirement for return to work clearance following COVID-19 when time-based strategies are appropriate.";"Reverse Transcription-Polymerase Chain Reaction (RT-PCR) amplification tests remain positive in some people?s respiratory samples after recovery from coronavirus disease 2019 (COVID-19) infection with prolonged viral RNA shedding demonstrated without direct evidence of there being viable virus capable of replicating or causing infection. Test-based strategies relying on the absence of viral fragments, such as RNA or antigen, for return to work clearance may therefore inappropriately delay return to work. The United States Centres for Disease Control (US-CDC) recommends time-based approaches. A time-based approach based on epidemiologic studies suggests that it is safe to return to work 10 to 20 days after symptom onset depending on the severity of the illness and symptom resolution criteria. Return to work criteria requiring one or more negative RT-PCR or other approved tests may still be considered in high risk occupational settings such as working with high risk persons in a health care setting.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7010;1;"NICE ";NICE;English;"Treatment with budesonide is not recommended in patients with COVID-19, as there is no evidence that it improves the outcomes of hospitalization, death or need for mechanical ventilation compared to patients receiving standard treatment.";"COVID-19 is a respiratory viral infection in which, as a result of the pandemic in 2020, various treatments have been tested to improve the results in terms of hospitalization and death, fundamentally. This review includes two randomized trials testing 3,217 non-hospitalized people with mild COVID-19, comparing treatment with inhaled budesonide versus usual care. Most of the evidence was rated as low to moderate quality.";2021;;;Uncertain;-; 6243;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to order neuroimaging or EEG in asymptomatic patients in the emergency department with syncope and a normal neurological evaluation.";"Syncope, and pre-syncope with observed convulsions are very common and frequently investigated in the emergency department. Typical syncope with a normal examination requires minimal investigation. Neuroimaging and EEG will not help in determining the etiology or management of patients with typical syncope in the absence of focal neurologic symptoms or findings on examination.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6244;19;"Choosing Wisely Canada";"Canadian Thoracic Society";English;"It is not recommended to delay conversations about wishes and goals with patients who have serious or progressive chronic respiratory illness, such as COPD, IPF, PH, or CF. Unnecessary and potentially harmful treatments can be avoided by having discussions and documenting these conversations.";"Supporting patients with serious or progressive respiratory illness to identify and document their values and treatment wishes is an important, but often neglected, intervention. While these patients often experience complex disease trajectories that make accurate prognostication challenging, these discussions can ensure future care is aligned with patients? preferences.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6245;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).";"Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. They also increase length of stay and misdiagnosis. There is strong evidence that physicians should not order CT head scans for patients with minor head injury unless validated clinical decision rules suggest otherwise (i.e., Canadian CT head rule for adults, and CATCH or PECARN rules for children). Despite their validity, these rules are never 100% sensitive and are meant to assist and not replace, clinical judgement. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6501;29;"Choosing Wisely Australia";"Canadian Society of Otolaryngology?Head & Neck Surgery";Spanish;e;e;2021;;;"Low value";e;e 6246;2;"Choosing Wisely�";"American Occupational Therapy Association";English;"Is not recommended to provide ambulation or gait training interventions that do not directly link to functional mobility.";"Occupational therapy practice requires consideration of contextual factors that affect a person?s ability to participate in meaningful occupations. Gait training and ambulation interventions do not necessarily consider the context of performing everyday activities. While occupational therapists can assess underlying performance skills for ambulation and gait and utilize related interventions, they must address functional mobility by considering the context in order to implement effective, evidence-based interventions that are personally meaningful to the individual.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6502;33;"Choosing Wisely � : Things we do for no reason";"JHM, Israilov S.";English;"It is not recommended the use of the tumor markers CA125 CA19-9 and CEA in the initial diagnosis of malignancy in unknown origin tumors.";"Research supports the use of the tumor markers CA125, CA19-9, and CEA as tests for monitoring, risk stratification, and treatment planning of ovarian, pancreatic, and colorectal tumors, respectively. Other clinicians have applied this paradigm with other biomarkers because of its feasible, noninvasive, and easy-to-use features. However, the study of biomarkers in symptomatic patients without a diagnosis does not add clarity to the differential diagnosis. Therefore, it is not recommended to routinely use these tumor markers as an initial diagnosis for malignant tumors of unknown origin without having previously performed imaging and pathological studies.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6247;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to use opioids for treatment of migraines.";"Opioids are not adequate for pain control for patients with migraines. The risk for harm, including impairment, dependence, tolerance, medication overuse headaches, and opioid use disorder with opioids is greater than the documented benefit. Additionally, opioids may worsen nausea and vomiting associated with the migraine. Prescription opioids for migraines would have minimal to no benefit with the excess of risk, and contribute to the opioid crisis. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6503;33;"Choosing Wisely � : Things we do for no reason";"JHM, Patel ";English;"Discontinuing urate-lowering therapy on admission is not recommended. ";"Urate-lowering therapy should be considered an essential medication and should be continued during the hospitalization of a patient with a history of gout. It should also be continued in case of an acute flare of gout, as well as in patients with acute or chronic renal failure, although in consultation with a pharmacist if a modification of the dose is necessary for patients with acute renal failure. When the hospitalist not treat urate-lowering therapy as an essential medication on admission, leads to increased morbidity, resource utilization, and cost of hospitalization.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6248;19;"Choosing Wisely Canada";"Canadian Pediatric Neurosurgery Study Group";English;"It is not recommended to order a standard-dose CT scan to initially investigate macrocephaly. Instead, ultrasound, MRI or ultra-low-dose CT should be ordered. ";"A common pediatric neurosurgery referral is a young child with a rapidly increasing head circumference crossing percentiles. The differential diagnosis is broad and includes benign expansion of the subarachnoid spaces (BESS), subdural collections, hydrocephalus, and neoplasm. When the fontanelle is open, the etiology can usually be diagnosed on head ultrasound, and this should therefore be the initial screening test of choice. In the absence of an open fontanelle, or if there are other signs and symptoms of acute raised intracranial pressure (vomiting, headache, irritability, drowsiness, full fontanelle, sun setting eyes), the etiology should be diagnosed with MRI, if available, in order to limit radiation exposure. There is growing evidence that exposure to radiation through CT imaging increases a child?s life long risk of cancer, and so all care should be taken to minimize this exposure as much as possible. Ultrasound (when fontanelle open), and/or MRI (when fontanelle closed), are therefore the screening tests of choice to investigate macrocephaly. New ultra-low dose CT technology is emerging that may reduce the radiation exposure down to the level of a skull x-ray. This is an acceptable alternative to MRI or ultrasound.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6504;33;"Choosing Wisely � : Things we do for no reason";"JHM, Glisch";English;"The prescription of tramadol in hospitalized patients with pain is not recommended.";"Many clinicians prescribe tramadol to patients with chronic pain because, compared to morphine, it binds weakly to the mu receptor. This leads to the belief that it produces less withdrawal syndrome and fewer side effects than other opioids. However, as its metabolism is carried out in the liver by the cytochrome P450 isoenzyme, and it can undergo several genetic polymorphisms, this process can be altered, producing many unpredictable individual variations in the pharmacodynamics of this drug. Therefore, it is recommended to carry out a prior evaluation of pain in this type of patient, complementing it with diagnostic tests and using other modalities to control pain such as topical agents, ice, psychotherapy, radiation or injections, if these are indicated. Trying to avoid prescription of tramadol due to adverse effects, lack of quality evidence on efficacy in these patients and unpredictable pharmacodynamics.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6249;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to prescribe opioids for management of chronic rheumatic disease before optimizing the use of non-opioid approaches to pain management.";"Opioids in chronic non-cancer pain are associated with substantial risks. Optimize non-opioid pharmacotherapy and non-pharmacologic therapy. Opioids are not superior to non-opioid medications for pain-related function over 12 months in moderate to severe hip or knee osteoarthritis, or mechanical back pain. Opioids should only be prescribed by physicians skilled in their use.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6505;33;"Choosing Wisely � : Things we do for no reason";"JHM, Memari";English;"It is not recommended to obtain routine urinalysis in older adults with delirium without signs or symptoms of urinary tract infection.";"Urinary infection can be the cause of an episode of delirium. The article does not recommend routine urinalysis and culture in older patients with delirium without symptoms of local or systemic infection. Try to identify the cause of the mental deterioration using information obtained from a reliable informant, perform a complete physical and neurological examination, and evaluate metabolic and electrolyte parameters. In case of localized or systemic symptoms of infection, routine urinary studies are recommended and antimicrobial therapy may be appropriate.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6250;2;"Choosing Wisely�";"American Occupational Therapy Association";English;"Is not recommended to use slings for individuals with a hemiplegic arm that place the arm in a flexor pattern for extended periods of time.";"Standard shoulder slings immobilize the upper extremity in a flexor pattern (i.e., a position of elbow flexion, and shoulder adduction and internal rotation). Utilizing a sling that places a person?s hemiplegic arm in this position for extended periods of time increases the risk of contractures and pain, and limits active use of the extremity, thereby decreasing opportunities for neuroplastic changes that support an organic increase in function. Education should be provided to clients and caregivers on safe positioning of the hemiplegic arm during activity and at rest.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6506;33;"Choosing Wisely � : Things we do for no reason";"JHM, Cunningham ";English;"Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain is not recommended. ";"Based on current evidence, CT has similar diagnostic accuracy to ultrasound for biliary and gynecologic pathologies necessitating urgent surgery (eg, acute cholecystitis, ovarian torsion), and a follow-up ultrasound adds little. Ultrasonography should be ordered as the initial imaging test when pacients present right upper quadrant abdominal pain or pelvic pain of suspected gynecological origin. It is not recommended to order an ultrasonography 24-48 hours after a negative CT to pursue biliary or pelvic pathology. The abdominal imaging test should only be repeated if the clinical circumstances evolve or if after consultation with a radiologist it is concluded that will answer a more sprecifin diagnostic question. In a patient presenting with diffuse abdominal pain with a negative CT scan, the clinician should reassess the history, physical examination and differential diagnosis before pursuing further diagnostic imaging.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6251;19;"Choosing Wisely Canada";"Canadian Neurological Society";English;"It is not recommended to use butalbital, butorphanol, or ergotamine as treatment for migraines except as a last resort.";"Butalbital, butorphanol, and ergotamine are not adequate abortive or preventative treatments for patients who suffer with migraines. Butalbital and butorphanol are barbiturate containing medications which carry the risks of sedation, intoxication, dependence, abuse potential, severe withdrawal, and substance use disorders. The risk of medication overuse headache with these medications is also significant. These medications are only helpful in refractory cases of migraines as a last resort. There are more effective and less harmful first line agents available for prophylactic and abortive treatment of migraine headaches.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6507;33;"Choosing Wisely � : Things we do for no reason";"MPH, DeFries T.";English;"It is not recommended the prescribtion of Thiamine, Folate and Multivitamins on discharge for Patients with Alcohol use disorder.";"Alcohol Use Disorder increases the risk of vitamin deficiency due to the toxic effect of alcohol on the gastrointestinal tract and liver and because of the caloric replacement of nutrient-rich intake with alcohol. Since the body is not capable of storing soluble vitamins, they must be ingested on a regular basis. In clinical practice, we treat discharged patients with this condition empirically with thiamin, folate, and other vitamins to reduce morbidity associated with nutritional deficiencies. However, counseling, motivational interviewing, and treatment for Alcohol Use Disorder should be offered. To this end, an evidence-based treatment for AUD should be offered, link dietary insecurity with appropriate resources, de-escalate vitamin prescription during hospitalization, and risk-stratify hospitalized patients with AUD with additional risk factors for vitamin deficiency.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6252;19;"Choosing Wisely Canada";"Canadian Pediatric Neurosurgery Study Group";English;"It is not recommended to do routine surveillance imaging for incidentally discovered Chiari I malformation without syringomyelia.";"Chiari I malformation, defined as cerebellar tonsillar herniation greater than or equal to 5mm below the foramen magnum on MRI brain, is a frequent incidental finding in children, with an estimated prevalence of 1 to 3%. The vast majority of children with incidentally discovered, asymptomatic Chiari I malformations without syringomyelia have no clinically significant progression of tonsillar descent on routine follow-up, and symptom development is often unassociated with radiographic change. Radiographic follow-up in the absence of new symptomatology is therefore unnecessary.";2021;;;"Low value";"- ";"Link to the recommendation on the website of the initiative" 6508;33;"Choosing Wisely � : Things we do for no reason";"JHM, Gay";English;"The use of appetite stimulants in involuntary weight loss in the hospitalized or nursing home population is not recommended.";"Unintentional weight loss affects more than 27% of older people and up to 60% of people admitted to nursing homes. The search to put an end to this problem has led professionals to opt for the use of orexigens. The problem is that several studies with certain medications have shown an increased risk of thrombi, physical deterioration or adrenal insufficiency, in some cases, such as megestrol acetate, being associated with the possibility of death. Therefore, the American Geriatrics Society does not recommend their use because they do not have a proven benefit in improving long-term results, and nutritionists recommend oral supplements to prevent this weight loss while avoiding these adverse effects.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6253;2;"Choosing Wisely�";"American Occupational Therapy Association";English;"Is not recommended to use reflex integration programs for individuals with delayed primary motor reflexes without clear links to occupational outcomes.";"Las intervenciones dise�adas �nicamente para integrar los reflejos retenidos no promueven la participaci�n en la ocupaci�n, y aunque pueden observarse en clientes con dificultades en el desempe�o ocupacional, la presencia de reflejos retenidos no equivale necesariamente a un deterioro funcional. Si se considera la posibilidad de intervenir con t�cnicas de integraci�n de reflejos (es decir, t�cnicas dise�adas para integrar o inhibir los reflejos motores primarios retenidos m�s all� de la etapa t�pica de desarrollo de la integraci�n), se necesitan herramientas y enfoques de evaluaci�n estandarizados para conectar el deterioro con el desempe�o ocupacional. La intervenci�n debe centrarse en la mejora de la participaci�n y el rendimiento laboral, en lugar de centrarse �nicamente en la integraci�n de los reflejos.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6254;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to delay or avoid palliative symptom management and advance care planning for a patient with life-limiting rheumatic disease because they are pursuing disease-directed treatment.";"A palliative approach to care alongside disease-specific treatment should be part of the continuum of care for patients with advanced rheumatic disease toward the end of life. This approach aims to improve quality of life for patients with life-limiting illnesses, through the prevention and relief of suffering, the control of symptoms, and the management of physical, psychosocial and spiritual distress. Such an approach is supported by a growing body of evidence that demonstrates improved patient satisfaction with care, decreased symptom burden and, in some cases, better survival, when a palliative approach to care is integrated early in a patient?s disease trajectory.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6510;33;"Choosing Wisely � : Things we do for no reason";"JHM, Caton";English;"Fluid restriction for the management of acute decompensated heart failure in patients with reduced ejection fraction is not recommended. ";"Acute decompensated heart failure patients with reduced ejection fraction should be treated with evidence-based neurohormonal blockade and initiate loop diuretics to alleviate congestion. It is recommended that these patients be allowed to drink when thirsty in the absence of hyponatremia. Initiating fluid restriction should be considered in those patients with concurrent hyponatremia or resistance to diuretics. In the present day of evidence-based pharmacologic therapies, research indicates that fluid-restriction does not help and potentially may harm, causing unintended adverse effects of increasing thirst and worsening renal function and quality of life.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6255;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"It is not recommended to insert or leave in place a urinary catheter without an acceptable indication";"While it?s common to insert indwelling urinary catheters for critical care patients, prolonged use can lead to catheter-associated urinary tract infections (CAUTI), urosepsis, increased hospital stays and other complications. Although critical illness can be a legitimate indication for urinary catheter use, daily assessment of urinary catheters is recommended. Some evidence indicates that reminder systems or stop orders in critical care settings can reduce the incidence of CAUTI and catheter duration. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6511;33;"Choosing Wisely � : Things we do for no reason";"JHM, Xu";English;"Serology is not recommended to detect noninvasive Helicobacter pylori infection in patients who do not have an indication for endoscopy.";"This clinical practice guideline aims to clarify which tests are appropriate for the diagnosis of Helicobacter pylori. In patients who do not have an endoscopic indication, stool antigen and urea breath tests are recommended. These two tests must be postponed 4 weeks from the last intake of medications that interfere with the results (antibiotics, bismuth, PPIs); H2 antagonists do not interfere. In patients with an endoscopic indication, biopsy is recommended. In cases of bleeding ulcer with a negative biopsy for H. pylori, repeat the biopsy when bleeding resolves or a stool antigen or urea breath test. Helicobacter pylori eradication should be confirmed in all cases diagnosed with one of the above tests. The antibodies (IgA, IgM) are not useful for the diagnosis or management of this type of infection.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6256;2;"Choosing Wisely�";"American Occupational Therapy Association";English;"Is not recommended to provide interventions for autistic persons to reduce or eliminate ?restricted and repetitive patterns of behavior, activities, or interests? without evaluating and understanding the meaning of the behavior to the person, as well as personal and environmental factors.";"Occupational therapy practitioners should provide person-centered, strengths-based interventions, and advocate for autistic persons on individual and societal levels by providing information to promote inclusivity and belonging, and to decrease stigma. Actions that are considered ?restricted and repetitive behaviors? by the DSM-5 (American Psychiatric Association, 2013) may serve as meaningful activities for self-regulation, communication, or self-expression. Attempting to change or extinguish these behaviors without direct request from the individual, without understanding and incorporating the underlying meanings, or substituting other actions to meet self-regulatory reasons for the behavior commonly results in camouflaging (e.g., masking or hiding behaviors), that can result in negative self-image, depression, and an increased risk of suicidality.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6512;33;"Choosing Wisely � : Things we do for no reason";"JHM, Douglas Auth";English;"The use of corticosteroids in the treatment of anaphylaxis is not recommended in adults or children.";"The use of corticosteroids is not recommended against anaphylaxis due to the associated adverse effects both in the elderly and in children, mainly cardiovascular effects in the elderly, and pneumonia and gastrointestinal problems in children. Even so, if used, it is recommended to administer them intramuscularly, since in this way an increase in cardiovascular risk is not observed, while intravenously it is. In contrast, The American Academy of Allergy, Asthma & Immunology supports that patients with a history of asthma who present with bronchospasm or significant upper airway edema may benefit from its use. In addition, they indicate that they reduce hypersensitivity reactions to chemotherapy drugs.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6513;33;"Choosing Wisely � : Things we do for no reason";"JHM, Kenny";English;"Calculation of corrected calcium levels to assess calcium homeostasis in patients with hypoalbuminemia or hypocalcemia is not recommended.";"Several studies conclude that applying calcium correction formulas in patients with hypocalcemia or hypoalbuminemia can lead to the belief that calcium levels are normal, leading to treatment withdrawal. Therefore, it is recommended to use tests to calculate serum calcium concentrations to assess calcium homeostasis, avoiding the use of calcium correction to estimate total calcium. In critical patients or with hypoparathyroidism or hyperparathyroidism, it is recommended to obtain iCa levels to evaluate them.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6514;33;"Choosing Wisely � : Things we do for no reason";"JHM, Niforatos";English;"Rasburicase for adult patients with tumor lysis syndrome is not recommended ";"Tumor lysis syndrome remains a metabolic emergency that requires rapid diagnosis and management to prevent morbidity and mortality. Rasburicase is often considered the standard-of-care treatment for hyperuricemia due to its ability to reduce circulating uric acid levels rapidly. Oncologists presume reducing uric acid levels prevents and treats TLS. As a preventive treatment, clinicians should identify patients high-risk of TLS and consider a single 3-mg dose of rasburicase and manage low- and intermediate-risk patients with allopurinol and hydration. We identify patients with TLS using the clinical and laboratory findings outlined in the Cairo-Bishop classification system. In the event of AKI secondary to TLS, clinicians should Initiate aggressive fluid resuscitation and manage electrolyte abnormalities. If urate-lowering therapy is part of local hospital guidelines for TLS management, consider a single dose regimen of rasburicase utilizing shared decision-making. The current literature does not provide compelling evidence that rapidly lowering uric acid with rasburicase to prevent TLS or to treat AKI secondary to TLS improves patient-oriented outcomes.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6515;33;"Choosing Wisely � : Things we do for no reason";"MD, Golfeuz S.";English;"It is not recomended to Ova an Parasite testing in patients with acute diarrhea arising during hospitalization systematically";"Initial studies of samples in patients with acute diarrhea show poor sensitivity. To do this, a ""wait and see"" guideline should be carried out for patients at high risk for parasitic diseases and to carry out targeted tests to focus on the cases with the greatest probability of being sensitive to the microbiological study. Furthermore, in high-risk patients with no travel history, the first option is to perform other rapid tests (PCR, DFA or EIA). In the case of negative, we can obtain samples for microbiological study and stop, if necessary, atypical parasites.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6260;2;"Choosing Wisely�";"American Occupational Therapy Association";English;"Is not recommended to initiate occupational therapy interventions without completion of the client?s occupational profile and setting collaborative goals.";"Best practice occupational therapy relies on a practitioner?s understanding of a client?s occupational history and experiences, patterns of daily living, interests, values, and needs, as well as active partnership with the client and care partners (e.g., partners, parents, caregivers) to develop meaningful goals. As stated in the fourth edition of the Occupational Therapy Practice Framework: Domain and Process (OTPF-4), ?only clients can identify the occupations that give meaning to their lives and select the goals and priorities that are important to them? (AOTA, 2020). If the client or care partners are not involved in developing the profile and identifying goals, priorities, and outcomes, full engagement in occupations may not be accomplished.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6516;2;"Choosing Wisely�";"JHM, Friedman";English;"It is not recommended the overuse in practice of resources in a pediatric hospital.";"The clinical practice guideline specifies a set of steps to implement this project, such as creating lists of recommendations aligned with quality metrics and measuring and supporting practice change. Practicing pediatric medicine in a well-resourced hospital setting should not lead to overuse in practice. The harms of this approach to our patients and health systems, coupled with the pressures of the pandemic, are compelling reasons to be more responsible. We must see it as an opportunity to reshape and rethink patterns and habits of practice. Overuse and overdiagnosis harm our patients and families physically and emotionally, and indirectly harm urgently needed resources. Providing safe, quality care and high value to our young patients requires constant critical thinking.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6517;33;"Choosing Wisely � : Things we do for no reason";"JHM, Black";English;"""NPO after midnight"" is not recommended before an operation or sedation in patients with low risk of aspiration.";"The American Society of Anesthesiologists (ASA) recommends calculating the risk of aspiration in patients who are going to undergo sedation so that, based on their level, they can undergo certain dietary restrictions or others. Low-risk patients are allowed to eat heavy fatty foods 8 hours before, light meals 6 hours, breast milk 4 hours, and carbohydrate drinks up to 2 hours before. This makes it possible to achieve normophysiology and increase patient satisfaction. Patients who have a high risk of aspiration or regurgitation will be subject to greater restrictions based on their underlying pathology, to avoid associated complications.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7029;33;"Choosing Wisely � : Things we do for no reason";;Spanish;"It is not required emergent hemodialysis after intravascular iodinated contrast exposure in chronic hemodialysis patients.";"It is not recommended since it does not improve clinical results and also delays vital diagnosis or therapeutic measures. The indication for hemodialysis is independent of iodinated contrast exposure in patients on chronic hemodialysis. The evidence is based on four studies, three of them prospective and one of them retrospective. ";2021;;;"High value";"Therapy after pacient radiation";"https://cdn.mdedge.com/files/s3fs-public/JHMVol16No9_Ninan00020915e.PDF" 6518;2;"Choosing Wisely�";"JHM, Abdul-Moheeth";Spanish;"Choosing Wisely principles are recommended to reduce laboratory testing for non-critical adults with COVID-19.";"The Society of Hospital Medicine?s Choosing Wisely recommendations include avoiding repetitive routine laboratory testing. In the setting of the early stages of the COVID-19 pandemic, the benefits of avoiding routine repetitive testing may have been more pronounced considering the need to limit unnecessary healthcare professional exposure to infected individuals and to conserve resources, including personal protective equipment and laboratory resources. Non-critically-ill COVID-19 patients at our hospital had more inpatient days where they did not receive specific laboratory tests. These data show sustainability and endurance of this intervention through both our summer and winter surges, and the association did not correlate directly with significant changes in the number of COVID-19 patient discharges, supporting that its impact is independent of case volume. We have no reason to believe that this decrease in routine laboratory ordering was associated with adverse outcomes for our patients. The principles of Choosing Wisely can be applied even within novel and quickly evolving situations, relying on rapid and critical review of evidence, clinician consensusbuilding, and leveraging available interventions to drive behavior change.";2021;;;"Not applicable";-;"Link to the recommendation on the website of the initiative" 6519;6;"Less Is More Collection - JAMA Network";"AMA, Nicolas L.";English;"It is not recomended the routine preoperative testing in patients undergoing low-risk surgery.";"The routine preoperative study in low-risk surgeries does not add value or benefit to the study of the surgical patient. Studies performed on these patients tend to be overused, costly, and can lead to downstream care cascadesinvolving invasive diagnostic tests. For this reason, personality strategies must be adopted for the type of surgery and the type of patient, as well as dispensing with those that offer no value in the management and prognosis of the patient.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6265;2;"Choosing Wisely�";"American Academy of Pediatrics Council on Environmental Health";English;"Is not recommended to do routinely measurements of environmental chemicals in a person?s blood or urine to make clinical decisions with the exception of certain heavy metals (eg, lead). ";"It is virtually impossible for people not to come into contact with hundreds of chemicals each day?whether those chemicals are in our food, air, water, soil, dust, or the products we use. And it is even more difficult for people to know whether those chemicals are harmful to their health or not. Presence does not mean toxicity. The measurement of an environmental chemical in a person?s blood or urine does not by itself mean that the chemical causes disease. Advances in analytical methods allow us to measure low levels of environmental chemicals in people, but separate studies of varying exposure levels and health effects are needed to determine whether such blood or urine levels result in disease. These studies must also consider other factors such as duration of exposure. For some environmental chemicals, such as lead, research studies have given us a good understanding of the health risks associated with different blood lead levels. For many environmental chemicals (eg, phthalates, polychlorobiphenyls) more research is needed to assess health risks from different blood or urine levels. Thus, just because a chemical is found to be in the body does not mean that harm will occur. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6521;33;"Choosing Wisely � : Things we do for no reason";"David Cohen, Daniel Ricotta, Payal Parikh";English;"It is not recommended to hold metformin routinely in hospitalized patients";"Hospitals routinely hold metformin in the inpatient setting. Metformin-associated shunting of metabolism toward anaerobic respiration increases the risk of lactic acidosis. Because the kidneys excrete metformin, the risk of developing metformin-associated lactic acidosis increases with renal impariment. Disease states common among hospitalized patients, such as hypoperfusion, advanced cirrhosis, alcohol abuse, cardiac failure, muscle ischemia, and severe infection, increase the risk of acute kidney injury and elevate blood lactate levels. ";2021;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 6522;22;"The Canadian Task Force for Preventive Health Care Guidelines";"A. Moore et al. ";English;"We recommend opportunistic screening of sexually active individuals under 30 years of age who are not known to belong to a high-risk group, annually, for chlamydia and gonorrhea at primary care visits, using a self- or clinician-collected sample";"Conditional recommendation; very low-certainty evidence. Overall, evidence suggests that pelvic inflammatory disease may be reduced through the routine offering of chlamydia screening in Canadian primary care. No studies were identified that examined the benefits of screening for gonorrhea for those at general risk. Eleven studies were identified on the harms of screening for chlamydia suggesting that some individuals undergoing screening may experience psychosocial harms (e.g., anxiety, shame and stigma) although this evidence was very uncertain and likely impacts a small proportion of those eligible for screening. No studies examined harms of screening for gonorrhea. Fourteen studies examining patient values and preferences, as well as Task Force patient engagement activities suggested that patients prioritize the benefits over the harms of screening, even when provided with the evidence and its uncertainty. Considering the potentially important benefit of screening relative to harms and patient values and preferences in favour of screening, the task force recommends opportunistic screening for chlamydia and gonorrhea in primary care for individuals under 30 years of age. The rates of chlamydia and gonorrhea are increasing among those aged 25-29 years in Canada, with rates and total cases similar to those aged 15-19 years. The recommendation to also screen males is based on the properties of sexual networks (given the roles of males in the transmission of these infections) and potential to reduce chlamydia and gonorrhea infection and its negative consequences in females (who carry the burden of health complications associated with chlamydia and gonorrhea infections). The recommendation to also screen for gonorrhea was made despite the lack of available evidence, given that many gonorrhea cases are asymptomatic , up to 40% of those with gonorrhea may have concurrent chlamydia and current Canadian clinical and laboratory practice is to combine testing for gonorrhea with chlamydia using a single sample. ";2021;;;"High value";-;"

Link to the recommendation on the website of the initiative

" 6523;1;"NICE ";NICE;English;"Leukomed Sorbact is recommended for use in closed surgical wounds following caesarean section and vascular surgery in patients where low to moderate post-surgical exudate is anticipated.";"Leukomed Sorbact is an interactive dressing that binds to the microbes that cause surgical site infection so they are removed when the dressing is changed. Leukomed Sorbact should be considered as an option for people with wounds that are expected to have low to moderate exudate after caesarean section and vascular surgery. It should be used as part of usual measures to help reduce the risk of surgical site infection. More evidence is needed on the use of Leukomed Sorbact on wounds after other types of surgery.";2021;;;"High value";-;"

Link to the recommendation on the website of the initiative

" 6268;2;"Choosing Wisely�";"American Academy of Pediatrics Council on Environmental Health";English;"Is not recommended to order ?chelation challenge? urinary analyses for children with suspected lead poisoning.";"The ?chelation challenge? was formerly used to assess whether a child had a significant body burden of lead, or ?lead poisoning,? and whether formal chelation would result in significant clearance of lead. Evidence exists that suggests that the chelation challenge has no better prognostic value than the standard blood lead level. Further, there is some evidence that the chelation challenge may in fact be potentially dangerous. In summary, chelation challenge has no clinical utility in the treatment of childhood lead poisoning today";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 7036;33;"Choosing Wisely � : Things we do for no reason";"Choosing Wisely �: Things we do for no reason";English;"The routine use of triple anticoagulant therapy is not recommended in patients with non-valvular atrial fibrillation and percutaneous coronary intervention.";"Clinicians frequently encounter patients with coronary artery disease and atrial fibrillation, and the literature reports a prevalence of coronary artery disease in patients with atrial fibrillation from 17% to 47%. Patients with atrial fibrillation and an elevated ischemic stroke risk should receive long?term anticoagulation with a direct oral anticoagulant or vitamin K antagonist to prevent thromboembolic events. Additionally, patients with coronary artery disease treated with percutaneous intervention benefit from dual?antiplatelet therapy with aspirin and a P2Y12 inhibitor (clopidogrel, ticagrelor, or prasugrel). Historically, clinicians prescribed dual-antiplatelet therapy with oral anticoagulation (triple therapy) for patients with atrial fibrillation and recent percutaneous intervention. When compared with an oral anticoagulant and a single antiplatelet agent (double therapy), triple therapy does not reduce the rates of post?percutaneous intervention ischemic events or mortality but does increase the risk of bleeding. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6271;19;"Choosing Wisely Canada";"Canadian Society for Vascular Surgery";English;"It is not recommended to perform unnecessarily frequent ultrasound examinations in asymptomatic patients with small abdominal aortic aneurysms. Abdominal Aortic Aneurysms between 4 to 4.9 cm in diameter should be surveyed by annual ultrasound.";"Regular ultrasound examination of asymptomatic patients with small abdominal aortic aneurysms is essential to document aneurysm growth and decide when intervention is warranted. The interval between examinations is dictated by the size of the aneurysm and its expected growth rate. Too frequent examinations can cause undue patient anxiety and are not cost effective.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6272;2;"Choosing Wisely�";"American Academy of Pediatrics Council on Environmental Health";English;"Is not recommended to order mold sensitivity testing on patients without clear allergy or asthma symptoms (particularly those with chronic fatigue, arthralgia, cognitive impairments, and affective disorders). ";"Mold can cause sensitization and clinical disease. Skin prick and in vitro tests can effectively identify patients who are sensitized to molds, although this does not always translate to clinical disease. Results of these tests must be interpreted in the context of the patient?s clinical presentation. Exposure to dampness and mold can increase the risk of developing asthma in children regardless of their atopic status and increased symptoms of asthma and rhinitis in individuals who already have these conditions. Interventional studies have found that a multifaceted series of interventions aimed at reducing indoor moisture, removing contaminated building materials, and reducing reservoirs (including carpeting and dust) can reduce exposure sufficiently to reduce symptoms in affected individuals. This implies a causal relationship between exposure to fungi and morbidity and provides a rationale for environmental interventions to reduce it.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6274;2;"Choosing Wisely�";"American Academy of Pediatrics Council on Environmental Health";English;"Is not recommended to order hair analyses for ?environmental toxins? in children with behavioral or developmental disorders, including autism";"The analysis of hair for a broad array of elements and chemicals as a way to diagnose the cause of childhood diseases such as autistic spectrum disorder has no scientific basis. Such assays may not be reliable: hair collection is not precise and it is a heterogeneous matrix; chemicals in hair may not be distributed evenly from the root up the shaft, the assays used may not be accurate technically, and hair can easily be contaminated by external residues of dust, shampoos, conditioners, or other hair treatments. Reports of finding of various metals, etc, can create a severe anxiety in the families requiring further testing by other means. Historically, testing by standard means fail to verify the apparent exposure reported by hair analysis. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6277;2;"Choosing Wisely�";"American Academy of Pediatrics Council on Environmental Health";English;"Is not recommended to perform routinely test urine for metals and minerals in children with autistic behaviors. Toxicologic exposures have not been conclusively associated with the development of autistic behaviors in children. Testing for metals and minerals may be harmful if treatment is guided on the basis of these results.";"Thimerosol or ethylmercury has been used as a preservative in multidose vaccine vials and have been blamed for the increase in autism rates over the past 2 decades. However, studies have failed to show a causative link between environmental exposures and the development of these symptoms. As symptoms of autism occur early in childhood and, possibly, months to years after any potential exposure may have resulted in neurotoxicity, the likelihood of continued presence of such toxicant is low. Parents, however, may be desperate for answers and seek out alternative sources for information and receive advice to obtain laboratory analysis for minerals and metals as causative agents without insurance reimbursement. Finding an abnormal result has led to ill-advised treatments and death in some patients. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6278;19;"Choosing Wisely Canada";"Canadian Rheumatology Association";English;"It is not recommended to order ANA antibodies as a screening test without specific signs or symptoms of a rheumatic condition.";"Anti-nuclear antibody (ANA) should not be used as a screening test in patients without specific signs or symptoms of systemic lupus erythematosus or other systemic autoimmune rheumatic disease (e.g. inflammatory arthritis, malar rash, photosensitivity, etc.) since ANA positivity may occur in non-rheumatic conditions and in ?healthy? populations (up to 20%). In consideration of juvenile idiopathic arthritis (JIA), a positive ANA indicates increased risk of uveitis, but is not a useful screening test for the diagnosis of JIA. Inappropriate ANA testing may be misleading, precipitate further unnecessary testing, and lead to patient anxiety.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6279;1;"NICE ";NICE;English;"It is not recommended to laparoscopic removal of uterine fibroids with electrical morcellation in postmenopausal women or women older than 50 years.";"Evidence on the safety of laparoscopic removal of uterine fibroids with electrical morcellation shows potentially serious complications. In particular, there is a risk of spreading undiagnosed malignant tissue, which is more prevalent in people who are postmenopausal or older than 50 years. The evidence on the efficacy of the procedure is limited in quantity. For persons who are premenopausal or age 50 and younger, this procedure should only be used with special arrangements for clinical monitoring, consent, and audit or investigation, physicians who wish to perform laparoscopic removal of uterine fibroids with electrical morcellation in premenopausal persons or age 50 and under should report to clinical leaders in their healthcare organization and provide patients (and their families and carers, as appropriate) with clear written information to support shared decision-making, including NICE information for the public. This procedure should only be performed by a surgeon with specific training in laparoscopic surgery. When a bag technique is required, the surgeon must also have specific training in the use of restraint systems.";2021;;;"Low value";-; 6280;1;"NICE ";NICE;English;"Transanal total mesorectal excision is not recommended for rectal cancer; only in the research setting.";"The incidence of rectal cancer increases with age. Treatment consists of resection of the affected part of the rectum with preservation of the anus or, when this is not possible, a colostomy. Complementary radiotherapy and chemotherapy may also be used. The aim of transanal total mesorectal excision is to improve the clinical outcome of rectal resection and to reduce the length of hospital stay and morbidity after surgery. As for the safety evidence of the technique, it is inconsistent: there is a risk of producing damage to adjacent structures and seeding of malignant tumors. It is therefore only recommended in research settings. Further research should specify patient selection, as well as tumor type, the use of neoadjuvant chemoradiotherapy and all complications (including spread of malignancy). ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6281;1;"NICE ";NICE;English;"It is not recommended to embolize genicular artery to treat knee osteoarthritis pain, it should only be used in research. ";"Although no major short-term safety problems have been found after genicular artery embolization for knee osteoarthritis pain, the evidence on its long-term efficacy and safety is inadequate in quality and quantity. That is why it is only recommended for investigational use in randomized controlled trials against sham and current best practice. This process should only be performed by interventional radiologists with specific training in this technique. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6282;1;"NICE ";NICE;English;"It is not recommended to hysteroscopic mechanical tissue removal for uterine fibroids, only in the research setting.";"Uterine fibroids (also known as leiomyomas or uterine fibroids) are benign tumors of the uterus. They can be asymptomatic or cause symptoms including heavy periods or bleeding between periods. They may be associated with fertility problems and miscarriage. Evidence on the safety of hysteroscopic mechanical tissue removal (hysteroscopic morcellation) for uterine fibroids shows that there are well-recognized, rare, but potentially serious side effects. The evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical management, consent, and audit or investigation. Physicians who wish to perform mechanical hysteroscopic tissue removal (hysteroscopic morcellation) for uterine fibroids should inform clinical leaders at their healthcare organization and provide patients (and their families and caregivers, as appropriate) with clear written information to I support shared decision making. The procedure should only be done by clinicians with specific training in this technique, including fluid management.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6284;1;"NICE ";NICE;English;"It is not recommended to perform an endobronchial nerve ablation for chronic obstructive pulmonary disease; only in a research setting.";"The evidence on the safety and efficacy of endobronchial nerve ablation for chronic obstructive pulmonary disease (COPD) is quantitatively inadequate. Therefore, this procedure should only be performed in the context of research. COPD affects mostly middle-aged and older adults; and the main cause is smoking. Although the lung damage caused by COPD is permanent, treatment can help slow the progression of the disease. Treatments include smoking cessation, pulmonary rehabilitation, inhaled beta-2 agonists, antimuscarinic inhalers and steroids, oral medication such as bronchodilators, mucolytics and steroids, and oxygen. The goal of endobronchial nerve ablation is to interrupt parasympathetic signaling to the lungs and decrease neuronal release of acetylcholine; to produce permanent bronchodilation, thereby decreasing mucus production and improving breathing. It is usually a minimally invasive outpatient procedure performed under general anesthesia.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6285;19;"Choosing Wisely Canada";"Canadian Obstetrical and Pediatric Transfusion Network Canadian Society for Transfusion Medicine";English;"Do not routinely perform a group and screen test at the time of delivery unless there is no prior test during the current pregnancy and/or the risk of maternal hemorrhage or transfusion is high.";"The likelihood of requirement for transfusion at the time of delivery is low. In a patient with a prenatal record confirming maternal ABO, Rh and a negative antibody screen provision of emergency uncrossmatched units is relatively safe when required on rare occasions. Routine pre delivery group and screen is not cost effective given the very low risk of transfusion with either vaginal delivery or routine Caesarean section. In the rare occasion that patients require a blood transfusion, O negative un-crossmatched blood or a stat crossmatch could be done pre-transfusion.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6286;19;"Choosing Wisely Canada";"Canadian Obstetrical and Pediatric Transfusion Network Canadian Society for Transfusion Medicine";English;"Do not perform serological weak D testing on antenatal samples with weak or variable RhD typing results.";"Serologically weak reactions with Anti D antisera (? 2+) should be investigated with RHD genotyping. Pregnant mothers with weak or variable RhD typing and with pending genotyping results should be treated as RhD negative and should receive RhIg. Patients with genotyping confirming weak D type 1, 2 or 3 should be treated as RhD positive. Patients with other weak and variant RHD genotypes should be treated as RhD negative.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6287;29;"Choosing Wisely Australia";"Australasian Chapter of Addiction Medicine";English;"Use a 'universal precautions' approach for all psychoactive medications that have known potential or liability for abuse including opioids, benzodiazepines, antipsychotic medications, gabapentinoids, cannabinoids and psychostimulants.";"The misuse of a prescription drug or drug class (e.g. benzodiazepines, opioids) is often followed by warnings to medical practitioners to avoid use of that medication or drug class. This may result in doctors using alternative psychoactive medications (e.g. quetiapine, pregabalin) which, in turn, become identified as ?drugs of misuse? and become ?problem drugs?. Underlying this trend is an overreliance on medication in preference to psychosocial and physical therapies and a failure to adopt a broader universal precautions approach to the use of psychoactive medications. As all psychoactive medications have the potential to be abused, a universal precautions approach to prescribing such medicines is recommended, based upon the following principles: 1. risk screening: identifying patients at risk of poor adherence to medications and/or at risk of developing harms related to their use of a medication 2. identifying clear treatment goals with the patient and considering the role of medication and other treatment options, including the potential harms and benefits of use of a medication 3. structuring treatment according to patient risk including instalment dispensing, approaches to increase medication adherence such as urine drug screens and prescription monitoring, written treatment agreements and regular clinical reviews and 4. regular monitoring of patient outcomes and medication-related issues associated with adherence and adverse events.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6288;19;"Choosing Wisely Canada";"Canadian Obstetrical and Pediatric Transfusion Network Canadian Society for Transfusion Medicine";English;"Do not repeat prenatal titrations for mothers with clinically significant antibodies (e.g. RhD, K) if prediction of fetal cognate antigen typing is feasible and is deemed to be negative.";"Testing of a paternal sample and finding a negative antigen status (when paternity is assured) and/or non-invasive prenatal determination of the fetal genotype from maternal plasma with prediction of a negative antigen status confirm that the fetus is not at risk for hemolytic disease of the fetus and newborn and that ongoing pregnancy monitoring is unnecessary.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6289;2;"Choosing Wisely�";"Society of Critical Care Medicine";English;"It is not recommended to continue antibiotic therapy without evidence of need.";"In addition to employing microbe-directed therapy, a core principle of antibiotic stewardship is limiting antimicrobial therapy to the shortest effective duration. As a general rule, antimicrobials should be discontinued when the condition for which they were prescribed has been adequately treated, as one strategy to ensure access to effective antimicrobials, at a time when increased antimicrobial resistance represents a global health care challenge.";2021;;;"Low value";-;"?Link to the" 6290;19;"Choosing Wisely Canada";"Canadian Obstetrical and Pediatric Transfusion Network Canadian Society for Transfusion Medicine";English;"Avoid routinely performing direct antiglobulin test on all neonatal cord samples. ";"The DAT is not a screening test for hyperbilirubinemia or hemolytic disease. Routine assessment of the DAT may reveal cases of ABO incompatibility which are clinically insignificant; conversely the DAT may fail to identify significant hemolysis due to non immune causes. The DAT should be performed only when anemia or hyperbilirubinemia is suspected or when maternal alloantibodies are present.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6292;2;"Choosing Wisely�";"Society of Critical Care Medicine";English;"It is not recommended to delay progress towards release from mechanical ventilation in ICU patients.";"Although mechanical ventilation is frequently lifesaving, it is also associated with numerous complications. Discontinuation of mechanical ventilation support is frequently the rate limiting step in ICU discharge. Current guidelines recommend removing patients from mechanical ventilation support as soon possible, utilizing mechanical ventilation liberation and sedation interruption protocols in concert with structured multidisciplinary rounds.";2021;;;"Low value";-;"

Link to the

" 6294;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"Don?t use anticholinergic medications concomitantly with cholinesterase inhibitors in patients with dementia.";"Anticholinergics (e.g. overactive bladder medications and first-generation antihistamines) competitively inhibit binding of the neurotransmitter acetylcholine, thus reducing the effects of acetylcholine. Cholinesterase inhibitors, used in the treatment of dementia, act by blocking the enzyme acetylcholinesterase thereby inhibiting acetylcholine degradation. Therefore, pharmacologic actions of anticholinergics and cholinesterase inhibitors oppose each other. Concomitant use of anticholinergics with cholinesterase inhibitors reduces the effectiveness of antidementia drugs, the benefits of which are modest at best; concomitant use increases the risk of adverse effects of anticholinergics and may also increase the rate of functional and cognitive decline. Medications with anticholinergic properties are commonly prescribed to treat comorbidities associated with dementia and sometimes the adverse effects of cholinesterase inhibitors. Patients with dementia are sensitive to cognitive impairment induced by medications with anticholinergic properties. In general, it has been recognized that anticholinergics are known to adversely affect cognition in older patients and even more so with concomitant dementia diagnosis.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6295;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"Don?t recommend highly anticholinergic medications in older adults without first considering safer alternatives or non-drug measures.";"Many medications have strong anticholinergic activity including first generation antihistamines (e.g. diphenydramine, doxylamine), tricyclic antidepressants, gastrointestinal antispasmodics, antiemetics, muscle relaxants, medications for urinary incontinence and medications to treat Parkinson disease. Older adults are more sensitive to adverse events associated with anticholinergics including confusion, dry mouth, blurry vision, constipation, urinary retention, decreased perspiration and excess sedation. Anticholinergics have also been associated with increased dementia risk. These medications are especially problematic for people with existing cognitive impairment and bladder anticholinergics should be used judiciously for these patients. It is important to inquire about over-the-counter antihistamine use and help patients select safer alternatives for sleep and seasonal allergies. For example, for seasonal allergies, second generation antihistamines have minimal anticholinergic effects and allergies may be managed with inhaled steroids. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6297;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"Don?t continue medications at transitions of care without a pharmacist or other qualified health care professional performing a comprehensive medication review to verify accurate and complete medication information in concert with current medical problems.";"Transitions of care can contribute to serious medication-related problems when transitioning between different care settings. Older adults with complex health care problems appear to be a group particularly at risk for increased adverse events. To mitigate errors in prescribing and transcribing, routine assessments should include a comprehensive medication review, medication reconciliation, and an accurate medication history with the patient and his or her advocate. A thorough medication history involves following a systematic process of interviewing the patient, family or caregiver and verifying the history with at least one other reliable source of information to determine the complete and correct list of the patient?s actual medication use at the time of the transition. Negative outcomes associated with transitions across healthcare settings include increased likelihood of polypharmacy when medications are continued that are no longer indicated, therapeutic drug duplication, heightened risk of adverse drug reactions, and poor adherence related to greater complexity of the medication regimen.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6299;2;"Choosing Wisely�";"American Society of Consultant Pharmacists";English;"Don?t initiate medications to treat new and emerging symptoms without first ascertaining that the new symptom is not an adverse drug event of an already prescribed medication.";"The risk of adverse drug reactions (ADR) and hospital admissions related to ADRs increases with age, polypharmacy and comorbidities. It is prudent for clinicians to be aware of the prescribing cascade to reduce the prescription of potentially unnecessary medications that may cause patient harm. Prescribing cascades are a type of problematic polypharmacy that occur when an adverse drug event (ADE) is misinterpreted as a new medical condition, and a second medication is prescribed to address this emerging ADE. If a suitable alternative is available, discontinuation of the medication thought to be the cause of the ADR would be the best course of action. The decision to prescribe a second medication to counteract an ADR from a first medication should only occur after careful consideration, and where the benefits of continuing therapy with the first medication outweigh the risks of additional adverse reactions from the second medication. Older adults are at an increased risk of experiencing prescribing cascades due to the higher incidence of polypharmacy and multi-comorbidity. For example, calcium channel blockers (CCBs) are commonly prescribed for hypertension and have the potential to cause peripheral edema. A prescribing cascade occurs when the edema is misinterpreted as a new medical condition and a diuretic is subsequently prescribed to treat the edema. Ideally, the choice of a different antihypertensive may be the best action at this time, in this example. Addressing the prescribing cascade involves focusing on the medication review process and deprescribing initiatives. There are a range of resources to prevent, detect, and reverse prescribing cascades to improve the appropriate use of medications.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6300;29;"Choosing Wisely Australia";"Australasian Chapter of Sexual Health Medicine";English;"Do not prescribe testosterone therapy to older men except in confirmed cases of hypogonadism ";"Hypogonadism justifying testosterone therapy regardless of age is confirmed based on measurement of circulating testosterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations. There is limited high-quality evidence to justify testosterone treatment in older men, usually with chronic disease, who have low circulating testosterone levels but without confirmed pathological hypogonadism, whether due to hypothalamic, pituitary or testicular disease. Moreover, excess cardiovascular events have been associated with testosterone treatment of older men without pathological hypogonadism. While the evidence on these side effects is mixed and additional studies are needed to clarify whether testosterone therapy increases cardiovascular risk, this provides an added reason to restrict the prescription of testosterone therapy to confirmed cases of hypogonadism. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6301;2;"Choosing Wisely�";"Society of Critical Care Medicine";English;"It is not recommended retain catheters and drains in place without a clear indication in ICU patients . ";"Patients in intensive care units typically require insertion of catheters and drains for fluid and medication delivery, pressure and flow monitoring, and fluid and gas evacuation. The majority of hospital-acquired infections and unintended safety events are associated with such devices. Daily assessment of need for invasive devices should be an essential element of critical care workflow, to reduce time of exposure by identifying the earliest opportunity for their discontinuation";2021;;;"Low value";-;"Link to the" 6302;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Neurological Surgery";English;"It is not recommended to routinely obtain a CT or MRI scan for developmentally normal, clinically asymptomatic infants with macrocephaly. ";"Most infants with macrocephaly do not have abnormalities that require neuroimaging or neurosurgical evaluation. Imaging should generally be reserved for infants with clinical concerns such as abnormal neurological examination findings, significant developmental delay, or rapidly increasing head circumference measurements (such as those crossing growth curves). When imaging is indicated, head ultrasonography should typically be considered as the first-line test for infants with an open fontanelle.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6304;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Dermatology";English;"It is not recommended to routinely request laboratory tests in patients with alopecia areata in the absence of signs and/or symptoms of the diseases in question. ";"Alopecia areata is a hair loss disorder believed to have an autoimmune origin. It is well-established that patients with alopecia areata have an increased risk of other autoimmune conditions, with thyroid disease being the most common. As in the case of vitiligo, it is more common to find thyroid autoantibodies or subclinical hypothyroidism than overt thyroid disease, unless there are clinically suspicious findings. Patients identified as having subclinical hypothyroidism are not currently treated and may even have resolution of the abnormal TSH. Recognizing the risk of associated autoimmune disease has led physicians over time to screen patients with alopecia areata for other diseases. There is no convincing evidence that extensive workups in the absence of specific clinical suspicion improves outcomes for patients and may in fact beget additional costs, including follow-up for patients screening positive, as well as harms. Although many studies suggest ordering these tests, this is based largely on the increased cosegregation of alopecia areata and thyroid disease and not on improved management strategies or outcomes from having identified an abnormal laboratory test result. Therefore, thyroid function testing, including screening for thyroid autoimmune disease or hypothyroidism, is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history of thyroid disease.";2021;;;"Low value";-;"Link to the" 6305;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Neurological Surgery";English;"It's not recommended to perform routine imaging for evaluation of VP shunt function in a pediatric patient without signs or symptoms of shunt malfunction.";"Routine imaging to evaluate ventricle size in an asymptomatic patient with hydrocephalus is not necessary. When imaging is needed, performing a rapid brain MRI is a recommended option to prevent radiation exposure to the child. Surveillance imaging, if needed, should only be ordered by specialists who treat hydrocephalus. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6307;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Dermatology";English;"It is not recommended treating tinea capitis with topical medications alone. ";"Tinea capitis, a dermatophyte infection of the hair shafts of the scalp, is treated with antifungal agents. Topical treatments cannot penetrate the hair shaft itself, which is where the infection lies; thus, monotherapy with topical medications is insufficient to effectively treat the infection. This insufficient treatment can lead to increased health care costs resulting from multiple visits and the prescribing of ineffective medications. For this reason, when tinea capitis is suspected or is diagnosed, systemic treatment is warranted, most commonly with off-label griseofulvin or terbinafine. Terbinafine is effective for most types of tinea capitis and is less expensive than griseofulvin with improved compliance because of a shorter required course of treatment. Topical treatments such as ketoconazole shampoo and selenium sulfide shampoo may be used adjunctively to decrease carriage of viable spores, thus possibly decreasing the time to cure and decreasing shedding of the organism, which decreases risk of transmission of infection to other individuals.";2021;;;"Low value";-;"Link to the" 6308;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Neurological Surgery";English;"It's not recommended to routinely perform imaging or routine elective procedures requiring sedation or general anesthesia for very young children with low-risk asymptomatic lesions.";"Low-risk asymptomatic lesions such as small rubbery scalp masses representing dermoid cysts or shallow midline sacral dimples do not routinely require intervention as a young infant. Routine magnetic resonance imaging requiring anesthesia is typically not recommended. Given the US Food and Drug Administration?s Drug Safety Communication on pediatric anesthesia (www.fda.gov/Drugs/DrugSafety/ucm532356.htm) warning that general anesthesia and sedation drugs used in children younger than 3 years for anesthesia of more than 3 hours or repeated use of anesthetics may affect the development of children?s brains, risks and benefits of elective imaging or procedures should be carefully weighed (http://smarttots.org/). If imaging is necessary, consider approaches such as feed-and-wrap for MRI in infants or referral to specialists to develop a clinical follow-up plan and timing of intervention as appropriate.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6310;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Neurological Surgery";English;"It's not recommended to obtain imaging of the cervical spine following trauma in an awake and alert pediatric patient without considering the use of clinical decision making (CDM) tools for cervical spine clearance. ";"Consideration should be given to avoid unnecessary radiation exposure when appropriate. For instance, CDM tools incorporate 3 or more variables from history, physical examination, or simple clinical tests to guide patient management. Results from the National Emergency X-Radiography Utilization Study (NEXUS) and the Pediatric Emergency Care Applied Research Network (PECARN) provide a high negative predictive value for significant cervical spine injuries in pediatric patients. Low-risk criteria from NEXUS include: no posterior midline cervical spine tenderness; no evidence of intoxication; normal level of consciousness; no focal neurological deficit; and no painful distracting injuries. PECARN developed a model that was highly sensitive for a normal cervical spine in the absence of: altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, conditions predisposing to cervical spine injury, high-risk motor vehicle crash, and diving. In comparison to NEXUS, the PECARN model takes into account mechanism of injury and specific extent and location of other associated injuries.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6311;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Dermatology";English;"It is recommended that the use of combination topical steroidal antifungals be avoided for tinea corporis, Candida skin infections, and diaper rash.";"Although combination topical antifungal/corticosteroids have been approved for the treatment of tinea corporis, candidiasis, and diaper dermatitis, we recommend against use of these agents. Many providers are unaware that the combination products contain a relatively high-potency topical steroid. For treatment of tinea corporis, the application of a topical antifungal agent alone is recommended. If symptoms such as severe pruritus require concomitant application of a topical steroid, a separate low-potency agent can be prescribed, allowing for a tapering course that should be limited to less than 2 weeks. A separate topical antifungal cream can be continued longer until the infection is cleared. This will reduce the risk of systemic absorption of the topical steroid. Combination products are often used for treatment of diaper dermatitis. In most patients, diaper dermatitis is an irritant contact dermatitis from stool that will usually respond to barrier diaper creams/ointments alone. Combination products, if applied with every diaper change, can result in skin atrophy, striae, and systemic absorption of the relatively high-potency topical steroids. It is instead recommended that barrier products be applied with every diaper change in this circumstance and a second low-potency topical steroid be applied, as needed, no more than twice a day and tapered as soon at the dermatitis is under control. Combination products are also often expensive and not covered by pharmacy plans.";2021;;;"High value";-;"Link to the" 6313;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Neurological Surgery";English;"It's not recommended to perform routine imaging for evaluation of infant head shape. ";"Routine imaging for the evaluation of infant head shape is not necessary. It exposes the child to unnecessary radiation. Positional plagiocephaly can be diagnosed on clinical examination. Most craniosynostosis presentations can also be discerned on clinical examination. Imaging may be obtained by specialists to make the diagnosis in complex cases and, if necessary, for surgical planning.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6314;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Dermatology";English;"It is recommended to avoiding the use of systemic corticosteroids (oral or injected) in most cases of atopic dermatitis.";"Although systemic corticosteroids can lead to rapid clearing of disease and improvement in pruritus, many short- and long-term adverse effects limit their use, including significant growth retardation, adrenal suppression in more than 90%, and rebound flaring and/or worsening of disease at the time of corticosteroid discontinuation. Atopic dermatitis treatment guidance put forth by the American Academy of Dermatology specifically advises against the use of systemic steroids in children with atopic dermatitis, with few exceptions. In general, atopic dermatitis can be adequately controlled with good skin care practices and topical prescription therapies. In patients who have recalcitrant disease, phototherapy and/or steroid-sparing systemic agents may be required for adequate control. Systemic corticosteroids should only be prescribed for severe flares once all other treatment options have been exhausted and should be limited to a short course for the purpose of bridging to a steroid-sparing agent.";2021;;;"High value";-;"Link to the" 6570;1;"NICE ";NICE;English;"It is recommended to diagnose and manage vaccine-induced immune thrombocytopenia and thrombosis ";"This guideline covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a syndrome which has been reported in rare cases after COVID-19 vaccination. Because VITT is a new condition, there is limited evidence available to inform clinical management, identification and management of the condition is evolving quickly as the case definition becomes clearer. This guideline was produced to support clinicians to diagnose and manage this newly recognised syndrome.";2021;;;Uncertain;"Diagnosis and management";"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 6059;35;"Evidencias COVID-19";"Evidence aid";English;"It should be avoided procedures that generate aerosols during the COVID-19 pandemic by health professionals ";"The reviews, covering a range of clinical areas, suggest that healthcare workers may be at increased risk of COVID-19 from aerosol generating procedures (AGPs).Some reviews suggest that measures to reduce these risks include delaying procedures during the pandemic and the use of antimicrobial treatments before and after the procedures.";2021;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6315;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It's not recommended to perform 3rd trimester Group B streptococcus (GBS) culture in patients with GBS bacteriuria during pregnancy. ";"Group B streptococcus (GBS) bacteriuria at levels of 105 CFU/mL or greater, either symptomatic or asymptomatic, warrants acute treatment during pregnancy and indicates the need for intrapartum antibiotic prophylaxis at the time of birth, and thus no additional rectovaginal culture later in pregnancy is necessary. Identification of asymptomatic bacteriuria with GBS during pregnancy at a level less than 105 CFU/mL does not require maternal treatment during the antepartum period but is an indication for intrapartum prophylaxis at the time of birth.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6060;35;"Evidencias COVID-19";Evidenceaid;Spanish;"It is recommended to accomplish a class?based school vaccination strategy that leads to slightly higher vaccine uptake in adolescents.";"COVID-19 vaccines are becoming available and existing research on how to improve the uptake of vaccination might be useful for policy makers. In this Cochrane review, the authors searched for comparative effectiveness studies of interventions to improve uptake of a variety of vaccinations among adolescents. ";2021;;;"High value";Preventive;"Link to the recommendation on the website of the initiative" 6061;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended to use patient reminder or recall interventions in order to improve the proportion of participants who receive immunization of COVID-19.";"COVID-19 vaccines are becoming available and existing research on how to improve the uptake of vaccination might be useful for policy makers. In this Cochrane review, the authors searched for comparative effectiveness studies to improve uptake of immunizations.";2021;;;"High value";"Prevention, patient management, management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6317;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Dermatology";English;"It is not recommended to routinely order laboratory tests for associated autoimmune diseases in patients with vitiligo in the absence of signs and/or symptoms of the diseases in question.";"Vitiligo is a depigmenting disorder believed to have an autoimmune origin. It is well-established that patients with nonsegmental vitiligo have an increased risk of other autoimmune conditions, with subclinical hypothyroidism being the most common. There is also a higher risk of having antithyroid antibodies (TPOs). Other autoimmune conditions have been associated with vitiligo but less commonly. Recognizing the risk of associated autoimmune conditions has led physicians to screen patients with vitiligo for other diseases. There is no convincing evidence that extensive workups in the absence of specific clinical suspicion improves outcomes for patients and may in fact beget additional costs and harms. Although many studies suggest ordering these tests, it is based largely on the increased cosegregation of vitiligo and thyroid disease and not on improved outcomes from having identified an abnormal laboratory test result. Therefore, thyroid function testing including screening for thyroid autoimmunity or hypothyroidism is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history of thyroid disease";2021;;;"Low value";-;"Link to the" 6062;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended tocilizumab in patients with severe COVID-19 disease. ";"The authors searched for studies that assessed the efficacy of adding tocilizumab to standard care for COVID-19 patients. At the time of the review, the included studies suggest that tocilizumab has the potential to reduce mortality rates and the need for mechanical ventilation in COVID-19 patients with severe disease. ";2021;;;"High value";"Treatment. Patients management. ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6318;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It's not recommended to routinely exclude women with two prior low transverse cesarean deliveries from having the choice to undertake a trial of labor after cesarean";"Although in some studies, women with two prior cesarean deliveries who attempt a trial of labor after cesarean have a higher rate of complications than women with one prior cesarean delivery, the absolute risk of any major complication remains low and the chance of achieving a vaginal birth are similar to those who have one prior cesarean. Given the risk of maternal morbidity and placenta accreta spectrum associated with multiple repeat cesarean deliveries, a trial of labor should remain an option for women with two prior low transverse cesarean deliveries.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6320;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It's not recommend delivery in a nondiabetic patient for suspected macrosomia before 39 0/7 weeks of gestation. ";"Recommendations regarding the optimal timing of delivery seek to balance maternal and perinatal risks. Delivery before 39 0/7 weeks of gestation without medical indication has been associated with increased adverse perinatal outcomes compared with those at or beyond 39 weeks of gestation. For suspected macrosomia, the accuracy of estimated fetal weight using sonographic and clinical estimates is inherently imprecise. In addition, the data comparing delivery to expectant management for suspected macrosomia are inconsistent with regard to reducing the risk of shoulder dystocia, especially when weighed against the harms of early delivery. Given the imprecision in fetal weight assessment, the increase in adverse perinatal outcomes, and the limited data demonstrating benefit, delivery before 39 weeks of gestation is not recommended for suspected macrosomia in nondiabetic patients.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6576;1;"NICE ";NICE;English;"The prevention of consumption, promotion of cessation and treatment of tobacco dependence in smoking patients are recommended.";"Smoking cessation support is recommended for everyone over the age of 12. It also covers ways to prevent children, youth, and young adults age 24 and younger from starting to smoke. Covers nicotine replacement therapy and electronic cigarettes to help people quit smoking or reduce the harm caused by tobacco.";2021;;;"High value";"prevention and treatment";https://www.nice.org.uk/guidance/ng209 6321;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"It is recommended that the use of orthopedic therapeutic biologics, including platelet-rich plasma and stem cell treatment, be avoided for foot and ankle problems without first considering established conventional treatment options.";"Orthopaedic therapeutic biologics (orthobiologics) comprise a variety of tissue grafts and autologous blood products that include platelet rich plasma (PRP) and mesenchymal stem cell treatment. Surgeons bear responsibility to offer their patients efficacious, safe and cost-effective treatments. Orthobiologic treatment can be costly and may not be covered by insurance. Patients can become financially vulnerable especially when pursuing orthobiologic treatment that extends beyond its intended use, scientific support, or regulatory approval. Surgeons should be well-versed in the scientific basis, techniques, potential risks, and regulatory status of orthobiologic treatments. Furthermore, surgeons should review the risks, benefits, and anticipated efficacy of orthobiologic therapy with patients in advance. Orthobiologic treatment options represent a rapidly expanding area of interest for both patients and providers, but remain relatively new and understudied. There is ongoing need for investigative research.";2021;;;"High value";-;"Link to the" 6066;35;"Evidencias COVID-19";"Evidence aid";English;"It is not recommended hydroxychloroquine for the treatment of COVID-19 ";"In this Cochrane review, the authors searched for randomized trials testing chloroquine or hydroxychloroquine in COVID-19 patients, people at risk of exposure to SARS-CoV-2 or people exposed to SARS-CoV-2. They included 12 trials (8569 participants) of the treatment of COVID-19 and 2 trials (3346 participants) for preventing COVID?19 disease in people who have been exposed to SARS?CoV?2. They found no trials of chloroquine or hydroxychloroquine for preventing COVID?19 disease in people at risk of exposure to SARS?CoV?2. ";2021;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6322;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It's not recommend to perform routine midtrimester serum biomarker risk stratification for preterm birth or preeclampsia in asymptomatic pregnant patients. ";"Routine midtrimester biomarker risk stratification for preterm birth (e.g., various cytokines) and preeclampsia (e.g., placental growth factor (PlGF), soluble FMS-like tyrosine kinase-1 (sFlt-1)) in asymptomatic pregnant women is not recommended due to its limited utility and poor predictive value, respectively. Importantly, employing interventions (eg, low-dose aspirin) based on screening results have not been shown to improve maternal or fetal outcomes. Furthermore, there is the potential to expose many women to unnecessary prophylactic intervention(s).";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6068;35;"Evidencias COVID-19";"Evidence aid";English;"It is recommended the targeted client communication using mobile devices to improve maternal and child health";"In this Cochrane review, the authors searched for studies with at least 20 participants that tested targeted client communication in pregnant women, postpartum women and parents of young children. Women and parents who receive targeted mobile text messages may be slightly more likely to make appointments or use healthcare services than those sent non-targeted text messages or messages by other means.";2021;;;"High value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6324;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It's not recommend to perform routine cell-free DNA screening for microdeletions in pregnant pacients. ";"Cell-free DNA screening for the common aneuploidies is associated with a high detection rate and low false-positive rate. This screening test is also now offered for a small number of microdeletion syndromes. Most of these microdeletions are extremely rare. Given the very low prevalence of these conditions, most positive test results will be false positives, and the positive predictive value of the test is very low. Moreover, data are lacking for the performance of microdeletion screening, which can add substantially to the costs of this test.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6325;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"It is not recommended making irreversible decisions based on the results of the cell-free DNA screening test in pregnancy.";"False positive and false negative results occur with cell-free DNA screening. Any positive cell-free DNA screening result should be confirmed with invasive diagnostic testing prior to a termination of pregnancy. If cell-free DNA screening is performed, adequate pretest counseling must be provided to explain the benefits and limitations.";2021;;;"Low value";-;"Link to the" 6071;35;"Evidencias COVID-19";"Evidence aid";Spanish;"It is recommended the continuation of psychiatric medication when prescribed and can be used safely in combination with COVID-19 medication";"In this rapid review, the authors searched for studies of interactions between psychotropic and some drugs used for COVID-19 patients. They included 30 studies. At the time of this review, the included studies showed that drug interactions were a major concern in the comorbidity of psychiatric disorders and COVID-19 infection, affecting expected therapeutic outcomes and toxicity. At the time of this review, the authors concluded that psychiatric medication can be safely used in combination with COVID-19 medication with careful selection of a drug with the least possibility of interaction, or careful patient monitoring and management.";2021;;;"High value";Treatment;"https://evidenceaid.org/resource/interactions-of-psychiatric-and-covid-19-medications-research-up-to-april-2020/" 6327;2;"Choosing Wisely�";"Society of Critical Care Medicine";English;"It's not recommend to provide care that is discordant with the ICU patient?s goals and values. ";"The condition of ICU patients is often uncertain and dynamic, which generates stress for ICU families and the care staff. Accordingly, eliciting and documenting desired care preferences helps ensure the provision of goal-concordant care. Patients, families and providers may participate as partners in shared decision-making to ensure that goals and values align with care that is offered and provided. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6072;35;"Evidencias COVID-19";"Evidence aid";English;"It is not recommended to use routine laboratory tests to determine if a person has COVID-19.";"In this Cochrane rapid review, the authors included 21 studies of the diagnostic accuracy of routine laboratory testing as a triage test for COVID-19. The included studies showed that none of the 67 different laboratory tests reviewed could be used to accurately rule in or rule out COVID-19 on their own, due to low sensitivity and specificity.";2021;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 6329;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA";English;"It is not recommended initiation of intravenous antibiotic therapy in well-appearing neonates with isolated risk factors for sepsis, such as maternal chorioamnionitis, prolonged rupture of membranes, or untreated group B streptococcal colonization. Use clinical tools like an evidence-based sepsis risk calculator to guide management. ";"Unnecessary exposure of infants to antibiotics is associated with increased parental anxiety, length of stay, increased cost, gut microbiome dysbiosis, necrotizing enterocolitis and possibly allergic and autoimmune diseases. Antibiotic therapy often leads to transfers to higher levels of care and thus decreased maternal-infant bonding. The use of evidence-based sepsis calculators has demonstrated reductions in antibiotic use of 50% or more without a concomitant increase in the incidence of early onset sepsis. ";2021;;;"Low value";-;"Link to the" 6074;35;"Evidencias COVID-19";"Evidence aid";English;" It is recommended the communication by text messages for citations and use of the health system in maternal and child health";"The COVID-19 pandemic has placed a strain on healthcare services. Existing research on client communication using mobile devices may provide useful information for healthcare providers and policymakers. In this Cochrane review, that tested targeted client communication in pregnant women and postpartum women, and parents of young children. They included 27 studies, from Cameroon (1 study), Canada (1), Ecuador (1) Guatemala (1), India (2), Kenya (7), Nigeria (3), Tanzania (1), Thailand (1), UK (1), USA (7), and Zimbabwe (1). The effects of mobile messaging on most health-related outcomes are uncertain.";2021;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6330;2;"Choosing Wisely�";"Society of Critical Care Medicine";English;"It's not recommend to delay mobilizing ICU patients.";"Patients can develop significant muscle weakness and atrophy (including the diaphragm) during their ICU stay due to immobilization. However, multidisciplinary facilitated early mobilization has been shown to be safe in the ICU setting. Numerous, patient-centered, clinically meaningful outcomes are supported by early mobilization of critically ill patients. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6076;35;"Evidencias COVID-19";"Evidence aid";English;"It is reccommended health messages to encourage vaccination during a pandemic or epidemic from credible sources.";"Several vaccines have been shown to be effective against COVID-19. Existing research on the public?s responses to messages encouraging vaccination during a pandemic or epidemic might provide useful information for policy makers. In this rapid systematic review, they discovered that messages which over-emphasised the health benefits of vaccines and used terminology that the target populations could not understand had negative impacts.";2021;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6332;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA";English;"Is not recommended using broad-spectrum antibiotics such as ceftriaxone for children hospitalized with uncomplicated community-acquired pneumonia. Use narrow-spectrum antibiotics such as penicillin, ampicillin or amoxicillin. ";"Using broad-spectrum antibiotic therapy does not improve rates of treatment failure, length of stay, or decrease costs when compared with narrowspectrum antibiotic therapy for children hospitalized with community-acquired pneumonia (CAP). The use of narrow-spectrum antibiotics for children hospitalized with CAP can limit the development of multi-drug resistant organisms, while achieving similar or better outcomes. ";2021;;;"Low value";-;"Link to the" 6077;35;"Evidencias COVID-19";"Evidence aid";English;"There is uncertainty in recommending extracorporeal membrane oxygenation as a treatment for patients with COVID-19.";"There is uncertainty in recommending extracorporeal membrane oxygenation as a treatment for patients with COVID-19. At the time of this review, the included studies suggest that while ECMO is beneficial in some patients, the recuperative effects of ECMO are uncertain.";2021;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6078;35;"Evidencias COVID-19";"Evidence aid";English;"There is uncertainty about the interventions based on signs and symptoms to diagnose Covid-19 cases.";"Cuando los pacientes con sospecha de COVID-19 se presentan en centros de atenci�n primaria o ambulatorios de un hospital, se pueden usar signos y s�ntomas para determinar si tienen la enfermedad. Esta revisi�n r�pida Cochrane actualizada muestra que seg�n los datos disponibles, ni la ausencia ni la presencia de ning�n signo o s�ntoma espec�fico es lo suficientemente precisa como para diagnosticar o descartar la enfermedad de COVID-19. Sin embargo, la p�rdida del sentido del olfato (anosmia) o del gusto (ageusia) puede ser �til como se�al de alerta para el COVID-19; y la presencia de fiebre o tos, dada su alta sensibilidad, tambi�n puede ser �til para identificar a las personas para realizar m�s pruebas.";2021;;;Uncertain;"Diagnosis. ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6334;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA";English;"It is not recommended to initiate phototherapy in term or late preterm well-appearing infants with neonatal hyperbilirubinemia if their bilirubin is below levels at which the AAP guidelines recommend treatment";"The risk of poor neurologic outcomes, such as cerebral palsy due to kernicterus, is extremely low for term and late preterm newborns with modestly elevated bilirubin levels. Confirmed cases of kernicterus have average bilirubin levels near 40 mg/dL, and are typically associated with hemolysis. While phototherapy for bilirubin values above published thresholds may be useful to prevent severe hyperbilirubinemia and exchange transfusions, its use for bilirubin values below published thresholds is unnecessary and is associated with additional costs and unnecessary hospitalization. ";2021;;;"Low value";-;"Link to the" 6336;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA";English;"It is not recommended continue hospitalization in well-appearing febrile infants once bacterial cultures (i.e. blood, cerebrospinal, and/or urine) have been confirmed negative for 24?36 hours, if adequate outpatient follow-up can be assured. ";"Routinely continuing hospitalization beyond 24?36 hours of confirmed negative bacterial cultures for well-appearing infants admitted for concern of serious bacterial infection does not improve clinical outcomes. Blood culture yield is highest in the first 12?36 hours after incubation with multiple studies demonstrating >90% of pathogen cultures being positive by 24 hours. If adequate outpatient follow-up can be assured, discharging well-appearing febrile infants at 24?36 hours if cultures are confirmed to be negative will decrease length of stay, antibiotic exposure, and iatrogenic complications. ";2021;;;"Low value";-;"Link to the" 6337;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA ";English;"It is not recommended intravenous antibiotics for predetermined durations for hospitalized patients with infections such as pyelonephritis, osteomyelitis, and complicated pneumonia. Consider early transition to oral antibiotics.";"Recent publications have demonstrated that strategies for early transition to oral antibiotics achieve equal or better outcomes for common inpatient infections and are safer than prolonged intravenous antibiotics in children. The use of intravenous lines such as peripherally inserted central catheters, which are often necessary for prolonged intravenous antibiotics, can lead to complications such as thrombosis or line infections. Antibiotic courses with predetermined durations are often not based on high-quality evidence and ignore individual response to treatments, which can vary significantly from patient to patient. Once a patient is able to tolerate them, early transition to oral antibiotics, based on individual patient clinical responses such as defervescence and other symptoms and signs of improvement, are patient and family centered and can improve the value of care for hospitalized children. ";2021;;;"Low value";-;"Link to the" 6339;2;"Choosing Wisely�";"Pediatric Hospital Medicine ? SHM, AAP, APA ";English;"It is not recommended to use two or more drugs known to increase the risk of bleeding without weighing the possible risks and benefits in pediatrics. These medications include direct oral anticoagulants (DOACs), warfarin, aspirin, selective serotonin reuptake inhibitors (SSRIs), antiplatelet agents, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids.";"Prescribing more than one of these medications concurrently may result in an enhanced risk of bleeding. This heightened bleeding risk may be mediated through complex pharmacokinetic and/or pharmacodynamic mechanisms. It is well established that the combination of anticoagulants and NSAIDs increase bleeding risk. A combination of warfarin with either single or dual antiplatelet therapy significantly increases the risk of major bleeding by 2- to 4-fold, respectively. The most commonly prescribed antidepressant therapeutic class (SSRIs), may decrease platelet serotonin uptake, leading to impaired platelet aggregation, and thereby increased bleeding risk. Specific to gastrointestinal bleeding, SSRIs may also increase gastric acid secretion. Bleeding has been observed in association with other antidepressants in some observational studies, however recent systematic reviews give weight to SSRIs in combination with NSAIDs for increased vigilance for risk of upper gastrointestinal bleeding. In patients where benefits outweigh the risks of the combination, appropriate education of patient and caregivers and appropriate follow-up monitoring for early detection of any signs and symptoms of bleeding is highly recommended. ";2021;;;"Low value";-;"Link to the" 6341;29;"Choosing Wisely Australia";"Australasian Chapter of Addiction Medicine";English;"It is not recommended elective withdrawal treatment in the absence of an agreed post-withdrawal treatment plan that addresses substance use and related health problems.";"The main aims of withdrawal management are to provide the means for safe withdrawal from a drug of dependence, including alcohol, and to link the patient to relevant ongoing treatment for their Substance Use Disorder (SUD) and health and social conditions. Evidence shows that withdrawal management results in better outcomes, including reduced readmission rates, when a structured post-withdrawal treatment plan is formulated in collaboration with the patient. ";2021;;;"Low value";-;"Link to the" 6342;29;"Choosing Wisely Australia";"Australasian Chapter of Addiction Medicine";English;"It is not recommended prescribing pharmacotherapies as a stand-alone treatment for substance use disorders (SUD), but rather as part of a broader treatment plan that identifies treatment goals, incorporates psychosocial interventions, and identifies how outcomes will be monitored.";"Safe and effective pharmacotherapies exist for the management of substance use disorders (e.g. methadone, buprenorphine, naltrexone for opioid dependence; acamprosate, naltrexone, disulfiram for alcohol dependence; nicotine replacement, varenicline, bupropion for nicotine dependence; and benzodiazepines as part of benzodiazepine withdrawal). However, the vast majority of studies of these pharmacotherapies have either evaluated their effectiveness in combination with psychosocial interventions or demonstrated them to be more effective when prescribed in combination with psychosocial interventions. Therefore, practitioners should always ensure that patients have clinical pathways available to access psychosocial interventions and that these interventions are incorporated into treatment care plans. ";2021;;;"Low value";-;"Link to the" 6087;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force A and B recommendations";English;"It is recommended that clinicians provide behavioral interventions for smoking cessation in adults and pregnant women.";"Clinicians are encouraged to ask all adults about tobacco use, advise smoking cessation, and provide behavioral interventions in adults and pregnant women, in addition to being able to use FDA-approved drug therapy in adults (except pregnant women, for whom there is insufficient evidence) . It is concluded that the net benefit of the cited recommendations has substantial evidence. This is a systematic review.";2021;;;"High value";"Smoking habit";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6343;1;"NICE ";NICE;English;"It's not recommend to use the lateral elbow resurficing for arthritis, it can only be used in specific research cases or selected clinical cases.";"This technique has a limited quantity and quality effectiveness, so it is not recommend except in some specific cases in which these instructions must be followed. Clinicians wishing to do lateral elbow resurfacing for arthritis should: -Inform the clinical governance leads in their healthcare organisation. -Give patients (and their families and carers as appropriate) clear written information to support shared decision making, including NICE's information for the public. -Ensure that patients (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these. -Enter details about all patients having the procedure onto the National Joint Registry. Clinicians should also audit and review their outcomes locally. -Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve. Healthcare organisations should: -Ensure systems are in place that support clinicians to collect and report data on outcomes and safety for every patient having this procedure. -Regularly review data on outcomes and safety for this procedure. The procedure should only be done in specialist centres by surgeons who do elbow arthroplasty regularly and have training in this specific technique. Report any problems with a medical device using the Medicines and Healthcare products Regulatory Agency's Yellow Card Scheme. Further research, which could include case series with long-term follow up, should report range of motion, patient-reported outcomes and complications.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6088;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force A and B recommendations";English;"There is uncertainty about the balance of the benefits and harms of pharmacotherapy in smoking cessation in pregnant women.";"Clinicians are encouraged to ask all adults about tobacco use, advise smoking cessation, and provide behavioral interventions in adults and pregnant women, in addition to being able to use FDA-approved drug therapy in adults (except pregnant women, for whom there is insufficient evidence) . It is concluded that the net benefit of the cited recommendations has substantial evidence. This is a systematic review.";2021;;;Uncertain;"Smoking habit";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6344;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"It is not recommended to perform a D-dimer in patients at high risk of pulmonary embolism. ";"The sequence for diagnostic testing in patients with suspected pulmonary embolism depends on the clinical circumstances. The certainty of a negative diagnosis for PE via an algorithm including a negative D-dimer result is enhanced when the algorithm follows a multibranch diagnostic pathway. While combining a negative D-dimer result with a low or moderate clinical probability for PE rules out these diagnoses, the use of D-dimer is not helpful in patients with a high probability clinical assessment since a negative D-dimer does not exclude PE in more than 15 percent of such patients. According to Wells? criteria for deep vein thrombosis, a score of less than two indicates low risk, and above two indicates intermediate/high risk. The high score is ?4.5 in the two-tier model and >6 in the three-tier model (2-6 indicates moderate risk in this model). ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6856;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Nephrology";English;"Treatment that markedly lowers glycated hemoglobin from <6.5% to <8.0% is not recommended in patients with early chronic kidney disease (stages 1-3).";"Diabetes mellitus is associated with significant cardiovascular morbidity and mortality and is the leading cause of chronic kidney disease (CKD) worldwide. Evidence indicates that tight glycaemic control in diabetic patients results in clinically significant preservation of kidney function. As such, patients with stage 1?3 CKD stemming from type 1 or type 2 diabetes mellitus should aim to achieve a HbA1c target of approximately 6.5% to <8.0%. Caution is recommended against intensively lowering HbA1c levels below this target range because of proven increased risks of hypoglycaemia and possibly death. While a lower HbA1c target (<6.5% or <7%) may be preferred in some patients, less stringent glycaemic goals (<7.5% or <8%) may be appropriate for others, especially those with a history of hypoglycaemia, long duration of diabetes, advanced atherosclerosis or advanced age/fragility.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6347;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Long-term systemic corticosteroids are not recommended for the treatment of chronic obstructive pulmonary disease.";"Despite their ongoing and frequent use, there is insufficient evidence regarding efficacy of systemic corticosteroids in the treatment of COPD without exacerbations. Well-known side-effects of this drug group are obesity, respiratory and peripheral muscle weakness, hypertension, psychiatric disorders, diabetes mellitus, osteoporosis, skin thinning and bruising. The burden of cardiovascular disease has a significant impact on all-cause mortality in COPD patients. The combination of limited efficacy and potential toxicity of the drugs, especially in the at-risk patients who tend to be older, less active and have histories of smoking, means that long term use of systemic corticosteroids in COPD is not recommended. In the cases of the exacerbations of COPD, a 2018 systematic review from Cochrane suggests that a five-day course of oral corticosteroids is likely to be sufficient and that the likelihood that shorter courses of systemic corticosteroids (of around five days) lead to worse outcomes compared with longer courses (10 to 14 days) is low.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6092;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force A and B recommendations";English;"There is uncertainty about the balance of benefits and harms of e-cigarettes to stop smoking";"It is concluded that the current evidence is insufficient to assess the balance of benefits and harms of electronic cigarettes for smoking cessation in adults, including pregnant people.";2021;;;Uncertain;"Electronic cigarettes";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6093;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";Spanish;"Is not recommended screening for asymptomatic carotid artery stenosis, in the general adult population.";"This recommendation applies to adults without a history of stroke or neurological signs or symptoms of a transient ischemic attack. Doppler echo produces false positives when performed in the general population. There is adequate direct evidence that treatment of asymptomatic patients with carotid artery stenosis with CEA or CAS may cause damage, including stroke or death.";2021;;;"Low value";"Carotid stenosis";"Link to the recommendation on the website of the initiative" 6350;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"It is not recommended to start maintenance inhalers in minimally symptomatic COPD patients with low risk of exacerbation.";"Most patients with COPD present with mild disease and few complaints but tend to live a very sedentary lifestyle. The cornerstone of management of mild COPD is smoking cessation, the only proven intervention to relieve symptoms, modify the natural history of disease and lower mortality rates. For asymptomatic or minimally symptomatic patients, quitting smoking is often the only required therapy. Other effective behavioral interventions include maintaining or increasing physical activity, ensuring adequate sleep and a healthy diet and the use of effective stress management strategies. Inhalers have evidence for only reducing exacerbations and do not modify disease. The use of short- or long-acting bronchodilators on a regular basis is not generally recommended for minimally symptomatic COPD patients with a low risk of exacerbation.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6098;35;"Evidencias COVID-19";"Evidence Aid";English;"Remotely delivered interventions including support, training or both, are recommended to reduce caregiver burden and improve caregiver depressive symptoms.";"The authors of this Cochrane review included 26 randomized clinical trials (2367 participants) and identified an additional 13 ongoing studies and 3 studies awaiting classification. They consider that remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone. The effects on the quality of life of people with dementia of remotely delivered interventions for their informal caregivers are uncertain.";2021;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6354;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Routine follow-up of solid pulmonary nodules smaller than 6 mm detected in low-risk patients is not recommended.";"There is a lack of direct evidence related to cancer probability in small nodules in low-risk patients. The National Lung Screening Trial, the largest randomised study of lung cancer screening in a high-risk population to date, showed that that CT lung screening reduces lung cancer mortality in high-risk patients when the minimum size of a positive pulmonary nodule is set at 4 mm. As more than half of baseline examinations in the study were positive for nodules 4 to 6 mm in size, raising the threshold for a positive result to 6 mm would decrease the baseline positive rate from 27.3% to around 13.4%. Since the positive predictive value of an examination deemed positive for a nodule of 4 to 6 mm stands at 0.5%, increasing the threshold to 6 mm might act to increase the PPV by a factor of 1.8 (7.2% at 6 mm vs 3.8% at 4 mm) without significantly affecting the sensitivity to detect cancer. Given that the average risk of cancer in solid nodules smaller than 6 mm in patients at high risk is less than 1%, it is reasonable to assume an even lower risk in a patient with low clinical risk. According to the risk categories proposed by the American College of Chest Physicians, low risk, which corresponds to an estimated risk of cancer of less than 5%, is associated with young age, less smoking, smaller nodule size, regular margins, and location in an area other than the upper lobe. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6357;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Serum CEA is not recommended for the diagnosis or follow-up of sarcoidosis. ";"Sarcoidosis is a multisystemic disease with heterogenous clinical presentations. Diagnosis of sarcoidosis is often challenging because of the lack of reliable biomarkers and other gold standard tests. Unusually high serum angiotensin converting enzyme (ACE) is present in up to 75 percent of untreated patients. However, testing for high serum ACE level has been repeatedly demonstrated to have a poor sensitivity, insufficient specificity (including a false positive rate of around 10 percent) and inconsistent correlation with disease severity. As such, its general clinical utility is limited.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6103;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended remotely delivered information, training and support for informal caregivers of people with dementia.";"The COVID-19 pandemic is placing a strain on caregivers for patients with conditions such as dementia. Research on the remote delivery of information, training and support for them might provide useful information for policy makers. Remotely delivered interventions including support, training or both, with or without information, may slightly reduce caregiver burden and improve caregiver depressive symptoms when compared with provision of information alone. The effects on the quality of life of people with dementia of remotely delivered interventions for their informal caregivers are still uncertain.";2021;;;"High value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6616;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"Criteria for the use of albumin in different situations";"DIGESTIVE: In paracentesis >5 liters, 6-8 g of albumin per liter of ascites extracted. In <5 liters, only justified in risk patients. In spontaneous bacterial peritonitis, administration of albumin is justified only in high-risk patients. In other bacterial infections or hepatic encephalopathy, the routine use of albumin is not recommended. The use of albumin is only recommended in hypervolemic hyponatremia when it is moderate-severe without response to conventional treatment, mainly candidates for transplantation. In hepatorenal syndrome, use albumin when first-line measurements are not sufficient, if AKI>=1, or if admission to the ICU is required. In patients admitted with anasarca/significant edema, consider albumin at a maximum dose of 10 g/day and only for as long as necessary. Currently, the administration of albumin is not recommended as routine chronic preventive treatment, being restricted to patients with recurrent ascites, without significant deterioration in liver function and without significant comorbidity that limits the short-term prognosis. The routine use of albumin in cirrhotic patients with hypoalbuminemia is not recommended. CRITICAL PATIENTS: Do not administer albumin as the first option in patients with sepsis/septic shock, only if the volume of crystalloids administered exceeds 2.5-3 liters. Do not administer albumin in patients with hypoalbuminemia without septic/hypovolemic shock, or in critically ill patients with neurological pathology. In traumatic coagulopathy (hemorrhagic traumatic shock), do not use albumin as the first option, which will be crystalloid solutions. In patients with edema and hypoalbuminemia, albumin will not be administered as the first option, which will be diuretics. SURGICAL PATIENTS: Do not use albumin to prime the extracorporeal circuit. Do not routinely administer albumin in postoperative patients during the postoperative period. PLASMA EXCHANGE: reduce the concentration of albumin when used as replacement fluid in plasmapheresis from 5% to 4%. OTHER SITUATIONS: Do not use albumin as the first option in burned patients, prefer crystalloid solutions. Do not administer albumin as the first option in patients with hypoalbuminemia, in this case diuretics will be administered. There is no evidence for the use of albumin in patients with nephrotic syndrome.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative
" 6105;35;"Evidencias COVID-19";EvidenceAid;English;"There is uncertainty about hemoglobin and ferrite values as prognostic measures of severity for COVID-19.";"Iron metabolism and anemia may play an important role in the prognosis of COVID-19 patients. In this rapid review, the authors searched for observational studies of biomarkers of anemia and iron metabolism in COVID-19 patients. At the time of this review, the included studies suggested that hemoglobin and ferritin levels in COVID-19 patients vary according to the severity of COVID-19, age, gender and comorbidity. At the time of this review, the included studies showed that patients with severe COVID-19 had lower red blood cell count and higher red blood cell distribution width than those with moderate COVID-19. At the time of this review, the meta-analysis showed pathologically high levels of ferritin among COVID-19 patients with significant differences between moderate and severe cases, and between survivors and non-survivors. At the time of this review, the prognostic capacity of hemoglobin and ferritin was uncertain. ";2021;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6107;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the prognostic capacity of hemoglobin and ferritin in patients with COVID-19 ";"Iron metabolism and anemia may play an important role in the prognosis of COVID-19 patients. It's rapid review. At the time of this review, the included studies suggested that hemoglobin and ferritin levels in COVID-19 patients vary according to the severity of COVID-19, age, gender and comorbidity. The included studies showed that patients with severe COVID-19 had lower red blood cell count and higher red blood cell distribution width than those with moderate COVID-19. The meta-analysis showed pathologically high levels of ferritin among COVID-19 patients with significant differences between moderate and severe cases, and between survivors and non-survivors. The prognostic capacity of hemoglobin and ferritin was uncertain.";2021;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6109;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended for policy makers to consider the information provided by community-based primary health workers that deliver services to populations in humanitarian settings during the pandemia";"The COVID-19 pandemic is placing a strain on healthcare resources, services and workers. In this scoping review, the authors searched for studies that investigated the role of community health workers in delivering health or nutrition services in low- or middle-income countries. Community health workers are able to provide services during acute and protracted crises, carrying out critical emergency response activities, although they might suffer from security threats and psychological trauma. Communities that do not have local health workers are likely to experience reduced access to services, especially when travel is limited. Engagement of local communities and leaders seems crucial for improving trust, acceptance and high use of services provided by community health workers.";2021;;;"High value";"Management Patient management";"Link to the recommendation on the website of the initiative" 6365;1;"NICE ";NICE;English;"Percutaneous Implantation of Pulmonary Arterial Pressure Sensors is recommended for monitoring treatment of chronic heart failure.";"Evidence on the safety and efficacy of percutaneous implantation of pulmonary artery pressure sensors for monitoring treatment of chronic heart failure is adequate to support using this procedure provided that standard arrangements are in place for clinical governance, consent and audit. Patient selection, continuing monitoring and management should be done by a multidisciplinary team. This should include healthcare professionals (both a doctor and a nurse) experienced in managing chronic heart failure, and interventional specialists experienced in right-heart catheterization and inserting this device.";2021;;;"High value";-;"?Link to the recommendation on the website of the initiative" 6111;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection";English;"Immunological and bioinformatics identification of T-cell and B-cell epitopes in SARS-Cov-2 is recommended for the development of vaccines against COVID-19. ";"Information on the immune and bioinformatics identification of the T-cell and B-cell epitopes of the SARS-CoV-2 virus is important for vaccine development. In this rapid review, the included studies suggest that B and T cell epitopes could be introduced as potential targets in the development of peptide vaccines against SARS-CoV-2. These studies also showed that B and T cells are important weapons of the immune system against pathogens and that the activation of these epitopes plays an important role in the body's defenses.";2021;;;"High value";Prevention;"Link to the recommendation on the website of the initiative." 6623;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"The use of the capillary C-Reactive Protein (CRP) test is not recommended in Primary Care in case of suspicion of lower respiratory tract infections.";"Taking into account the conclusions drawn from the report regarding the key and important variables pre-established with the services involved for decision-making (mortality, antibiotic prescription, hospital admissions and referrals to the emergency room) and the initial interest raised regarding the cost ratio -effectiveness, the use of the rapid test for C-reactive protein measurement in a general way in the primary care setting is not justified, in cases of lower respiratory tract infections at any age or acute infections of any kind in children. It should be noted that the report's conclusions and recommendations are not applicable to other settings such as hospital or extra-hospital emergencies or other specialized care settings, since they have not been analysed. Other aspects that could be considered such as the impact on organizational issues or other characteristic elements of each healthcare organization are difficult to measure and it is not possible to analyze the effect at these levels through the scientific literature.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6113;35;"Evidencias COVID-19";"Evidencias COVID-19";English;"It�s uncertainty as to wether rapid site-of-care antigen and molecular tests are useful for the diagnosis of SARS-CoV-2 infection. ";"It�s includes 78 cohort studies with results for 24,087 samples. The studies evaluated 16 antigen and five molecular assays. The authors concluded that some antigen tests are accurate enough to replace PCR laboratory tests when used in people with COVID-19 symptoms and that antigen tests may be more useful in identifying outbreaks or in selecting people with symptoms for PCR testing. However, the included studies found that people who received a negative antigen test result may still be infected with SARS-CoV-2. At the time of this review, the studies included that molecular site-of-care testing was found to be of very high precision and potential for use, but the authors concluded that further evidence of its performance in real-life settings is needed. The authors also concluded that more evidence is needed on rapid tests in people without symptoms, on the accuracy of repeat tests, tests in non-healthcare settings (e.g., schools and self-assessments), and direct comparisons of brands of drugs. proof. At the time of this review, the included studies showed that various site-of-care molecular tests showed very high precision and potential for use, but the authors concluded that more evidence of their performance is needed in real-life settings. The authors also concluded that more evidence is needed on rapid tests in people without symptoms, on the accuracy of repeat tests, tests in non-healthcare settings (e.g., schools and self-assessments), and direct comparisons of brands of drugs. proof. ";2021;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6369;1;"NICE ";NICE;English;"It is not recommended to use a Coronary Sinus Narrowing Device Implant for all patients with refractory angina. ";"Evidence on the safety of coronary sinus narrowing device implantation for refractory angina shows well-recognized complications. Evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. The procedure should only be done in specialist centres by interventional cardiologists with specific training in the technique. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6370;1;"NICE ";NICE;English;"There is not enough evidence to recommend using QAngio XA 3D quantitative flow ratio (QAngio QFR) and CAAS vessel fractional flow reserve (CAAS vFFR) during invasive coronary angiography to assess coronary stenosis in stable angina. ";"FFR or iFR can be used with invasive coronary angiography to assess coronary stenosis. However, they can have unpleasant side effects and increase the risk of adverse events, such as damage to the artery. CAAS vFFR and QAngio QFR use X?ray images taken during an invasive coronary angiography to construct a 3D image of the artery. This image is used to estimate the effect of coronary stenosis on blood flow through the artery without the side effects and risk of adverse events of FFR or iFR QAngio QFR's diagnostic accuracy is considered acceptable for assessing coronary stenosis during invasive coronary angiography, but its clinical effectiveness is uncertain. CAAS vFFR's diagnostic accuracy and clinical effectiveness is uncertain. Further research is recommended in both diagnostic-only catheter labs and interventional catheter labs. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6115;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the use of interleukin 6 blocking agents for treating patients with COVID-19.";"A rapid review was made on the possible use of interleukin 6 blocking agents as treatment for patients with COVID-19. This review is based on randomized trials with tocilizumab (which shown a decrease in mortality in the first 28 days after treatment and fewer serious adverse events) and sarilumab (with uncertain results).";2021;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative" 6371;1;"NICE ";NICE;English;"Do not recommend the laparoscopic renal denervation for loin pain haematuria syndrome ";"Evidence on the safety and efficacy of laparoscopic renal denervation for loin pain haematuria syndrome is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research. Further research should report details of patient selection, technique used and long-term follow-up outcomes.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6116;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended to follow specific guidelines in surgical and operating room procedures during the COVID-19 pandemic.";"The COVID-19 pandemic is affecting the provision of surgery for patients. Recommendations are made at the surgical, staff and patient levels based on multiple reviews. Recommendations for practices relevant to the conduct of surgery include the use of pre-operative planning, negative pressure ventilation in operating theatres, limited personnel, single-use equipment, designated donning and doffing areas, dedicated COVID-19 theatres and teams and COVID-free facilities, use of regional anaesthesia to minimise duration of surgery, limited use of electro-cauterization within procedures, limiting the use of endoscopic procedures to emergencies and selected suspected or confirmed cancer patients, and telemedicine for postoperative follow-up. Recommendations for staff involved in surgery include use of appropriate personal protective equipment (PPE), training, screening, showers following procedures and the provision of psychological support. Recommendations for surgery patients include screening for SARS-CoV-2, self-isolation before elective admission and the use of surgical masks during admission.";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 6372;35;"Evidencias COVID-19";"Evidence aid";English;"It is recommended to carry out implementation strategies for health systems in low-income countries";"Educational meetings, nutrition training of health workers, educational outreach, practice facilitation, local opinion leaders, audit and feedback, and tailored interventions are useful implementation strategies targeted at healthcare workers. Training healthcare workers to be more patient centered in clinical consultations; use of birth kits; clinician education and patient education to reduce antibiotic prescribing in ambulatory care settings; and in-service neonatal emergency care training improve professional practice and healthcare outcomes. Mass media interventions to increase uptake of HIV testing; intensive self-management and adherence, behavioral interventions and mobile phone text messages for adherence to antiretroviral therapy; community based health education, and reminders and recall strategies to increase vaccination uptake or patients being treated for active tuberculosis; interventions to increase uptake of cervical screening (invitations, education, counselling, access to health promotion); health insurance information and application support are effective intervention strategies when targeted at healthcare recipients. Educational meetings may not be effective for complex behaviours.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6373;1;"NICE ";NICE;English;"Routine adoption of SeHCAT (tauroselcholic acid [75 selenium]) to diagnose bile acid diarrhea is not recommended in people with: chronic diarrhea of ??unknown cause, suspected or diagnosed diarrhea-predominant irritable bowel syndrome, or functional diarrhea and Crohn's disease without ileal resection who have chronic diarrhea";"SeHCAT is a test for diagnosing bile acid diarrhoea. Having bile acid diarrhoea can affect quality of life and limit daily activities, such as the ability to work. There is an unmet clinical need for a test to diagnose bile acid diarrhoea. Having a test is important to explain the person's symptoms and offer treatment. Despite additional research since NICE diagnostics guidance on SeHCAT in 2012, clinical evidence on SeHCAT remains limited in quantity and quality. Most studies are small and give results only for people who had a positive SeHCAT test result. It is unclear how the test results are used to guide management of bile acid diarrhoea, and how well people tolerate treatment. So, it is uncertain how having a diagnosis affects clinical outcomes, particularly in the longer term. The lack of data on the link between the SeHCAT test and longer-term clinical outcomes means that the economic model includes many assumptions, so its results are not reliable. Because of this, SeHCAT's cost effectiveness cannot be determined, so it cannot be recommended for routine adoption. So, although SeHCAT shows promise, further data collection and research are needed. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6118;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about oral hygiene care reducing the incidence of ventilator?associated pneumonia in critically ill patients on mechanical ventilation.";"Some patients with COVID-19 will become critically ill and require mechanical ventilation in an intensive care unit. One complication of this is ventilator-associated pneumonia. This is an updated Cochrane review showing that chlorhexidine mouthwash or gel probably reduces the incidence of ventilator?associated pneumonia in critically ill patients, when compared to placebo or usual care. Oral hygiene care including both antiseptics and toothbrushing may be more effective than antiseptics alone at reducing the incidence of ventilator?associated pneumonia and length of stay in intensive care unit.";2021;;;Uncertain;"Oral hygiene.";"Link to the recommendation on the website of the initiative" 6374;35;"Evidencias COVID-19";"Evidence aid";English;"Early psychological interventions are recommended for frontline responders in disaster situations.";"The COVID-19 pandemic and other emergencies and disasters places a strain on the physical and mental health of healthcare workers and frontline responders. Effective interventions to alleviate this would help improve the resilience of health systems.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6375;1;"NICE ";NICE;English;"Routine creation of a percutaneous endovascular antebrachial arteriovenous fistula for hemodialysis access is not recommended.";"Evidence on the safety of percutaneous endovascular forearm arteriovenous fistula creation for haemodialysis access raises no major safety concerns. However, evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6120;35;"Evidencias COVID-19";"Coronavirus [COVID-19]: Evidence Collection";English;"There is uncertainty that interleukin - 6 blocking agents for treating COVID - 19 patients";"Interleukin ? 6 blocking agents have been suggested as treatments for COVID-19. In this living Cochrane review, the authors searched for randomized trials of interleukin ? 6 blocking agents for COVID-19 patients. They did not restrict their searches by language of publication and did the most recent search on 26 February 2021. They included 9 tocilizumab trials (6428 participants) and two sarilumab trials (880 participants), with one trial testing both drugs. They also identified 39 additional trials of interleukin ? 6 blocking agents with no results available, of which 9 were completed and 7 were terminated. At the time of this rapid review, the included studies showed that tocilizumab reduced mortality in the first 28 days after treatment compared to standard care alone or placebo and probably resulted in slightly fewer serious adverse events than standard care alone or placebo. At the time of this rapid review, the included studies showed that the effects of sarilumab are uncertain. At the time of this rapid review, the effects of other interleukin?6 blocking agents are uncertain because no studies were available. ";2021;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6376;35;"Evidencias COVID-19";"Evidence aid";English;"Personal protective equipment is recommended to reduce the risk of respiratory infection among healthcare workers involved in emergency trauma surgery.";"Preventing the transmission of infectious diseases among healthcare workers is important to the building of resilient health systems, especially during epidemics and pandemics. Various types of personal protective equipment (PPE) are used to help achieve this. Use of N95 respirators and surgical masks is associated with a reduced risk of COVID-19 when compared with no mask use (high certainty evidence). In moderate- to high-risk environments, N95 respirators are associated with a further reduction in the risk of COVID-19 infection when compared with surgical masks. Eye protection reduces the risk of infection of healthcare workers caring for trauma surgery patients. Decontamination of masks and respirators with ultraviolet germicidal irradiation, vaporous hydrogen peroxide or dry heat is effective and does not affect the performance or fit of PPE.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6377;1;"NICE ";NICE;English;"It is recommended that lateral elbow resurfacing should only be used with special arrangements for clinical governance, consent, and audit or research due to the evidence on the safety and efficacy of for arthritis is limited in quantity and quality. ";"Rheumatoid arthritis is the most common form of arthritis in the elbow. Osteoarthritis that needs surgery is less common in the elbow than in weight-bearing joints, such as the knee and hip. Symptoms include pain, swelling and stiffness in the elbow. Treatment for elbow arthritis depends on the severity of the disease. Conservative treatments include analgesics and corticosteroid injections to relieve pain and inflammation, and physiotherapy and prescribed exercise to improve function and mobility, but when symptoms are severe, surgery may be indicated. Options include arthroscopic debridement, interposition arthroplasty, replacement or excision of the radial head, or total elbow replacement. A potential advantage of this procedure over a total elbow replacement is that it preserves the natural inner compartment of the elbow. Movements are therefore likely to be more like a natural elbow joint. The procedure should only be done in specialist centres by surgeons who do elbow arthroplasty regularly and have training in this specific technique.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6378;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Screening for gestational diabetes in asymptomatic pregnant women at or after 24 weeks of gestation is recommended.";"Gestational diabetes is diabetes that develops during pregnancy. Prevalence of gestational diabetes in the US has been estimated at 5.8% to 9.2%, based on traditional diagnostic criteria, although it may be higher if more inclusive criteria are used. Pregnant persons with gestational diabetes are at increased risk for maternal and fetal complications, including preeclampsia, fetal macrosomia (which can cause shoulder dystocia and birth injury), and neonatal hypoglycemia. Gestational diabetes has also been associated with an increased risk of several long-term health outcomes in pregnant persons and intermediate outcomes in their offspring.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6379;35;"Evidencias COVID-19";"Evidence aid";English;"Personal protective equipment for protecting healthcare staff from highly infectious diseases";"A variety of types of personal protective equipment (PPE) are used to try to protect healthcare workers from infection with, for example, the SARS-CoV-2 virus. A powered, air-purifying respirators may protect better than a N95 mask and gown but was more difficult to put on. Long gowns may protect better against contamination than coveralls and were easier to take off; and gowns may protect better against contamination than aprons. PPE made of more breathable material may lead to a similar number of spots on the trunk compared to more water?repellent material but may have greater user satisfaction. Other interventions that may reduce contamination include sealed gown and glove combinations; a better fitting gown around the neck, wrists and hands; a better cover of the gown?wrist interface; and tabs to grab to facilitate the removal of masks or gloves; using Centers for Disease Control and Prevention recommendations for removing PPE; one?step removal of gloves and gown; double?gloving compared to single gloving; and spoken instructions and extra sanitation of gloves with quaternary ammonium or bleach when removing PPE. ";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6380;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Screening for prediabetes and type 2 diabetes is recommended in adults aged 35 to 70 years who are overweight or obese. Physicians should offer or refer patients with prediabetes to an effective preventative rash.";"According to the 2020 National Diabetes Statistics Report from the Centers for Disease Control and Prevention, an estimated 13% of all American adults (18 years and older) have diabetes and 34.5% meet the criteria for prediabetes. The prevalence of prediabetes and diabetes are higher in older adults. Of people with diabetes, 21.4% did not know or did not report having diabetes, and only 15.3% of people with prediabetes reported being told they had the condition by a health care professional. Estimates of the risk of progression from prediabetes to diabetes vary widely, perhaps due to differences in the definition of prediabetes or the heterogeneity of prediabetes. A large cohort study of 77,107 people with prediabetes reported that the risk of developing diabetes increased with increasing level of hemoglobin A1c and with increased body mass index. Diabetes is the leading cause of kidney failure and new cases of blindness among adults in the US. It is also associated with an increased risk of cardiovascular disease, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis and has been estimated to it was the seventh leading cause of death in the US in 2017.1 Screening for prediabetes and type 2 diabetes in asymptomatic adults may allow earlier detection, diagnosis, and treatment, with the ultimate goal of improving health outcomes.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6381;35;"Evidencias COVID-19";"Evidence Aid";English;"Is recommended the use of corticosteroids vin hospitalized patients with COVID-19.";" At the time of this review, the included studies provided moderate?certainty evidence that systemic corticosteroids probably slightly reduce all?cause mortality in people hospitalized because of symptomatic COVID?19 and low?certainty evidence that there may also be a reduction in ventilator?free days. At the time of this review, the included studies provided insufficient evidence to determine the effects of systemic corticosteroids on patients with asymptomatic or mild disease (non?hospitalized participants).";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6382;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S Preventive Services Task Force";English;"Screening for chlamydia and gonorrhea is recommended for all sexually active women age 24 and younger and for women age 25 and older who are at increased risk of infection.";"Chlamydia and gonorrhea are among the most common sexually transmitted infections (STIs) in the US Chlamydia infection among women (698.9 cases per 100,000 women) was almost double the rate among men (399.9 cases per 100,000 men). Gonorrhea infection was more frequent in men (224.4 cases per 100,000 men) than in women (152.6 cases per 100,000 women). Infection rates are highest among adolescents and young adults of both sexes. In 2019, almost two-thirds (61.0%) of all reported chlamydial infections, and in 2018 more than half (54.1%) of new gonococcal infections, were among people aged 15-24 years. Chlamydial and gonococcal infections in women are often asymptomatic and can lead to pelvic inflammatory disease and its associated complications, such as ectopic pregnancy, infertility, and chronic pelvic pain. Newborns of pregnant people with untreated infection can develop neonatal chlamydia. gonococcal or chlamydial pneumonia or ophthalmia. Infection in men can cause urethritis and epididymitis. Men are often asymptomatic; however, gonorrhea is more likely to cause symptoms in men than women than chlamydia. Both types of infection can increase the risk of getting or transmitting HIV.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6383;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S Preventive Services Task Force";English;"Low-dose aspirin (81 mg/day) is recommended as a preventative medication after 12 weeks' gestation in people at high risk of preeclampsia.";"Preeclampsia is one of the most serious health problems that affect pregnant persons. It is a multisystem inflammatory syndrome that is often progressive but has an unclear etiology. Worldwide, preeclampsia is the second most common cause of maternal morbidity and mortality. It is a complication in approximately 4% of pregnancies in the US and contributes to both maternal and infant morbidity and mortality.1 Preeclampsia also accounts for 6% of preterm births and 19% of medically indicated preterm births in the US. This recommendation is consistent with the 2014 USPSTF recommendation. It is strengthened by new evidence from additional trials demonstrating reduced risks of perinatal mortality with aspirin use.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6384;35;"Evidencias COVID-19";Evidence-Aid;English;"Is recommednded to healthcare workers to wear N95 respirators in high-risk coronavirus areas and medical masks in low-risk areas.";"At the time of this review, there was no significant evidence of a difference between N95 respirators and medical masks for protecting healthcare workers from respiratory viruses, but low-quality evidence suggested that N95 respirators have a stronger protective effectiveness against coronavirus infections than medical masks.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6385;1;"NICE ";NICE;English;"It is recommended that the transapical transcatheter mitral valve-in-valve implantation for a failed surgically implanted mitral valve bioprosthesis only be used with special arrangements for clinical governance, consent, and audit or research due to the evidence on its efficacy is limited in quality.";"Mitral valve replacement is where an artificial prosthetic valve (bioprosthetic or mechanical) is inserted by open heart surgery. It is most commonly done for severe symptomatic mitral regurgitation but may also be done in patients with severe mitral valve stenosis or a combination of both. Symptoms of severe mitral valve disease typically include shortness of breath, fatigue and palpitations (because of atrial fibrillation). Bioprosthetic valves have some advantages over mechanical valves, but they are more likely to degenerate and fail over time. This can result in severe stenosis or regurgitation, needing replacement of the bioprosthetic valve. ransapical transcatheter mitral valve?in?valve implantation is a less invasive alternative when repeat open heart surgery is considered to have a high risk. It avoids the need for routine cardiopulmonary bypass and can be used to treat failed bioprosthetic mitral valves originally placed during open heart surgery. Patient selection should be done by a multidisciplinary team which must include interventional cardiologists experienced in the procedure, cardiac surgeons, an expert in cardiac imaging, and where appropriate, a cardiac anaesthetist and a specialist in medicine for older people. The multidisciplinary team should determine the risk level for each patient and the device most suitable for them. The procedure is technically challenging and should only be done in specialised centres, and only by clinical teams with special training and experience in complex endovascular cardiac interventions, including regular experience in transcatheter valve implantation procedures. Centres doing these procedures should have cardiac surgical support for emergency treatment of complications and subsequent patient care.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6130;1;"NICE ";NICE;English;"It is recommended Encorafenib plus cetuximab is recommended as an option for treating BRAF V600E mutation-positive metastatic colorectal cancer in adults who have had previous systemic treatment";"Treatment for BRAF V600E mutation-positive metastatic colorectal cancer after previous systemic treatment includes combination chemotherapy, usually FOLFIRI (5?fluorouracil, folinic acid and irinotecan) followed by trifluridine?tipiracil then best supportive care. Encorafenib plus cetuximab is the first colorectal cancer treatment that targets the BRAF V600E mutation, and could be used second or third line. Clinical trial evidence shows that encorafenib plus cetuximab increases how long people live compared with FOLFIRI plus cetuximab or irinotecan plus cetuximab. However, these drug combinations are not used in NHS clinical practice, because NICE does not recommend cetuximab beyond first-line treatment for metastatic colorectal cancer. Assumptions are needed to indirectly compare encorafenib plus cetuximab with FOLFIRI or trifluridine?tipiracil using evidence from other clinical trials. This makes the results uncertain.";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6386;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"It is not recommended to lower blood pressure rapidly and abruptly in patients in a hypertensive emergency situation.";"In the event of a hypertensive crisis, it should be ruled out if there is damage to the target organs, to identify whether it is a hypertensive emergency or a hypertensive emergency. Hypertensive emergencies are not associated with short-term adverse outcomes and most are due to lack of adherence to usual treatment for hypertension. The management of hypertensive emergencies is carried out with oral treatment and not intravenously, although it will be necessary to assess the indication of oral drugs. A drastic reduction in blood pressure can cause serious damage (hypoperfusion, hypotension) and is therefore not recommended in patients with hypertensive urgency.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6387;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Psiquiatr�a y Salud Mental ";Spanish;"In patients being treated for schizophrenia, the use of combinations of three or more antipsychotics is not recommended.";"Antipsychotic drugs are an essential component of the treatment of patients with schizophrenia. The combination of antipsychotics is associated with a higher burden of adverse effects, specifically in terms of extrapyramidal symptoms, cognitive alterations, hyperprolactinemia, sedation, sexual dysfunction, metabolic symptoms, and diabetes. The combination of antipsychotics should be reserved for cases of resistance to clozapine or when it has not been tolerated. There is no available evidence that combinations of three or more antipsychotics can have a reasonable risk-benefit balance in the treatment of schizophrenia.";2021;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 6388;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Screening for vitamin D deficiency in asymptomatic adults is not recommended.";"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults. For asymptomatic, community-dwelling, nonpregnant adults, the USPSTF found that the evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency. More research is needed.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6389;1;"NICE ";NICE;English;"It is recommended that the transapical transcatheter mitral valve-in-ring implantation after failed mitral valve repair surgery should only be used with special arrangements for clinical governance, consent, and audit or research.";"The mitral valve allows blood to flow from the left atrium to the left ventricle. Mitral valve regurgitation happens when the valve does not close properly and blood flows back into the atrium from the ventricle. The heart has to work harder to pump blood from the left ventricle to the aorta, resulting in an enlarged left ventricle. If not treated, this can lead to shortness of breath, fatigue and palpitations (because of atrial fibrillation) and eventually heart failure. If symptoms of mitral valve regurgitation are severe enough, mitral valve annulus surgical repair may be done by open heart surgery in patients who are well enough for this kind of operation. A surgical valve annulus repair may fail over time and can result in the need for further intervention. The standard treatment after a failed mitral valve annuloplasty is repeat open heart surgery. Repeat open heart surgery is associated with a higher risk of morbidity and mortality than primary surgery. Transapical transcatheter mitral valve-in-ring implantation is a less invasive alternative. It avoids the need for cardiopulmonary bypass and can be used to treat failed annuloplasty rings originally placed during open heart surgery.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6390;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S Preventive Services Task Force";English;"It is recommended that primary care physicians prescribe oral fluoride supplements beginning at 6 months of age for children whose water supply is deficient in fluoride.";"Dental caries is the most common chronic disease in children in the US.1-3 According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children aged 2 to 5 years had dental caries in their primary teeth.4 Prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%).5 Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6135;1;"NICE ";NICE;English;"It is not recommended Trifluridine - tipiracil for the treatment of metastatic gastric cancer or adenocarcinoma of the gastroesophageal junction with 2 or more systemic treatment regimens in adults.";"Trifluridine?tipiracil (Lonsurf, Servier) is indicated as 'monotherapy for the treatment of adult patients with metastatic gastric cancer including adenocarcinoma of the gastroesophageal junction, who have been previously treated with at least 2 prior systemic treatment regimens for advanced disease'. Current treatment for metastatic gastric cancer and gastro-oesophageal junction cancer, for most people who have had 2 treatments, is best supportive care. The clinical evidence suggests that people having trifluridine?tipiracil live longer compared with best supportive care. But the evidence also suggests that it is unlikely to extend how long people live by at least 3 months. This means trifluridine?tipiracil does not meet NICE's criterion to be considered a life-extending treatment at the end of life.These evidences are in clinical trials and are considered by 3 committees and a review was carried out by the evidence review group. This recommendation is not intended to affect treatment with trifluridine?tipiracil that was started in the NHS before this guidance was published. Adverse events: The most common side effects included nausea, anaemia, decreased appetite, vomiting, diarrhea, fatigue, neutropenia, asthenia and thrombocytopenia. Neutropenia was also more common (53% compared with 4%). It concluded that neutropenia may affect health-related quality of life. The company considered trifluridine?tipiracil to be innovative because it provides an alternative oral treatment option that increases overall survival, patients with metastatic gastric cancer or adenocarcinoma of the gastroesophageal junction have a high mortality. The committee recalled that trifluridine?tipiracil was clinically effective compared with best supportive care, but it had not seen evidence of additional benefits.";2021;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6391;35;"Evidencias COVID-19";"Evidence Aid";English;"It is not recommended Remdesivir as a treatment for COVID-19 patients.";"Remdesivir has been suggested as a treatment for patients with COVID-19 but at the time of this review, the available evidence suggested that remdesivir probably has little or no effect on all-cause mortality through 28 days in hospitalized patients with COVID-19. Furthermore, the effects of remdesivir on clinical improvement and worsening, and across subgroups defined by respiratory support at baseline are uncertain. The authors of this Cochrane review search for randomized trials of remdesivir to treat hospitalized COVID-19 patients. They did not restrict their searches by language of publication and did the search for this version of the review on 16 April 2021. They included 5 trials (7452 participants) and identified an additional 2 ongoing trials. ";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6392;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Service Task Force";English;"It is recommended to prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride.";"The USPSTF recommends to prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride because dental caries is the most common chronic disease in children in the US. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children aged 2 to 5 years had dental caries in their primary teeth. Prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%). Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries. All children are at potential risk for dental caries.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6137;1;"NICE ";NICE;English;"It is recommended Brigatinib as an option for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) that has not been previously treated with an ALK inhibitor in adults. ";"People with ALK-positive advanced NSCLC who have not had an ALK inhibitor before are usually offered alectinib. If a person's ALK status is not known at diagnosis, crizotinib is offered after chemotherapy. Brigatinib may be offered as an alternative to these treatments. Clinical evidence shows that brigatinib is more effective than crizotinib at delaying disease progression. It suggests that brigatinib extends life more than crizotinib, but this is uncertain. There is no clinical trial evidence directly comparing brigatinib with alectinib. An indirect comparison suggests that brigatinib is as effective as alectinib in delaying disease progression, including in the central nervous system. However, although it appears that brigatinib could extend life as much as alectinib, there is uncertainty because of a lack of long-term data.";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6393;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S Preventive Services Task Force";English;"It is recommended that clinicians offer pregnant people effective behavioral counseling interventions aimed at promoting healthy weight gain and preventing excessive gestational weight gain during pregnancy.";"The prevalence of overweight and obesity is increasing among persons of childbearing age and pregnant persons. Obesity rates during pregnancy increased from 13% in 1993 to 24% in 2015. In 2015, almost half of all persons began pregnancy with overweight (24%) or obesity (24%).Prepregnancy obesity is higher in Alaska Native/American Indian (36.4%), Black (34.7%), and Hispanic (27.3%) women compared with White women (23.7%). Asian women have the lowest rates of obesity (7.5%).Excess weight at the beginning of pregnancy and excess gestational weight gain (GWG) have been associated with adverse maternal and infant health outcomes such as a large for gestational age (LGA) infant, cesarean delivery, or preterm birth.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6138;1;"NICE ";NICE;English;"The use of VAC Veraflo Therapy is not recommended routinely for the treatment of acute infected or chronic wounds that are not healing.";"Acute infected or chronic wounds are typically cleaned, dead or infected tissue removed, and then bandaged. Chronic non-healing wounds often receive advanced care such as absorbent or moisture-providing dressings. Other wounds are treated with negative pressure using a pump to remove excess fluids without instillation. The VAC Veraflo Therapy System uses negative pressure, but also slowly introduces a cleansing fluid into the wound bed. The fluid is administered in automated treatment cycles, allowing the wound to be repeatedly cleansed without removing the dressing. The clinical evidence for VAC Veraflo Therapy System is mostly low quality. The best available evidence shows no clinical benefit over negative pressure wound management without instillation.";2021;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6394;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Is recommended screening for hypertension in adults ";"The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6395;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Neumologia";Spanish;"In patients with dyspnea, wheezing, or cough due to acute heart failure without chronic obstructive pulmonary disease or asthma, bronchodilator treatment is not recommended.";"In acute heart failure is common the presence of dyspnea, cough or wheezing, a condition also called cardiac asthma. It is important to differentiate the symptoms caused by acute heart failure or respiratory pathology, because the pathophysiology and treatments are different. The treatment of acute heart failure (AHF), regardless of its clinical presentation, does not include bronchodilators. Still, several studies show that they continue to be used.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6140;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended to develop specific rehabilitation strategies for patients in the post-acute and chronic phase of COVID-19";"A living review related to the rehabilitation needs and management of COVID-19 patients was done and concluded that more information is now available about the clinical scenario after hospital discharge and that most recent papers about the acute phase of COVID-19 report on progress during and after early rehabilitation in patients with respiratory failure and musculoskeletal symptoms. Studies done in the post-acute and chronic phases mainly report on medium (2 to 4 months after infection onset) and long-term health consequences of COVID-19 such as persistence of fatigue and muscle weakness. It is suggested that comprehensive clinical and functional monitoring may help in the development of specific rehabilitation strategies for patients in the post-acute and chronic phase, given that COVID-19 can affect physiological systems other than the respiratory system.";2021;;;"High value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6396;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Service Task Force";English;"It is not recommended the screening for asymptomatic carotid artery stenosis in the general adult population. ";"Carotid artery stenosis is atherosclerotic disease that affects extracranial carotid arteries. Asymptomatic carotid artery stenosis refers to stenosis in persons without a history of ischemic stroke, transient ischemic attack, or other neurologic symptoms referable to the carotid arteries. This recommendation applies to adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms referable to the carotid arteries. Although screening for asymptomatic carotid artery stenosis is not recommended for the general adult population, several factors increase risk for carotid artery stenosis, including older age, male sex, hypertension, smoking, hypercholesterolemia, diabetes, and heart disease. However, there are no externally validated, reliable methods to determine who is at increased risk for carotid artery stenosis or who is at increased risk of stroke when carotid artery stenosis is present. The USPSTF does not recommend screening adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms referable to the carotid arteries.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6141;1;"NICE ";NICE;English;"It is not recomended the self-expanding implant insertion into the intersphincteric space for faecal incontinence. ";"Faecal incontinence is an inability to control bowel movements, resulting in the involuntary passage of faeces. Causes of incontinence include problems in the colon, rectum and problems with the sphincter muscles, nerve damage and loss of higher-level cerebral control. Insertion of self-expanding implants into the intersphincteric space for fecal incontinence is performed around the entire circumference of the internal anal sphincter. A solid polyacrylonitrile cylinder is used that becomes thicker, shorter, and smoother 2 days after implantation. These expand and press, forming a ring that creates an artificial sphincter. Despite that, other research in the form of randomized controlled trials and registry-based research needs to be done to capture long-term results. Also, details of patient selection should be reported.";2021;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6397;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Farmacia Cl�nica";Spanish;"Pharmacological treatment is not recommended as the first therapeutic option in people with overactive bladder syndrome with or without urinary incontinence.";"The non-pharmacological approach, as it has a superior or similar effectiveness to the pharmacological one and does not present adverse effects, represents the first therapeutic option in the management of the symptoms of overactive bladder. It is recommended to maintain non-pharmacological measures for a minimum of 6 to 12 weeks, and consider adding pharmacological treatment if the impact on quality of life continues to be moderate or severe, despite correct compliance with non-pharmacological measures. Before offering a drug for the treatment of overactive bladder, it is necessary to assess the risk of adverse effects, including cognitive impairment or high blood pressure, depending on the drug chosen. This is especially relevant for the group of older people.";2021;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6142;1;"NICE ";NICE;English;"The use of Mepolizumab is recommended as an option for the treatment of severe refractory eosinophilic asthma in adults with a blood eosinophilic count of 400 cells per microliter or higher and at least 3 severe asthma exacerbations.";"Severe refractory eosinophilic asthma is a debilitating condition that does not respond enough to standard therapy. Asthma exacerbations can be sudden, life-threatening, and lead to hospitalization and intubation. The experts highlighted the urgent need for more biological treatments for people who are not eligible for benralizumab or reslizumab, whose asthma does not respond to this therapeutic line or who would need more intensive treatment with oral corticosteroids, which are associated with multiple side effects. The committee concluded that people with severe eosinophilic asthma with a blood eosinophilic count of 400 cells per microliter or higher and at least 3 severe asthma exacerbations would welcome the new treatment option, Mepolizumab.";2021;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6398;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S Preventive Service Task Force";English;"It is recommended annual screening for lung cancer with low-dose computed tomography in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.";"Lung cancer is the second most common cancer and the leading cause of cancer death in the US. In 2020, an estimated 228,820 persons were diagnosed with lung cancer, and 135,720 persons died of the disease. The most important risk factor for lung cancer is smoking. Smoking is estimated to account for about 90% of all lung cancer cases, with a relative risk of lung cancer approximately 20-fold higher in smokers than in nonsmokers. Increasing age is also a risk factor for lung cancer. The median age of diagnosis of lung cancer is 70 years. Lung cancer has a generally poor prognosis, with an overall 5-year survival rate of 20.5%. However, early-stage lung cancer has a better prognosis and is more amenable to treatment. This recommendation applies to adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Low-dose computed tomography has high sensitivity and reasonable specificity for the detection of lung cancer, with demonstrated benefit in screening persons at high risk. Other potential screening modalities that are not recommended because they have not been found to be beneficial include sputum cytology, chest radiography, and measurement of biomarker levels";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 6143;1;"NICE ";NICE;English;"Is not recommended to treat cervical cancer with minimally invasive radical hysterectomy when the tumor is 2cm or more in women. ";"Cervical cancer is common in women under 35 years. The most common symptoms are abnormal vaginal bleeding or discharge, and discomfort during intercourse. Radical hysterectomy is the most common surgical treatment for cervical cancer. It is conventionally done through an incision in the abdomen or through the vagina. Minimally invasive radical hysterectomy for early stage cervical cancer is done using general anaesthesia. A uterine manipulator is often inserted through the vagina and attached to the uterus and cervix. The abdomen is insufflated with carbon dioxide, and several small incisions are made to provide access for the laparoscope and surgical instruments. The evidence included 1 randomised controlled trial (reported in 3 publications), 13 non-randomised comparative studies, 1 cohort study, 2 systematic reviews and 7 case reports, which was discussed by the committee.";2021;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6399;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Task Force Services";English;"Screening for colorectal cancer is recommended for all adults ages 45 to 75";"The USPSTF recommends screening for colorectal cancer in all adults aged 45 to 75 years and in all adults aged 50 to 75 years. The USPSTF expanded the recommended ages for colorectal cancer screening to 45 to 75 years (previously, it was 50 to 75 years). The USPSTF continues to recommend selectively screening adults aged 76 to 85 years for colorectal cancer. The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient's overall health, prior screening history, and preferences.";2021;;;"High value";-;"Link to the recommendation on the website of the initiative" 5120;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence on the safety of selective internal radiation therapy (SIRT) for unresectable colorectal metastases in the liver shows there can be serious complications, but these are well recognised and infrequent.";"In people who cannot tolerate chemotherapy or have liver metastases that are refractory to chemotherapy, there is evidence of efficacy but this is limited, particularly for important outcomes such as quality of life. Therefore, in these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. In people who can have chemotherapy, evidence on overall survival and quality of life is inadequate in quality. Therefore, in these people, this procedure should only be used in the context of research. Clinicians wishing to do SIRT for unresectable colorectal metastases in the liver, in people who cannot have chemotherapy or have liver metastases that are refractory to chemotherapy, should: - Inform the clinical governance leads in their NHS trusts. - Give patients clear written information to support shared decision making, including NICE's information for the public. - Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. - Audit and review clinical outcomes of all patients having the procedure. Clinicians should enter details for all patients having SIRT for unresectable colorectal metastases in the liver onto a suitable register. Patient selection should be done by a specialist hepatobiliary cancer multidisciplinary team that can offer the full range of treatment options for this condition. This procedure should only be done by clinicians with specific training in SIRT including techniques to minimise the risk of damage to surrounding tissue. ";2020;;;"High value";"Colorectal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5376;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There is uncertainty in the scientific literature that supports the use of ACEI or ARA-II in hypertensive patients to obtain a supposed benefit against COVID-19 infection.";"- The hypotheses of potential benefit are based on experience with a previous virus (SARS-CoV), have been tested primarily in animal or in-vitro models and include both ACEI and ARA-II. - There is a potential risk of severe hypotension in patients hospitalized with respiratory failure and receiving treatment with ARS drugs. In order to give more clarity to the situation, the Spanish Agency for Medicines and Health Products (AEMPS) has issued a safety note in which it is recalled that ?patients under treatment with drugs from these groups must continue treatment, without that a modification of the same is currently justified ? - Adequately designed studies are needed to help determine if there really is an influence of the use of RAS drugs on the relevant clinical variables related to the patient with COVID-19.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5632;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The effectiveness of Over-the-counter medications for acute cough or acute pneumonia are uncertain";"Most people with COVID-19 will develop a persistent cough and some may develop pneumonia. Non-prescription, over-the-counter (OTC) medicines have been used in the past to help with this in people without COVID-19. However, suppression of the cough mechanism might impede airway clearance and cause harm. There is a Cochrane systematic review, where the authors searched for randomised trials testing OTC cough medications in children and adults with cough that was secondary to acute pneumonia for which they were receiving antibiotics. They identified 4 eligible studies (224 participants). There is insufficient evidence for or against the effectiveness of OTC medicines for acute cough in children or adults with acute pneumonia.";2020;;;Uncertain;"Treatment COVID-19, over-the-counter medications, cough, respiratory infection";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5888;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Reprocessing of surgical masks is not recommended.";"Reprocessing of respirators under controlled conditions and by trained personnel is recommended.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5377;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Healthcare professionals should perform effective hand hygiene before direct contact with a patient including aseptic procedures, after direct contact with a patient, immediately after exposure to body fluids, after touching a patient?s surroundings, and immediately after glove removal. ";"(Grade A) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines.1,2 - A scoping review of the literature using a five-stage methodological framework including 21 papers.3 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5633;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of oxygen supplementation at higher levels for critically ill patients";"Some patients with COVID-19 will become critically ill and need help with their breathing. They may be given extra oxygen to breathe, which might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). Clinicians need to decide on the amount of supplemental oxygen to use. There is a Cochrane systematic review, where the authors searched for randomized trials of the effects of different levels of supplemental oxygen in adult ICU patients. They identified 10 studies (1458 participants). All the studies compared more with less oxygen, but using very different levels of oxygen supplementation. The effects of higher levels of oxygen are uncertain, but higher levels may increase mortality and adverse effects. ";2020;;;Uncertain;"Prevention COVID-19, ICU, mechanical ventilation, adverse events, mortality ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5889;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"There is uncertainty on the effectiveness of video call interventions for reducing social isolation and loneliness in older adults";"The review did not include any studies that reported evidence of the effectiveness of video call interventions to address social isolation in older adults. The evidence regarding the effectiveness of video calls for outcomes of symptoms of depression was very uncertain. Future research in this area needs to use more rigorous methods and more diverse and representative participants. Specifically, future studies should target older adults, who are demonstrably lonely or socially isolated, or both, across a range of settings to determine whether video call interventions are effective in a population in which these outcomes are in need of improvement. ";2020;;;Uncertain;"Managements of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5378;35;"Evidencias COVID-19";" Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Despite uncertainty associated with the pathogenic characteristics of SARS-CoV-2, measures to isolate cases and contacts and play an important role in bud control.";"A study that used a mathematical model to predict the effectiveness of measures to isolate cases and contacts in a SARS-CoV-2 outbreak. The authors considered the most current information available on the virus and simulated outbreaks with variable parameters, namely initial cases (5 to 40), basic reproductive number (1.5 to 3.5), the average time between the onset of symptoms and isolation, the proportion of transmission that occurred before the onset of symptoms and the proportion of subclinical infections. In most of the simulated scenarios, the effective isolation of cases and contacts was sufficient to control the COVID-19 outbreak in 3 months. However, some factors, such as the delay between the onset of symptoms and isolation, a lower number of contacts found in each case, and asymptomatic transmission, reduced the probability of controlling the outbreak.";2020;;;"High value";"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5634;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Hydroxychloroquine is not recommended for routine treatment in patients with Covid-19";"Under the premise that hydroxychloroquine has been widely administered to patients with Covid-19 without strong evidence to support its use, an observational study was conducted with a cohort of 1,376 patients in New York (NY), USA. The association between hydroxychloroquine use and respiratory failure at a large medical center that cares for a considerable number of Covid-19 patients in NY was examined. The use of hydroxychloroquine was presumed to be associated with a lower risk of a composite endpoint of intubation or death. The hydroxychloroquine regimen used was a loading dose of 600 mg twice on day 1, followed by 400 mg daily for an additional 4 days. Azithromycin at a dose of 500 mg on day 1 and then 250 mg daily for an additional 4 days in combination with hydroxychloroquine was a suggested additional therapeutic option. In this study with a large sample of consecutive patients who had been hospitalized with Covid-19, the risk of intubation or death was not significantly higher or lower among patients who received Hydroxychloroquine than among those who did not (risk ratio, 1.04 ; 95% CI, 0.82 to 1.32). Given the observational design and the relatively wide confidence interval, the study should not be considered to rule out the benefit or harm of Hydroxychloroquine treatment. However, the findings do not support the use of Hydroxychloroquine at present. The clinical guideline at that medical center was updated to eliminate the suggestion that Covid-19 patients be treated with Hydroxychloroquine today.";2020;;;"Low value";"Treatment COVID-19, Hydroxychloroquine, Azithromycin, respiratory failure ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5890;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";Spanish;"It is recommended to put in practice interventions to alleviate moral distress experienced by nurses working in critical care settings";"? Nurses should receive training or engage in continuous professional development programs to develop moral resilience and relational skills that facilitate coping with moral distress. (Grade B) ? Healthcare organizations should have structures (e.g. informational resources for staff, access to ethics consultants, educational opportunities for staff) and processes in place that support individual practitioners to develop moral resilience and address cases of moral distress. (Grade B) ? Nurses who experience moral distress may be advised to seek support from their experienced colleagues who have a contextual understanding of the critical care environment. (Grade B) ? Nurses should be encouraged to advocate for their rights, initiate as-needed discussions with doctors or other relevant health practitioners and families, and speak out their concerns to relevant people and seek help when necessary from health practitioners such as social workers. (Grade B) ? Nursing ethics huddles may be considered when ethically challenging issues occur. (Grade B)";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5379;35;"Evidencias COVID-19";" Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Administration of plasma to convalescent patient has benefits for patients with COVID-19 and severe respiratory failure.";"After plasma transfusion (which occurred between 10 and 22 days after hospital admission), 4 patients normalized their body temperature within 3 days. There was a reduction in the SOFA score in all patients, an increase in the PAO2 / FIO2 ratio, a reduction and possible negative viral load (within 12 days after the transfusion), and a subsequent increase in the titer of specific antibodies to SARS. -CoV -2, like neutralization. ARDS decreased in 4 patients up to 12 days after the transfusion and 3 of them no longer required mechanical ventilation. Until the last follow-up date, 2 months later, three patients were discharged after hospital stays of 51, 53 and 55 days, respectively, and 2 patients remained hospitalized, but in a stable condition 37 days after the transfusion.";2020;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5891;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";Spanish;"It is recommended to put in practice control measures and general practice principles for the handling, laundering and storage of hospital laundry";"? Hand hygiene should be performed before handling clean linen and after handling dirty linen. (Grade B) ? All linen should be color coded according to the type of linen and clearly labelled. (Grade B) ? Water soluble bags should be used for infectious linen. (Grade B) ? Washing cycles should include a disinfection cycle. (Grade B) ? Clean and dirty linen should be stored away from each other. (Grade B)";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5380;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"There is uncertainty regarding the use of remdesivir in patients with severe COVID-19 disease in clinical practice";"A retrospective cohort study, funded by Gilead, looked at 53 patients with confirmed severe SARS-CoV-2 infection, who were given remdesivir (viral RNA polymerase inhibitor) between 01/25/2020 and 3 / 7/2020, in the context of compassionate use for 10 days (first day with a loading dose of 200 mg intravenously and the remaining 9 days with a daily dose of 100 mg). All patients were hospitalized with oxygen saturations of 94% or less in ambient air or with supplemental oxygen support. Of the 53 patients analyzed, 30 (57%) were under invasive mechanical ventilation and 8% under extracorporeal membrane oxygenation. Over the next 18 days it was found that the majority (n = 36, 68%) of the patients had a clinical improvement, including 17 of 30 ventilated patients (57%) who ended up being extubated. Of this group, 25 patients (47%) were discharged from the hospital and 7 (13%) died (mortality rate of 18% of ventilated and 5% of non-ventilated). Larger and more reliable clinical studies are required to be used safely in clinical practice.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5636;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The effectiveness of the combination of hydroxychloroquine and azithromycin as routine treatment of COVID-19, with the presence of significant adverse events, is uncertain.";"In a retrospective observational cohort study conducted in France, individuals with SARS-CoV-2 RNA documented by PCR from a nasopharyngeal sample were offered early treatment with Hydroxychloroquine plus Azithromycin (HCQ + AZ), independently, as standard care. whether they had symptoms or not. Such treatment was found to reduce viral load and all deaths resulted from respiratory failure and not cardiac toxicity. Adverse clinical outcomes were associated with increased age, severity on admission, and low serum HCQ concentration. Negative clinical outcomes were also independently associated with the use of selective beta-blocking agents and angiotensin II receptor blockers. Some patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia, and transient blurred vision).";2020;;;Uncertain;"Treatment COVID-19, Hydroxycloroquine, Azithromycin, adverse events";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5892;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";Spanish;"There is uncertainty on the effectiveness of antiviral therapies for its use in patients with coronavirus.";"The current evidence for the effectiveness of antiviral therapies for coronavirus is not conclusive and suffers from a lack of well-designed prospective trials or observational studies. None of the interventions examined in this review can be recommended for use in patients with coronavirus. Similarly, no firm recommendations can be made for or against these interventions from a safety perspective due to a lack of conclusive evidence. Some important safety signals potentially related to ribavirin use were identified (anemia, altered liver function) but also require further investigation to clarify their relation to the drug.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5381;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Renin-angiotensin-aldosterone system inhibitors should continue to be administered to at-risk patients diagnosed with COVID-19 infection.";"The preclinical studies (in animal models) have planted the security management guideline for ISRAA administration in patients with COVID-19. However, according to current evidence, despite the questions about the effect of ISRAA in ECA2 and how these drugs can affect the severity of SARS-CoV-2 infection, it seems justified that this pharmacological group should continue to be administered to patients of stable risk that has been evaluated for what has not been diagnosed with coronavirus. The main questions that must be formulated on these medications have some role to play in the treatment of COVID-19, on the contrary, patients who currently take these medications must stop taking them before an infection or at least when an infection occurs. . . It is important to recognize that patients who are taking these medications must continue treatment, as their sudden interruption can cause serious complications. The European Society of Cardiology confirms this position and the American College of Cardiology has stated that, in the case of cardiovascular patients diagnosed with COVID-19, individual treatment decisions must be made according to the hemodynamic condition of each patient, as well as severity of its clinical condition.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5637;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The safety and efficacy of hydroxychloroquine alone or in combination with other medicinal products in patients with COVID-19 is uncertain.";"This systematic review evaluated the safety and efficacy of Hydroxychloroquine, alone or in combination with other medications. In terms of clinical cure, two studies reported a potential benefit in ""normalizing body temperature"" and another study reported fewer ""days of cough"" in the HCQ arm. HCQ treatment resulted in fewer cases showing the radiological progression of lung disease. No difference in virological cure, death or clinical worsening of disease, or safety was observed compared to conventional control / treatment. It is highlighted that conclusive and useful studies are lacking in this review. In addition, an ECA is awaited. The review was of low quality with inadequate information retrieved from the original RCTs found. A quantitative synthesis was not performed for observational studies (mainly case series). ";2020;;;Uncertain;"Treatment COVID-19, Hydroxycloroquine, safety, adverse events, lung disease";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5893;35;"Evidencias COVID-19";"NIPH Live map of COVID-19 evidence";Spanish;"There is uncertainty for the electronic follow-up of children and youth in childcare institutions";"Electronic communication ? such as email, text, video ? are commonly used in childcare institutions. Employees are comfortable with such tools and report that there are many more benefits than drawbacks with electronic communication. There are clinical, practical, ethical and legal implications with electronic communication ? most of which are positive. Benefits: Electronic communication in general is efficient, enhances productivity, offers qualitatively good communication and respects youths? preferences. Video facilitates positive communication, improves relations and trust in the caseworker, and supports clinical follow-up. Written communication is simple, saves time, and eases demands regarding documentation. Drawbacks: Electronic communication in general triggers some uncertainties with regard to privacy and confidentiality, and some employees feel they are ?always? on the job. It may be more difficult to assess the youth and family dynamics (e.g. drug use). Technical difficulties is a source of frustration. What facilitates electronic communication: It is important to assist the implementation of electronic communication (strategically, technically, organizationally, clinically, legally, etc.). Ensure: policies concerning their use, a set of various forms of electronic communication, training and technical support, safeguards for employees? professional boundaries.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6149;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not attempt to normalise albumin with albumin infusions following the acute phase of burn resuscitation.";"Albumin infusions are part of the acute resuscitation strategy of many burn centres globally, and may be associated with the administration of smaller volumes of crystalloid. Patients with severe burn injuries frequently develop chronic hypoalbuminaemia following resuscitation, due to hypermetabolism, fluid and protein loss from wounds, and impaired albumin synthesis. Attempting to restore serum albumin levels with the continuous infusion of human albumin solutions does not appear to improve outcomes in burn patients, and is costly.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5638;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"There is uncertainty about the effects of Chloroquine and Hydroxychloroquine on preventing the spread of COVID-19";"Although there are clinical opinions in favor of the prophylactic use of Chloroquine (CQ) and Hydroxychloroquine (HCQ) against COVID-19, there are no original clinical studies on the prophylactic role of CQ or HCQ in COVID-19. Furthermore, although the preclinical results are promising, to date there is a paucity of evidence to support the efficacy of CQ or HCQ in the prevention of COVID-19. Considering potential safety concerns and the likelihood of imparting a false sense of safety, CQ or HCQ prophylaxis against COVID-19 should be thoroughly evaluated in observational studies or high quality randomized controlled studies. In conclusion, this article describes the scarce data for the use of chloroquine and hydroxychloroquine for COVID-19. It also shows that much more information is needed about these medications, although they are already being prescribed without clinical evidence. ";2020;;;Uncertain;"Treatment COVID-19, Hydroxycloroquine, Azithromycin, adverse events8";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5894;35;"Evidencias COVID-19";"NIPH Live map of COVID-19 evidence";English;"There is a good correlation between diagnostic accuracy of symptomatic patients tested with rRT-PCR using self- collected saliva samples compared nasopharyngeal or oropharyngeal swabs";"The results indicate that the correlation between diagnostic accuracy of symptomatic patients tested with reverse transcription polymerase chain reaction (rRT-PCR) using self- collected saliva samples, compared to health care worker administrated nasopharyngeal or oropharyngeal swabs is good, corresponding to a sensitivity of 97-100 % and a specificity of 89-100%. The results should be considered with caution as further studies may change the estimates. Additionally, six of the studies are indicative of various types of salivary sampling as appropriate for detection of SARS-Cov-2 nucleic acid. These findings are highly relevant in the face of shortages of both swabs and personal protective equipment for health care workers. Self-collection of saliva is comfortable for patients as well as being easy, cheap, and non-invasive with minimal equipment required.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6150;19;"Choosing Wisely Canada";"Canadian Fertility and Andrology Society";English;"Don?t prescribe gonadotropins in doses of >450 units daily for controlled ovarian stimulation in IVF.";"Several studies demonstrate that the use of high doses of gonadotropins (approximately 450 units daily or greater) does not result in an increased number of dominant follicles recruited, mature oocytes retrieved, nor good quality embryos produced compared with lower dosing regimens. Furthermore, higher doses of gonadotropins have been associated with an increased risk of ovarian hyperstimulation syndrome (OHSS). Given that there is a greater cost to the patient and potential for harm, with no evidence of an improved outcome, avoidance of high doses of gonadotropins is recommended.";2020;;;"Low value";-;"https://choosingwiselycanada.org/fertility-and-andrology/" 5383;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"Brief advocacy interventions to promote the physical and psychosocial well?being may reduce depression and improve quality of life for women who have experienced intimate partner abuse.";"In this Campbell systematic review, the authors searched for randomized or quasi?randomized trials of the effects on intimate partner violence and women?s wellbeing of advocacy interventions, among women aged 15 years and over. They did not restrict by language of publication and did their search in April 2015. They included 11 randomized and 2 quasi-randomized trials (total: 2141 participants). More intensive advocacy interventions may reduce physical abuse for women who have experienced intimate partner abuse. Brief interventions are not effective in reducing physical or sexual abuse for women who have experienced intimate partner abuse The effects of these interventions when delivered in the context of social distancing are uncertain. The effects of intensive advocacy interventions delivered remotely are uncertain. ";2020;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5895;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"It is recommended to implement pharmacovigilance systems to ensure the safety of preventive vaccines. ";"Through 3 clinical trials it is observed that the safety profile of the most common vaccines is excellent, the side effects are not very significant and therefore these vaccines present adequate safety. ";2020;;;"High value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5384;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection.";English;"The use of non-sterile gloves is recommended in healthcare settings because they contribute to the prevention of cross-transmission from healthcare workers to patients and vice versa.";"Gloves should be worn during Standard Non-Contact Aseptic Technique (ANTT) and during patient care when there is a potential for direct contact with blood or other potentially infectious materials (eg, body fluids, wet body substances and saliva, membranes mucous membranes and non-intact skin) and / or contaminated elements and / or surfaces. ? An assessment of hand health (eg, assessing open skin areas to be covered) should be performed before putting on gloves. ? Hand hygiene should be done immediately before putting on gloves. ? Gloves should be changed if they are broken or heavily contaminated. ? Gloves should be removed and discarded immediately once a patient care episode is completed. ? Hand hygiene should be done immediately after removing gloves. ? Prolonged and indiscriminate use of gloves should be avoided, as it can cause adverse reactions and skin sensitivity.";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5640;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain that the use of hydroxychloroquine with or without azithromycin reduces the risk of mechanical ventilation in patients with COVID-19.";"Despite limited and conflicting data on the use of hydroxychloroquine in patients with Covid-19, the U.S. Food and Drug Administration has authorized the emergency use of this drug when clinical trials are unavailable or infeasible. Hydroxychloroquine, alone or in combination with azithromycin, is being widely used in Covid-19 therapy based on anecdotal and limited observational evidence. In this study, we found no evidence that use of hydroxychloroquine, either with or without azithromycin, reduced the risk of mechanical ventilation in patients hospitalized with Covid-19. An association of increased overall mortality was identified in patients treated with hydroxychloroquine alone. These findings highlight the importance of awaiting the results of ongoing prospective, randomized, controlled studies before widespread adoption of these drugs. ";2020;;;Uncertain;"Treatment COVID-19, Hydroxycloroquine, Azithromycin, ICU, mechanical ventilation";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5896;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;"There is uncertainty in psychological interventions to promote the resilience of health students.";"The results of a review containing 30 clinical trials conclude that the heterogeneity of interventions, the paucity of data in the short, medium and long term, and the geographic distribution restricted to high-income countries limit the generalizability of the results.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6152;19;"Choosing Wisely Canada";"Canadian Fertility and Andrology Society";English;"Don?t routinely perform laser assisted hatching on fresh embryos prior to transfer.";"Laser assisted hatching (LAH) is a technique where the zona pellucida is disrupted to improve implantation and therefore live birth rates from embryos created through IVF. Although there may be a benefit to performing LAH on fresh embryos in certain patient populations, the routine use of LAH for all patients undergoing a fresh embryo transfer has not been shown to improve live birth rates.";2020;;;"Low value";-;"https://choosingwiselycanada.org/fertility-and-andrology/" 5385;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection.";English;"Educational interventions that include practice in personal protective equipment removal can significantly reduce the risk of contamination";"Educational interventions that include practice in PPE removal with immediate visual feedback on skin and clothing contamination is recommended as it can significantly reduce the risk of contamination during removal of PPE. (Grade A)";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5641;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain that ivermectin is associated with lower mortality and length of hospital stay in patients with COVID-19";"A cohort study was conducted to find out if Ivermectin has effects on the outcomes of COVID-19. Although we report a strong potential signal for benefit in COVID-19, these data must not be considered conclusive since unknown confounders cannot always be reliably accounted for, even when propensity score matching techniques are emplooyed in developing control groups. There is no substitute to a properly conducted randomized clinical trial. However, ass the tempo of COVID-19 rages and aggressively so, we believe that even this preliminary information is important to communicate so that clinicians can consider this therapy for appropriate testing in this setting. We conclude that administration of ivermectin during COVID-19 illness in hospitalized patients is associated with a lower mortality and hospital length of stay. These findings require confirmation in randomized controlled trials. ";2020;;;Uncertain;"Treatment COVID-19, ivermectin, mortality, lenght of hospital stay";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5897;35;"Evidencias COVID-19";"Epistemonikos - COVID-19 L�OVE Working Group";Spanish;"Is not recommended the use of Favipiravir against COVID-19 pending further evidence.";"The available evidence on favipiravir for the treatment of COVID-19 is of very low certainty. It is not possible to establish whether it is an effective drug for this disease. There are numerous ongoing studies. However, in selected critically ill patients it is weakly recommended.";2020;;;"Low value";treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la " 5386;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"It is recommended urban green space exposure as it has been shown to boost the immune system and mental health, and reduce the risks of cardiovascular and respiratory diseases";"The COVID-19 pandemic has led to the closing of some leisure facilities, bars, restaurants, cafes and, with the need to self-isolate and socially distance, parks and green spaces have become an important resource for potential health and wellbeing benefits. A 2016 review was commissioned by the World Health Organisation (WHO) to evaluate existing evidence on the health effects of green space in urban areas. It includes evidence from previous WHO reviews, reviews by other researchers and research studies that had been recently published. The review included all definitions of urban green space (e.g. natural surfaces, natural settings, urban greenery, blue space (water elements), parks, private gardens, woodlands). Visiting the natural environment and coming into contact with certain physical and/or chemical factors in green space can benefit the immune system. Having contact with nature can be restorative and have mental health benefits, shifting those with high stress levels to a more positive emotional state, enhancing relaxation and e alleviating symptoms of depression. Use of green space is associated with reduced risks of cardiovascular and respiratory diseases.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5642;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain whether early use of vitamin C will prevent and treat Coronavirus disease";"There have been several publications about the use of some compounds that are considered antioxidants that may have some effectiveness in respiratory diseases. In daily practice, the population uses vitamin C (ascorbic acid) in different presentations for its management. In this publication (Cheng, 2020) recommends its use based on some observational studies. It should be remembered that there is a Cochrane Review that demonstrates the low effectiveness of Vitamin C in the common cold. The author describes that high doses of intravenous VC have also been used successfully in the treatment of 50 patients with moderate to severe COVID-19 in China. The doses used varied between 2 g and 10 g per day, administered over a period of 8 to 10 hours. An additional bolus of Vitamin C may be required between critically ill patients. The oxygenation index improved in real time and all patients were finally cured and discharged [In fact, the high-dose VC has been used clinically for several decades, and a recent document from the NIH expert panel clearly states that This regimen (1.5 g / kg of body weight) is safe and without major adverse events. Because development of effective vaccines and antiviral drugs takes time, VC and other antioxidants are among the agents currently available to mitigate ARDS associated with COVID-19. Given the fact that high doses of VC are safe, healthcare professionals should closely consider this opportunity. The author notes that well-designed clinical trials are obviously needed to develop standard protocols for their use.";2020;;;Uncertain;"Treatment COVID-19, Prevention COVID-19, vitamin C, ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5898;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"There is uncertainty as to whether combined therapy with an immunomodulatory agent and an antiviral agent is the best therapeutic option in the treatment of COVID19";"A total of 891 articles were found for a search, of which 289 studies were clinical studies in human, which were further evaluated in detail. Till date we do not have any definitive therapy for COVID19. We have not validated data from randomized controlled trials (RCTs) for treatment as well as for prevention for COVID19. As of today, we have more than 350 RCTs happening with different agents. ";2020;;;Uncertain;"Treatment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6154;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not administer opioid analgesics without considering the co-administration of adjunctive agents, and psychological as well as physical strategies to patients with burn injuries.";"Reliance on opioids as the dominant or only analgesic is associated with harms including not only higher opioid requirements and significant side-effects e.g. nausea, constipation, drowsiness, but also dependence, diversion, and overdose. One should implement a multi-modal analgesic strategy including acetaminophen and NSAIDS if there are no contra-indications. One should also consider medications directed at neuropathic pain (e.g. gabapentin, pregabalin, duloxetine, amitriptyline), as well as physical (e.g. positioning) and psychological (e.g. distraction, relaxation, meditation) interventions to optimize mental health, reduce anxiety and promote effective sleep.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5387;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer an antibiotic for treatment or prevention of pneumonia if COVID?19 is likely to be the cause and symptoms are mild";"As COVID?19 pneumonia is caused by a virus, antibiotics are ineffective.Inappropriate antibiotic use may reduce availability if used indiscriminately, and broad-spectrum antibiotics in particular may lead to Clostridioides difficile infection and antibiotic resistance.";2020;;;"Low value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5643;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Vitamin D is recommended for use in the aging population to protect them against SARS-CoV2 infection.";"The authors conclude that vitamin D levels are very low in the aging population, especially in Spain, Italy and Switzerland. They found significant relationship between vitamin D levels and the number COVID-19 cases and especially the mortality caused by this infection. This is also the most vulnerable population group for COVID-19, likewise, they consider that the use of vitamin D supplements should be recommended to protect against SARS-CoV2 infection. The authors only study in European countries, among other things, to avoid the possible effect of latitude and exposure to sunlight.";2020;;;"High value";"Prevention COVID-19, vitamin D, public health ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5899;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"The effectiveness of digital contact tracing technologies has not been proven in epidemics.";"Six cohort studies that reported quantitative data and six model studies that reported simulations of digital solutions for contact tracing were identified. The effectiveness of digital solutions has not been widely demonstrated, as there is very little published data in real-life outbreak contexts.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6155;19;"Choosing Wisely Canada";"Canadian Fertility and Andrology Society";English;"Don?t prescribe corticosteroids, IVIG, leukemia inhibitory factor or lymphocyte immunization therapy for patients undergoing IVF, those with a history of recurrent implantation failure or patients with recurrent pregnancy loss.";"Multiple studies have demonstrated no improvement in live birth rate or clinical pregnancy rate with steroids, granulocyte colony-stimulating factor (GCSF), leukemia inhibitory factor (LIF) or immunoglobulin (IVIG) in those undergoing IVF or those with a history of recurrent implantation failure (RIF). In women with a history of recurrent pregnancy loss (RPL), there is evidence demonstrating no improvement in live birth rate with IVIG or lymphocyte immune therapy.";2020;;;"Low value";-;"https://choosingwiselycanada.org/fertility-and-andrology/" 6411;31;"Smarter medicine";"Sociedad Profesional Suiza de Geriatr�a";English;"The use of drugs other than metformin to achieve a hemoglobin A1c level of less than 7.5% is not recommended in most older people with type 2 diabetes; moderate glycemic control is generally preferable.";"There is no evidence that the use of medications for tight glycemic control is beneficial in most older people with type 2 diabetes. The use of medications to reduce glycated hemoglobin to less than 7.0% may be harmful, including an increased mortality rate. In the elderly, tight control has consistently caused higher rates of hypoglycemia. Given the significant time frames required to achieve the theoretical microvascular benefits of tight control, glycemic goals should reflect the patient's goals, health status, and life expectancy.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5132;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Virtual Touch Quantification (VTq) Software is recommended to diagnose and control liver fibrosis ";"VTq is as accurate as transient elastography in diagnosing and staging liver fibrosis, and may offer other benefits in terms of imaging the liver and sampling selected areas to assess fibrosis and identify associated pathologies. By avoiding liver biopsies, it may also benefit people whose liver fibrosis needs monitoring. Cost savings through adopting VTq will be greater in hospitals in which liver biopsy is the primary method for diagnosing and monitoring liver fibrosis. VTq should be considered as an option for people with chronic hepatitis B or C who need assessment of liver fibrosis.";2020;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5388;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer a corticosteroid when managing suspected or confirmed pneumonia in adults unless the patient has other conditions for which these are indicated, such as asthma or COPD.";"For further information please visit the link";2020;;;"Low value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5644;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain that hospital use of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers is associated with an increased risk of mortality.";"Given the important concern of the use of IECAs and ARA II in patients with hypertension diagnosed with COVID-19. This multicenter retrospective study included 1,128 adult patients with hypertension diagnosed with COVID-19, including 188 who took IECAS / ARA II, sought to determine the association between hospital use of IECAS/ ARA II and all-cause mortality in patients with hypertension. arterial COVID-19. In conclusion, although patients hospitalized for COVID-19 with hypertension, hospital use of IECAS/ ARA II was associated with a lower risk of all-cause mortality compared to non-users of IECAS/ ARA II. The interpretation of the study should consider the potential for residual confounding factors, it is unlikely that hospital use of IECAS / ARA II is associated with an increased risk of mortality.";2020;;;Uncertain;"Treatment COVID-19, IECA, ARA II, mortality, hypertension";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5900;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"it is recommended the use of moisturizers and protective creams, alone or in combination, in the primary prevention of occupational irritant dermatitis.";"In this review, there are 9 trials included (2888 participants) and also identified 2 ongoing studies and 1 additional article that is pending assessment. The results of protective creams, moisturizers, a combination of both protective and moisturizing creams, or education on skin protection showed imprecise effects that favored the intervention.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6156;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not administer analgesia and sedation (e.g. opioids and benzodiazepines) without regular titration, interruption or dose reassessment of the administered agents in mechanically ventilated patients for their burn injuries.";"It is important to regularly review the indication and dosage of analgesia and anxiolytics (including but not limited to opioids and benzodiazepines) in patients mechanically ventilated for their burn injuries. Higher doses of opioids and benzodiazepines are associated with delays in extubation, an increased risk of systemic infections (including ventilator associated pneumonia), deep vein thrombosis, delirium, and longer hospital stays, which in turn result in deconditioning, and long-term psychological effects.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5389;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection.";English;"It is recommended de use of alcohol-based solutions for hand hygiene in hospitals";"? Alcohol hand-rubs are recommended as a convenient and effective routine hand hygiene practice in hospital settings. (Grade A) ? New and untrained healthcare workers should be instructed in the correct techniques for hand antisepsis. (Grade B) ? Alcohol-based hand-rubs should be applied for a minimum of 15 seconds. (Grade B)";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5645;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain that the anti-inflammatory effects of NSAIDs reduce symptoms in patients with COVID-19.";"Several alerts have been published on the use of nonsteroidal anti-inflammatory drugs for patients with COVID 19. The Quick Review found no RCTs. She reviewed 5 observational studies compiled by the Oxford Center for Evidence-Based Medicine (CEBM). It should be noted that the duration of treatment (acute or chronic) with NSAIDs in the studies is not clear in the review. Available evidence suggests that although the anti-inflammatory effects of NSAIDs reduce acute symptoms (such as fever), they may have no effect or worsen long-term results, possibly by masking symptoms of worsening acute respiratory tract infection. . Further testing is needed to confirm this and to determine if these results also apply to infections like COVID-19.";2020;;;Uncertain;"Treatment COVID-19, NSAID, anti-inflammatory, respiratory tract infection";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5901;35;"Evidencias COVID-19";"Cochrane - Revisi�n sistem�tica";Spanish;"There is no strong evidence of rapid site-of-care antigen and molecular testing for the diagnosis of SARS ? CoV ? 2 infection";"Treatment Identifies early stage testing for SARS ? CoV ? 2 infection. The findings currently have limited applicability, as there is no certainty that tests are performed in the same way in clinical practice, or based on COVID-19 symptoms, duration of symptoms, or in asymptomatic people. Rapid tests allow earlier detection of those who test positive. However, the current evidence is not strong enough to determine its usefulness in clinical practice.";2020;;;Uncertain;diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5390;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection.";English;"The use of Hand hygiene monitoring technology (HHMT) is recommended to increase hand hygiene compliance and reduc the risk of transmission of healthcare-associated infection (HCAI).";"There is emerging evidence to support the use of HHMT to increase hand hygiene compliance and reduce the incidence of HCAI; however, at this time no one type of HHMT can be recommended. It is however, recommended that organizations consider the context in which an HHMT will be used, and conditions unique to their setting, before installing any HHMT. (Grade B)";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5646;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"There is uncertainty about the benefits of ivermectin in patients with SARS-CoV-2.";"Ivermectin is a drug that has been tested in vitro and is being studied in clinical trials being conducted in Australia among other countries. This publication reports that Ivermectin, an FDA-approved antiparasitic that previously was shown to have broad-spectrum antiviral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells, 2 hours after infection with SARS-CoV-2 capable of effecting a veces5000 fold reduction in viral RNA at 48 h. Ivermectin, therefore, warrants further research for possible human benefits.";2020;;;Uncertain;"Treatment COVID-19, invermectin, FDA";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5902;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"There is no evidence that the use of convalescent plasma as a treatment in hospitalized COVID-19 patients reduces the risk of disease progression or mortality.";"The available evidence does not allow to define whether the use of convalescent plasma as part of the treatment of hospitalized patients for COVID-19 can reduce the risk of disease progression or mortality, so its use should be limited to experimental studies. The initiation time, dose and duration of treatment to achieve higher levels of antibodies in recipient patients with COVID-19 have not been established. The impact of this intervention as a prophylaxis in people at risk or as a treatment in patients with mild or asymptomatic forms is unknown.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6158;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not undertake medical or surgical procedures if these are inconsistent with the burn patient?s expressed goals of care.";"All patients should have a goals of care discussion (between the health care team and the patient and/or substitute decision maker) during the first 48 hours of their hospital stay. This is especially relevant for patients with extensive burn injuries, the elderly, and those at high risk of death. Interventions should only be undertaken when they are in keeping with the patient?s previously expressed goals of care or best interests, as determined by the patient?s substitute decision-maker in conjunction with the clinical team. ";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5391;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is uncertainty to suggest that exercise has no impact on the rate and duration of acute respiratory infection but may provide a small reduction in severity of symptoms. ";"Research in exercise immunology suggests moderate exertion may decrease the risk of acute respiratory infection in healthy adults but lacks assessment of its reliability. COVID-19 research would need to dedicate resources to robustly investigate exercise interventions as prevention or potential treatment during mild cases or to speed recovery from intensive care following ARI.";2020;;;Uncertain;"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5647;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"There is uncertainty about the clinical benefits of convalescent plasma (PC) therapy in patients with COVID-10. ";"A cross-sectional observational study was carried out, which included 10 patients diagnosed with severe COVID-19, from different hospitals in China. After convalescent plasma (CP) transfusion, the level of neutralizing antibodies increased rapidly in five cases. Clinical symptoms improved significantly along with the increase in oxyhemoglobin saturation in 3 days. Several parameters tended to improve compared to pre-transfusion, including increased lymphocyte count (0.65 � 109 / L vs. 0.76 � 109 / L) and decreased C-reactive protein (55.98 mg / L vs. 18.13 mg / L). Radiological examinations showed varying degrees of absorption of the lung lesions in 7 days. Viral load was undetectable after transfusion in seven patients who had previous viremia. No serious adverse effects were observed. This study showed that CP therapy was well tolerated and could improve clinical outcomes by neutralizing viremia in severe cases of COVID-19. The optimal dose and time point, as well as the clinical benefit of CP therapy, need further investigation in larger, well-controlled trials.";2020;;;Uncertain;"Treatment COVID-19, convalescent plasma, safety";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5903;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones, Facultad de Medicina - Universidad de";Spanish;"It is recommendedental the health Interventions for college students during the COVID-19 Pandemic";"68 articles and 99 web resources were consulted. After reviewing the full text, 12 scientific articles and 11 web resources were included. With which it was concluded that it is beneficial to carry out structured and revised programs, promotion and prevention of mental health, attention to symptoms, pedagogical adaptations.";2020;;;"High value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa " 6159;19;"Choosing Wisely Canada";"Canadian Fertility and Andrology Society";English;"Don?t routinely perform sperm DNA fragmentation testing.";"High-grade evidence to support the routine use of sperm DNA fragmentation testing as part of initial screening investigations for infertility is lacking. Sperm DNA fragmentation tests are poor at predicting outcomes in patients undergoing assisted reproductive technologies, particularly for patients undergoing IVF or intracytoplasmic sperm injection (ICSI), and should not be used to guide treatment decision-making.";2020;;;"Low value";-;"https://choosingwiselycanada.org/fertility-and-andrology/" 5392;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"There is no evidence of the efficacy of anti-virals in Covid-19";"Anti-virals: 1. Remdesivir 100-200 mg / day iv for 5-10 days in clinical trials. 2. Lopinavir / Ritonavir 400 mg / 100mgr oral twice daily for 14 days in a clinical trial. 3. Favipiravir 1,600-2,400 mg loading dose followed by 600-1,200 mg twice daily for 7 days in clinical trials with or without Tocilizumab. 4. Oseltamivir 150-300 mg / day for 14 days in clinical trials with or without ritonavir or ASC09F. 5. Darunavir / cobicistat 800 mg / 150 g daily for 5 days in clinical trial.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5648;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"There is uncertainty about the effects of BCG vaccine for the prevention of COVID-19 in the elderly population.";"The question was raised whether the BCG vaccine would also affect the spread of the disease, with the caveat that the number of reported cases of COVID-19 will largely depend on the number of tests conducted by country. Upper and upper middle income countries that have a current universal BCG policy (55 countries) had 59.54 � 23.29 (average � s.e.m) cases per million inhabitants. Consistent with BCG's role in slowing the spread of COVID - 19, upper middle and upper income countries that never had a universal BCG policy (5 countries) had approximately 4 times the number of cases per million population , with 264.90 � 134.88. This difference between countries was significant (p = 0.0064, Wilcoxon rank sum test), suggesting that extensive BCG vaccination along with other measures could delay the spread of COVID-19. We also wondered if countries in Upper and upper middle incomes with current universal vaccination policies (28 countries) would show a relationship between the number of cases and the year in which universal vaccination began. Interestingly, there was no significant correlation (r = 0.21, p = 0.27) between the year vaccination started and the total number of COVID-19 cases, suggesting that early vaccination of the elderly population was not a factor to reduce the number of cases.";2020;;;Uncertain;"Prevention COVID-19, BCG, vaccine, public health, elderly";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5904;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"There is no evidence that rapid diagnostic techniques for SARS-CoV-2 infection (antigens and molecular tests) in primary care or hospital care have the same precision as in specialized laboratories.";"The systematic review includes 22 studies of moderate quality, with a high risk of bias in 50% of the studies. It is concluded that there is no evidence that rapid diagnosis techniques for SARS-CoV-2 infection in primary or hospital care, which include screening tests and confirmatory studies of infection (by RT-PCR and clinical picture) have the same precision as in specialized laboratories.";2020;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5393;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"Hydroxychloroquine appears effective against coronavirus, based on very low quality evidence";"Scientific basis: 1. Several studies that I could not access (n = 15) in vitro with COVID-19 show efficacy, without specifying the magnitude. 2. It showed in vitro efficacy against other coronaviruses. (Virology Journal 2005; 2:69) 3. Multicenter clinical trial 10 Chinese hospitals (n = 100), original source inaccessible, 500 mg / day, they say that it shows clinical efficacy in clarifying the viral load and improvement of lung lesions. (BioScience Trends. 2020; 14 (1): 72-73. doi: 10.5582 / bst.2020.01047) 4. French study, not randomized and open. 200 mg x 3 / day. Very bad quality. They even do more calculations (APP). Numbers doing TIA and in the worst case, for negative PCR after the 6th day: RR = 0.63 (0.34-1.19) with n = 42. Study with low statistical power. (doi.org/10.1101/2020.03.16.20037135)";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5649;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"There is uncertainty about the use of chloroquine as a treatment for COVID-19.";"This systematic review does not have quantitative analysis, it is narrative, the authors define the purpose and findings as follows: ""Purpose: COVID-19 (coronavirus disease 2019) is a public health emergency of international concern. From this Currently, there is no known effective pharmaceutical treatment, although it is very necessary for the patient to contract the severe form of the disease.The objective of this systematic review was to summarize the evidence regarding chloroquine for the treatment of COVID-19. found that chloroquine appears to be effective in limiting the replication of SARS-CoV-2 (the virus that causes COVID-19) in vitro. Therefore, pre-clinical evidence of effectiveness and safety evidence of long-term clinical use term in other indications justifies clinical research on chloroquine in patients with COVID-19. However, clinical use must comply with the framework of Use of Emergen Monitoring Unregistered Interventions (MEURI) or be ethically approved as a trial as established by the World Health Organization. High-quality safety data and clinical trial data are urgently needed.";2020;;;Uncertain;"Treatment COVID-19, chloroquine, public health";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5905;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"There is no evidence that physical distancing alone protects against COVID-19.";"Current recommendations for safe physical distancing (one to two meters) are based on outdated evidence. In a systematic review carried out in the context of the COVID-19 pandemic, it was observed that the distribution of viral particles is affected by numerous factors such as air flow, ventilation, type of activity, viral load and duration of The exhibition. In higher risk situations, a physical distance of more than two meters should be considered and occupation time minimized. Physical distancing must be implemented together with other strategies, such as hand hygiene, cleanliness of environments, occupation, management of closed spaces, ventilation and adequate protective equipment such as masks.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6161;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not routinely initiate fluid resuscitation in patients when the burn is less than 15% total body surface area (TBSA).";"Partial and full thickness burns affecting less than 15% of the TBSA do not require specific directed fluid resuscitation. Patients with burn injuries under 15% can typically meet their requirements with maintenance intravenous fluid infusions or oral fluid intake alone. There may be other associated indications for fluid replacement, however, such as concomitant trauma, dehydration, alcohol intoxication, or other fluid losses.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5394;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"No evidence of efficacy of any treatment for cytokine storm";"Different drugs have been proposed for cytokine storm management: ? Inhibit IL-1, with Anakinra ? Inhibit IL-6 by Tocilizumab ? Anti-inflammatories like Celecoxib and Mesalazine (+ neuraminidase inhibitors) ? Gemfibrocil, which inhibits IL-6, gamma-Interferon and TNF ? Corticosteroids ? Intravenous immunoglobulin None of them shows conclusive evidence for viral diseases that are accompanied by a cytokine storm. The basis for treatment is purely pathophysiological.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5650;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain whether ibuprofen exacerbates COVID-19 infection.";"Regarding the information that has emerged about the danger of using ibuprofen in COVID-19 infections, it is wanted to communicate that the World Health Organization (WHO) and some Regulatory Authorities such as the European Medicines Agency (EMA), the NHS of the United Kingdom, the AEMPS in Spain and the HPRA in Ireland have stated that there is currently no evidence to confirm an aggravation of COVID-19 infection with ibuprofen or other NSAIDs. The EMA even recommends that when starting fever or pain treatment for COVD-19 infection patients and professionals consider the options available including paracetamol and non-steroidal anti-inflammatory drugs. In summary (see additional information below), and until additional evidence is generated, we believe that the approach suggested by the UK NHS is adequate, which, recognizing the lack of evidence regarding the harmful effects of ibuprofen in covid-19 infections, does not advise suspending treatments with this medicine, but in the case of starting them, prioritize the use of paracetamol to treat the symptoms of the infection.";2020;;;Uncertain;"Prevention, epidemiology, treatment COVID-19, ibuprofen, NSAIDS";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5906;35;"Evidencias COVID-19";"Cochrane - Revisi�n sistem�tica";Spanish;"There is no evidence that oxygen targets in the intensive care unit during mechanical ventilation improve ARDS";"We are very uncertain as to whether a higher or lower oxygen target is more beneficial in patients with ARDS and receiving mechanical ventilation in an intensive care setting. We identified only one RCT with a total of 205 participants exploring this question, and rated the risk of bias as high and the certainty of the findings as very low. Further well?conducted studies are urgently needed to increase the certainty of the findings reported here. This review should be updated when more evidence is available. ";2020;;;Uncertain;"patient management ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa " 5395;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"There is no evidence that vitamins and trace elements have a role in the treatment of COVID-19";"From the analysis of two articles found related to the topic (a systematic review and a randomized clinical trial), it highlights: - A systematic review, where the search strategy is not described, the quality evaluation and no meta-analysis is considered, addresses vitamins A, B, C, D, E, Omega-3 PUFA, Selenium, Zinc and Iron, in addition to other treatments (immunoglobulins, etc). However, they do not describe or find experimental studies (RCTs) evaluating the efficacy of these hypothetical treatments. - An RCT highlights that the infusion of Vitamin C for 96h does not improve the clinical situation or organic failure (SOFA), nor does it improve the biomarkers of inflammation and vascular damage.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5651;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The combination of multiple Public Health interventions is recommended to slow the spread of the epidemic";"The potential role of a series of public health measures, called non-pharmaceutical interventions (NPI), aimed at reducing contact rates in the population and therefore reducing transmission of the virus, is evaluated. As the conclusion of this report, the effectiveness of any isolated intervention may be limited, requiring multiple interventions to be combined to have a substantial impact on transmission. Two fundamental strategies are proposed: (a) mitigation, which focuses on slowing down, but not necessarily stopping, the spread of the epidemic, reducing the maximum demand for medical care and protecting people at increased risk of serious disease from infection, and (b) suppression, which aims to reverse epidemic growth, reducing the number of cases to low levels and maintaining that situation indefinitely. Each policy has great challenges. Optimal mitigation policies (combining home isolation of suspected cases, home quarantine of those living in the same home as suspected cases, and social distancing of the elderly and others at increased risk of serious illness) could reduce demand maximum medical attention in 2/3 and deaths in half. Meanwhile, the unmitigated epidemic would likely result in hundreds of thousands of deaths and healthcare systems (especially intensive care units) greatly overwhelmed by demand that is beyond capacity. For countries capable of achieving this, this leaves deletion as the preferred health policy option.";2020;;;"High value";"Prevention COVID-19, health policy, public health, epidemic";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5907;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"There is no evidence for the use of favipiravir in the treatment of patients hospitalized for moderate forms of COVID-19 and without risk factors.";"There is no evidence that the use of favipiravir in the treatment of patients hospitalized for moderate forms of COVID-19 increases clinical and radiological improvement and viral clearance. Due to its relative safety, it would be an alternative treatment for patients without risk factors with moderate forms.";2020;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6163;19;"Choosing Wisely Canada";"Burns Canada";English;"It is not recommended to perform routine investigations such as daily blood tests or chest radiographs unless they will guide decision making with respect to management of the patient with burns.";"The medical team should regularly reassess the indications for routine daily bloodwork and chest radiographs as the clinical course proceeds, especially when there has been no significant intervening condition change. Several studies have demonstrated the cost benefits of such a strategy, without compromising the delivery of optimal patient care.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5396;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Current data do not support the use of hydroxychloroquine for prophylaxis or treatment of COVID-19.";"There are no published trials of prophylaxis. Two trials of hydroxychloroquine treatment that are in the public domain, one non-peer reviewed, are premature analyses of trials whose conduct in both cases diverged from the published skeleton protocols registered on clinical trial sites. Neither they, nor three other negative trials that have since appeared, support the view that hydroxychloroquine is effective in the management of even mild COVID-19 disease.";2020;;;"Low value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ " 5908;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommenced the use of nanoscale materials in the treatment of COVID-19.";"In this sistematic review, the authors searched for studies on the effects of nanoscale materials against coronaviruses in vitro or in animal models. They included 6 in vitro studies, 14 animal model studies and 1 that was both an in vitro and animal model study. Positive association was found between efficacy of nanoscale materials and coronaviruses in vitro and in animal models.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5397;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"The widespread use of masks by citizens is recommended to reduce community transmission of the coronavirus";"This study highlights that one of the main routes of transmission of SARS-CoV-2, which is high, is produced by the emission of small respiratory drops when coughing or sneezing, although data on transmission when speaking is also available. Therefore, potential contagion situations multiply. Transmission occurs at any stage of infection (both in an initial phase, in asymptomatic people, and in those with symptoms) and some studies show that infected people have a high transmission capacity in the first days of infection, with a high viral load in the upper respiratory tract. For this reason, the spread of the virus should be reduced by establishing, among other measures, a limitation of contacts with infected people, the study of contacts, hygienic measures and the use of masks in public to reduce the probability of transmission. the latter which is more effective when its compliance is high: - the available data from studies in an experimental or laboratory situation show that cloth masks have the capacity to block the drops emitted by the person wearing them in the most relevant size range (between 5 and 10 �m); - There are no clinical trials that have evaluated the impact of masks on people with COVID-19, and indirect data from other studies are inconsistent, but generally speaking, the use of masks decreases the spread of respiratory viruses ( the data from the most recent studies can be found in another entry in 'Evidences COVID-19' https://bit.ly/2REH8Ze). Other systematic reviews (discussed below) [2, 3] and primary clinical trials have shown that a reduction in respiratory virus transmission can be achieved by combining a series of measures based on hand hygiene, other barrier methods, and isolation. or distancing from suspected or infected cases; - the results of clinical research should be interpreted according to the current context and how the public can receive and adhere to recommendations such as those of wearing a mask routinely. It is complex to anticipate the change in behavior in people and there are doubts about whether, due to an attitude of risk compensation, the perception of security offered by the mask could affect negligence with other important measures such as social distancing. On the other hand, there are also data that suggest that the use of preventive methods promotes a safer attitude or that the proper communication of the need for this type of measure is a way of empowering citizens to act responsibly. ; - the assessment of the impact of measures such as the widespread use of masks by the population can only be based on projections and / or modeling. Some show that the use by half of the population of masks with an efficiency of 50% could have an impact on the reproduction factor of the new coronavirus, reducing it from a global R0 2.4 to 1.35 after implementing the measure (or going from an initial spread of 100 cases to more than 30,000 in a month to just under 600 after implementing the measure).";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5653;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain whether chloroquine, hydroxychloroquine, or remdesivir have beneficial effects for the treatment of COVID-19.";"The results of in vitro studies comparing Chloroquine (CQ) with Hydroxychloroquine in the effort to find a faster solution while investigating remdesivir (GS-5734) are described. A recent case report showed that remdesivir treatment improved the clinical condition of the first SARS-CoV-2 infected patient in the United States, and a Phase III clinical trial of remdesivir against SARS-CoV was launched on February 4. 2 in Wuhan, 2020. However, as an experimental drug, remdesivir is not expected to be widely available to treat large numbers of patients in a timely manner. Therefore, of the two potential drugs, CQ appears to be the drug of choice for large-scale use due to its availability, proven safety record, and relatively low cost. In light of preliminary clinical data, CQ has been added to the list of test drugs in the guidelines for the diagnosis and treatment of COVID-19 (sixth edition) published by the National Health Commission of the People's Republic of China .";2020;;;Uncertain;"Treatment COVID-19, chloroquine, hydroxychloroquine, remdesivir ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5909;35;"Evidencias COVID-19";"Evidence Aid";English;"Is recommended the Access to mental health services and psychological support for health workers involved in providing patient care during the COVID-19 pandemic.";"Findings from several relevant systematic reviews conclude that health workers involved in disease outbreaks or pandemics have reported a variety of mental health symptoms; stress, anxiety, psychological discomfort, depressive symptoms, insomnia and ""moral damage"". He highlighted concerns for his personal safety, families and patients.";2020;;;"High value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6165;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not excise and autograft partial thickness burns, including scald burns in children, without a period of wound care and observation, unless obvious deep partial thickness.";"A significant proportion of partial thickness burn injuries will heal within two to three weeks without surgery. A period of observation of a week or more, especially in smaller burns, will allow the wound to manifest features of healing or the capacity to heal. This is especially true in the context of paediatric scald burns, the most common category of burn injuries globally. A conservative approach to the management of these wounds has the potential to reduce healthcare costs, the need for operative procedures, and the impact of donor site wound care and pain. There is also limited evidence to suggest that a wound that heals within three weeks is more likely to scar prominently when compared to a split thickness skin graft.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 6421;31;"Smarter medicine";"Sociedad Suiza de Enfermedades Infecciosas";English;"Antibiotic prescription for uncomplicated upper respiratory tract infections is not recommended.";"Antibiotics should be used with caution in the era of increasing antibiotic resistance. Since many upper respiratory tract infections are viral in nature, antibiotics are useless anyway.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5398;35;"Evidencias COVID-19";"Hospital Universitario Donostia- Unidad de Epidemiolog�a Cl�nica";Spanish;"There is no scientific evidence to quantify the risk of transmission of Covid-19 in the surgical act.";"Routine screening for COVID-19 is recommended before urgent or elective surgery. Due to the important prognostic potential of COVID-19 in patients requiring cardiovascular surgical treatment and the safety of healthcare professionals, it is recommended that an active search for infected patients be carried out in all cases of elective surgery.";2020;;;"Low value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5654;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There is uncertainty about the efficacy of mHealth due to the complexities of healthcare delivery and human interactions which challenge simplistic conclusions about how healthcare professionals will perceive and experience the use of mHealth .";"Perceptions reflect the interaction between technology, contexts, and human attributes. Detailed descriptions of the program, implementation processes, and contexts, along with efficacy studies, will help unravel this interaction to formulate hypotheses about the effectiveness of mHealth.";2020;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 5910;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that school closings can prevent the transmission of COVID-19";"Based on available reviews, the overall effects of school closings on COVID-19 transmission are uncertain. School closures alone might prevent 2-4% of deaths, which was less than other social distancing methods. ";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5143;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to be aware that: there are many causes of leg ulcers: underlying conditions, such as venous insufficiency and oedema, should be managed to promote healing, most leg ulcers are not clinically infected but are likely to be colonised with bacteria, antibiotics do not help to promote healing when a leg ulcer is not clinically infected.";.;2020;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5911;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"Disaster training programs for medical students are recommended to improve the preparedness, knowledge and skills they need during a pandemic.";"En esta revisi�n sistem�tica, los autores buscaron investigaciones sobre cursos de capacitaci�n en desastres para estudiantes de medicina. 23 estudios cumplieron con los criterios de inclusi�n. Llegaron a la conclusi�n de que la implementaci�n de programas de capacitaci�n en desastres para estudiantes de medicina mejora la preparaci�n, el conocimiento y las habilidades que son importantes para los estudiantes de medicina en tiempos de pandemia.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6167;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not recommend the administration of hydroxycobalamin (Vitamin B-12A or 'cyanokit') to patients prior to assessment in the burn centre, unless the history and investigations strongly support its use.";"Evidence supporting the routine use of hydroxycobalamin is weak and may be associated with the development of renal impairment. Hydroxycobalamin may be administered in the burn centre in the setting of a severe inhalation injury and uncorrected worsening metabolic acidaemia. Patients with a strong clinical picture of severe inhalation injury who require prolonged transport to a burn centre may be the exception to this rule.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5400;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"It is recommended guidance from healthcare workers when supporting patients with COVID-19 related anxiety.";"The key recommendations from current guidance and research for healthcare workers supporting patients with COVID-related anxiety include: Regulating exposure to COVID-related media. Maintaining a strong social network. Looking after your body and avoiding unhealthy coping strategies. Focusing on self-care techniques including mindfulness.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ " 5656;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is uncertain that treatment with antihypertensive drugs has to be suspended as it is a risk against COVID-19.";"Many of the patients infected with COVID-19 are elderly patients who have underlying pathologies (diabetes mellitus, ischemic heart disease), which in turn are risk factors for increased severity and mortality from COVID-19, which is why It is expected that many of them are treated with ACE or AIIRA, without this meaning that antihypertensive treatment itself is the factor that worsens the prognosis of their COVID-19 infection. Patients in treatment with medicines from the ACE or AIIRA group should continue with the treatment, without currently justifying a modification of the same. In patients with COVID-19 infection with severe symptoms or sepsis, both antihypertensive drugs that act on the renin angiotensin system and other types of antihypertensive drugs should be managed according to clinical guidelines, taking into account the patient's hemodynamic situation.";2020;;;Uncertain;"Prevention COVID-19, ACE, antihypertensive ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5912;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that additional work breaks prevent musculoskeletal symptoms and disorders.";"They included 6 randomized trials and identified an additional study in progress from which it was concluded that additional work breaks may have a positive effect on productivity and job performance, but may have no effect on musculoskeletal pain, discomfort or fatigue.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6168;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not administer prophylactic antibiotics to patients presenting with acute burn injuries.";"The available evidence does not support the routine use of early systemic antibiotic prophylaxis in the management of patients with acute burn injuries. In addition to exposing patients to side-effects, antibiotic use without indication encourages the development of resistance, thus reducing treatment options during the patient?s hospital course. Topical antimicrobial dressings are the standard of care for these patients.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5401;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is uncertainty about the effectiveness of N-acetylcysteine in the treatment of IDOC-19";"Could the N-acetylcysteine and its antioxidant properties may have purpose for use in the therapy and/or prevention of acute viral respiratory infections including influenza. However, the therapeutic efficacy of NAC is likely to be strain-dependent. Clinical trial evidence for the use of NAC as an antioxidant in influenza and other acute viral respiratory tract infections is very limited. It is therefore difficult to draw any concrete conclusions without evidence from larger trials. We did not find any COVID-specific evidence for the use of N-acetylcysteine.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ " 5913;35;"Evidencias COVID-19";"Evidence Aid";English;"The effects of higher oxygen levels are uncertain, but they can increase mortality and adverse effects.";"10 randomized trials (1458 participants) of the effects of different levels of supplemental oxygen in adult ICU patients. All the studies compared more with less oxygen, but using very different levels of oxygen supplementation. The effects of higher levels of oxygen are uncertain, but higher levels may increase mortality and adverse effects.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4890;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Take a structured clinical history in people with suspected asthma. Specifically, check for: wheeze, cough or breathlessness, and any daily or seasonal variation in these symptoms any triggers that make symptoms worse a personal or family history of atopic disorders.";"Examine people with suspected asthma to identify expiratory polyphonic wheeze and signs of other causes of respiratory symptoms, but be aware that even if examination results are normal the person may still have asthma. ";2020;;;"High value";Asthma;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5146;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to do not take a sample for microbiological testing from a leg ulcer at initial presentation, even if it might be infected.";.;2020;;;"High value";" Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5402;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is uncertainty about the use of lopinavir/ritonavir in the treatment of COVID19";"There is no strong evidence of the efficacy of lopinavir/ritonavir in the treatment of VOC-19. In general, the limited studies identified are subject to methodological flaws. ";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ " 5914;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended the use of corticosteroids in adult patients with severe COVID-19 infection who are ventilated or receiving supplemental oxygen therapy, as it reduces mortality and acute respiratory distress syndrome.";"In the following systematic reviews, including Singh 2020, Ye 2020 and Yang 2020, it was concluded that the use of corticosteroids could reduce mortality from COVID-19 and acute respiratory distress syndrome (ARDS). However, no benefit was found in patients with mild COVID-19 infection and it is not recommended for use in children.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6170;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Don?t use ultrasound routinely to evaluate clinically evident inguinal hernias.";"The diagnosis of most inguinal hernias can be made with a focused patient history and physical examination. Routine ultrasounds add little value to the diagnosis and management of clinically evident inguinal hernias and can result in treatment delay. These investigations should therefore not be performed where there is a clearly palpable abdominal wall defect and should instead be limited to use in the evaluation of occult inguinal hernias.";2020;;;"Low value";-;"https://choosingwiselycanada.org/general-surgery/" 5403;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is uncertainty about the benefits of traditional antivirals for treating COVID-19 the";"The historical record of clinical studies could help in the search for possible treatments against COVID-19 based on molecules that have shown promise in the past and that are tested in trials with larger populations.";2020;;;Uncertain;"Treatment COVID-19 ";"Link to the recommendation on the website of the initiative/ " 5659;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"It is recommended that the nutritional status of each infected patient be evaluated before the administration of general treatments, since the effects of different interventions for COVID-19 are uncertain.";"This is a systematic review without quantitative analysis describing the effects of potential interventions according to some found literature of various medications including vitamins, minerals, interferons, chloroquine, and other medications. For example, it recognizes some benefit of using interferons from various studies. It also includes chloroquine for its ability to transport zinc. None of the findings is conclusive. In this way the review notes that the nutritional status of each infected patient is evaluated prior to the administration of general treatments and that current vaccines against the children's RNA virus, including the influenza vaccine, are immunized for uninfected individuals. and health workers. Furthermore, they suggest that convalescent plasma should be administered to patients with COVID-19 if available.";2020;;;"High value";"Prevention COVID-19, Treatment COVID-19, chloroquine, vaccine, plasma";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5915;35;"Evidencias COVID-19";"Evidence Aid";English;"Psychosocial support is recommended in patients with COVID-19";"In this qualitative evidence synthesis, the authors searched for studies evaluating the organization of post-disaster psychosocial support in the Netherlands. Post-disaster psychosocial support must be up to date, allow for flexibility to reflect the uniqueness of each disaster (especially slow-onset disasters), be well implemented and be regularly practiced with an emphasis on cultural sensitivity. Information delivery during disasters should be transparent and there should be rapid monitoring of social media.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6171;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not routinely swab open wounds and do not prescribe systemic antibiotics based on these results, without clinical features of local or systemic infection.";"Most wound swabs in the context of a burn injury will yield bacterial growth. These organisms may be commensal organisms not responsible for wound infection or sepsis, and do not warrant therapy. The use of systemic agents predisposes to antimicrobial resistance, is expensive, and may also expose patients to unnecessary side-effects. Burn wound swabs should form part of standardized admission surveillance programs for resistant organisms such as MRSA.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 5148;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to only offer an antibiotic for adults with a leg ulcer when there are symptoms or signs of infection (for example, redness or swelling spreading beyond the ulcer, localised warmth, increased pain or fever). When choosing an antibiotic take account of: the severity of symptoms or signs, the risk of developing complications, previous antibiotic use.";.;2020;;;"High value";" Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5404;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"The guidelines recommend the use of a surgical mask in routine healthcare procedures, whereas for those that involve the generation of aerosols, they recommend N95 or FFP2 (FFP3 ECDC)";"Systematic reviews conclude, as well as recommendations, that surgical masks are as frequent as N95 and FFP2 for admission to a room of patients with suspected or confirmed COVID-19. When healthcare personnel perform aerosol-generating procedures, such as tracheal intubation, noninvasive ventilation, tracheostomy, cardiopulmonary resuscitation, manual ventilation before intubation, and bronchoscopy, use highly protective ones.";2020;;;"High value";"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5916;35;"Evidencias COVID-19";"Evidence Aid";English;"There is evidence that COVID-19 patients can clear SARS-CoV-2 through feces";"It is a quick review that included 17 studies on the detection of SARS-CoV-2 RNA in the feces of patients with COVID-19. They conclude that about half of COVID-19 patients can shed SARS-CoV-2 through their feces, with detection rates associated with the disease and severity of symptoms. It could be a potential test method, in those for whom respiratory testing would be difficult.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6172;19;"Choosing Wisely Canada";"Canadian Fertility and Andrology Society";English;"Don?t routinely perform preimplantation genetic testing for aneuploidy screening on patients undergoing IVF.";"Preimplantation genetic testing for aneuploidy (PGT-A) was developed to help select the best embryos for transfer in an in vitro fertilization (IVF) cycle by screening out aneuploidy. However, there is no clear improvement in cumulative live birth rate compared with IVF alone. PGT-A is expensive, carries a risk of misdiagnosis, and there is no long-term data reported on childhood outcomes. PGT-A should not be performed routinely without an indication and patients should be counselled on the risks and limitations of testing.";2020;;;"Low value";-;"https://choosingwiselycanada.org/fertility-and-andrology/" 6428;31;"Smarter medicine";"Sociedad Suiza de Enfermedades Infecciosas";English;"Extension of postoperative antibiotic prophylaxis to prevent surgical site infections is not recommended.";"Longer postoperative antibiotic prophylaxis does not prevent surgical site infections any more effectively than shorter perioperative prophylaxis. In addition, prolonged prophylaxis is a risk factor for acquired antibiotic resistance.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5149;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to give oral antibiotics if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.";.;2020;;;"High value";" Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5917;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that digital contact tracing reduces transmission of COVID-19.";"Six cohort studies and 6 model studies were included in this rapid Cochrane review. They also identified an additional article that is pending evaluation and 3 ongoing studies. It was concluded that there is low-certainty evidence in the reduction in secondary cases if digital contact tracing is used in conjunction with other public health measures such as self-isolation. Additionally, digital solutions can have equity implications for at-risk populations with poor access to the Internet and poor access to digital technology.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6173;19;"Choosing Wisely Canada";"Burns Canada";English;"Do not transfuse red blood cells to patients with burn injuries who have haemoglobin levels greater than 70 g/l, unless there is active haemorrhage or myocardial ischaemia.";"Blood products are a limited resource. Blood transfusion is associated with adverse effects, including transfusion reactions, immunosuppression, lung injury, and circulatory overload. In the context of stable patients with burn injuries, who are not actively bleeding or with active myocardial ischaemia, the current evidence supports a restrictive transfusion trigger to maintain haemoglobin above 70g/l. Unnecessary transfusions can also be avoided by ordering and infusing one unit of red blood cells at a time (with interval blood tests to confirm indication for a further unit), rather than ordering two units immediately.";2020;;;"Low value";-;"https://choosingwiselycanada.org/burns/" 6429;31;"Smarter medicine";"Sociedad Suiza de Radiolog�a";English;"Systematic computed tomography is not recommended in suspected pulmonary embolism, only if the pretest probability of pulmonary embolism is strong or moderate.";"Patients with signs and symptoms of acute pulmonary embolism require prompt investigations: a complete medical history and examination with evaluation of the clinical likelihood of the condition, medical tests, and imaging tests. Gathering the pre-test clinical probability can help avoid unnecessary additional investigations (medical tests, imaging tests).";2020;;;"High value";"- ";"Link to the recommendation on the website of the iniciative" 5150;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended if intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.";.;2020;;;"High value";"antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5918;35;"Evidencias COVID-19";"Evidence Aid";English;"The effects of a strategic response from police officers and mental health professionals are uncertain.";"They included 5 systematic reviews of international research, as well as 8 primary quantitative studies and 8 primary qualitative studies, and concluded that the majority of systematic reviews and primary studies were at risk of multiple biases due to their designs or lack reporting methods. The effects of a strategic response by police officers and mental health professionals, and the most efficient way for them to provide mental health care to people, are uncertain.";2020;;;Uncertain;"Prevention ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6174;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Consider a watchful waiting approach in patients with asymptomatic or minimally symptomatic inguinal hernias.";"For minimally symptomatic hernias, surgical repair can prevent potential complications of hernia incarceration and strangulation, but the risk of post-operative complications from infection, hernia recurrence, and chronic inguinal pain approaches the overall risks of incarceration. Watchful waiting for asymptomatic or minimally symptomatic inguinal hernias is a safe option for carefully selected patients and does not preclude patients from undergoing elective repair should discomfort worsen.";2020;;;"High value";-;"https://choosingwiselycanada.org/general-surgery/" 5151;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommeded when prescribing antibiotics for an infected leg ulcer in adults, give advice to seek medical help if symptoms or signs of the infection worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days of starting treatment.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5407;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"Although hygiene-related knowledge increased in studies that focused on STH prevention and transmission, the lack of evidence in this topic areas means that the effects of handwashing promotion interventions on children?s handwashing behaviour, diarrhea, and STH are uncertain.";"Physical interventions, such as handwashing, should interrupt or reduce the transmission of COVID-19. Existing research into handwashing to prevent diarrhea and soil-transmitted helminth (STH) infections in childhood may provide useful information for helping to prevent the spread of COVID-19. In this systematic review, the authors searched for research from a low- or middle-income country that tested the effects of a hygiene promotion intervention (which included messages around handwashing) and targeted children. They restricted their search to studies published in peer-reviewed, English language journals and did their searches in July 2016. They included 7 cluster randomized trials and 1 cluster non-randomised trial. These were done in China (2 studies), Egypt (1), India (1), Kenya (2), Malaysia (1) and Peru (1), and had targeted children aged 5 to 12 years. ";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5919;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that non-pharmacological interventions improve sleepiness at work and sleep disorders caused by shift work";"We included randomized trials of non-pharmacological interventions targeting healthcare professionals to reduce sleepiness at work and improve the duration and quality of sleep between shifts for shift workers. It was concluded that the relationship between them is uncertain.";2020;;;Uncertain;treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6175;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Don?t use computed tomography (CT) for the evaluation of suspected appendicitis in pediatric patients until an ultrasound has been considered as an option.";"Ultrasound is an accurate and cost-effective imaging modality for initial evaluation of suspected appendicitis in the pediatric population. Evidence shows that the sensitivity and specificity of ultrasound is high with reports of up to 95%, though this may vary based on center experience and capabilities. Where findings on ultrasound exam are equivocal, CT can be considered as part of a step-up investigative approach after discussion with the patient and caregivers about risks of childhood radiation exposure.";2020;;;"Low value";-;"https://choosingwiselycanada.org/general-surgery/" 5152;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to reassess an infected leg ulcer in adults if: symptoms or signs of the infection worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days the person becomes systemically unwell or has severe pain out of proportion to the infection.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5408;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"Interventions to protect against cyber abuse increase a child?s knowledge as to what constitutes abuse but do not have an effect on risky behaviour, such as disclosing one?s name, participating in open chat rooms or emailing strangers.";"During the COVID-19 pandemic, some schools have been closed to try to reduce the spread of the disease. This means that children might be spending more time online and the risk of cyber abuse and bullying might increase, raising the need for effective interventions to prevent and reduce it. In this Campbell systematic review, the authors searched for research assessing the effects of interventions intended to increase internet safety knowledge and decreasing risky online behaviour. They did not restrict their search by language of publication and searched for studies published in the ten years to 2009. They included three studies (2713 participants). One study was from Canada and the other two were done in the USA. More recent research might change the conclusions of this review.";2020;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5920;35;"Evidencias COVID-19";"Evidence Aid";English;"Economic self-help groups are recommended for the economic and political empowerment of women.";"In this Campbell systematic review, the authors searched for quantitative studies of the effects of self-help interventions and qualitative studies on mechanisms that empower women and perspectives of women in low- and middle-income countries. Economic self-help groups have positive effects on women?s economic and political empowerment, as well as social empowerment - such as, women?s family size decision-making power and social mobility. ";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6176;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Routine preoperative chest x-rays and baseline laboratory studies, such as complete blood count, metabolic panel, or coagulation studies, should not be obtained in patients undergoing low-risk surgery with no significant systemic disease (ASA I or II) and the absence of symptoms.";"Obtaining routine preoperative radiological and laboratory testing offers little value to the perioperative care of asymptomatic patients undergoing low-risk surgery. Evidence suggests that abnormal results within this setting rarely affect management or change clinical outcomes. Instead, a focused history and physical examination should be performed to identify which preoperative investigations are required. Where preoperative testing may add value is in the setting of symptomatic patients or higher risk surgery where significant blood loss and fluid shifts may be expected. A discussion with the patient, anesthesiologists, and surgical team would help guide decision-making in these circumstances.";2020;;;"Low value";-;"https://choosingwiselycanada.org/general-surgery/" 5153;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended when reassessing an infected leg ulcer in adults, take account of previous antibiotic use, which may have led to resistant bacteria.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5409;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";Spanish;"In?home intensive services (parent training and provision of emotional support to the parent) are more effective than interventions in outpatient/clinic settings";"There have been increases in domestic violence during the COVID-19 pandemic. Information is needed on interventions to minimise psychological damage to children who witness it. In this Campbell systematic review, the authors searched for studies that had evaluated the effects of psychosocial interventions to promote well?being among children exposed to intimate partner violence and which they rated as having low or moderate risk of bias. They did not restrict their search by date of publication and did the most recent search in April 2018. They included 8 randomized trials (924 participants), which were conducted in India (1 study), the Netherlands (1) and the USA (6). The effects of online courses, which might be required because of social distancing, are uncertain. ";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5921;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended the use of aptamer molecules for both the diagnosis and treatment of COVID-19.";"In this quick review, the authors searched for studies on the use of aptamers for the diagnosis and treatment of coronavirus. They included 3 studies on diagnostic aptamers and 2 studies on therapeutic aptamers. It is concluded that nucleic acid aptamers are useful as drugs and diagnostic probes. Although aptamers for SARS-Cov-2 have not been isolated so far, it appears that modeling other coronavirus aptamers may be helpful in finding an appropriate shortcut.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6177;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and with no personal or family history of colorectal neoplasia.";"The aim of screening investigations for colorectal cancer, such as fecal immunochemical test (FIT) and colonoscopy, is to reduce deaths through early detection and removal of polyps (a precursor to colon cancer) and early stage colorectal cancers. While colonoscopy is a safe screening modality, increased risks have been associated with advanced age and comorbidities. Life expectancy, presence of symptoms, personal and family history, previous investigations, and patient preference must all be considered in order to determine the safety and appropriateness of screening investigations and surveillance colonoscopy. If colonoscopy is determined to be unsafe or inappropriate, FIT should not be offered as an alternative.";2020;;;"Low value";-;"https://choosingwiselycanada.org/general-surgery/" 6433;31;"Smarter medicine";"Sociedad Suiza de Radiolog�a";English;"Routinely performing a phase without contrast injection during contrast-enhanced abdominal computed tomography scans is not recommended.";"Abdominal computed tomography scan protocols should only include a non-injection phase if this provides additional diagnostic information. This is the case for the following indications: characterization of kidney injury, adrenal injury, liver injury, in case of hematuria, in the context of abdominal postoperative follow-up, follow-up after stent placement, and in case of gastrointestinal bleeding.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5154;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";Spanish;"It is recommended to be aware that it will take some time for a leg ulcer infection to resolve, with full resolution not expected until after the antibiotic course is completed.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5410;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"LHWs provide promising benefits in promoting immunisation uptake and breastfeeding, improving TB treatment outcomes, and reducing child morbidity and mortality when compared to usual care.";"The COVID-19 pandemic is placing a great strain on health systems and healthcare workers. One way to ease this may be to make greater use of community or lay health workers (LHW). In this Cochrane systematic review, the authors searched for randomised trials evaluating the effects of LHW interventions in primary and community health care on maternal and child health and the management of infectious diseases. They did their most recent search in February 2010 and identified 55 trials from high-income countries (many of which focused on low income and minority populations), 12 trials from middle-income countries and 15 trials from low-income countries. There is also a linked Cochrane Review of qualitative evidence for factors influencing the implementation of LHW programmes. The effects of using LHWs for other health issues are uncertain. ";2020;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5922;35;"Evidencias COVID-19";"Evidence Aid";English;"New Safety Measures Recommended for Surgical Procedures During the COVID-19 Pandemic";"The COVID-19 pandemic is affecting the provision of surgery for patients and several rapid systematic reviews have been done. Based on the available evidence at the time of these reviews, recommendations for practices relevant to surgery include the use of pre-operative planning, negative pressure ventilation in operating theatres, limited personnel, single-use equipment, designated donning and doffing areas, dedicated COVID-19 theatres and teams and COVID-free facilities, using regional anaesthesia to minimise duration of surgery, limiting the use of electro-cauterization within procedures, limiting the use of endoscopic procedures to emergencies, selected suspected or confirmed cancer patients and telemedicine for postoperative follow-up, the use of appropriate personal protective equipment, training, screening, showers following procedures and the provision of psychological support for healthcare workers, screening, self-isolation before elective admission and the use of surgical masks during admission.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6434;31;"Smarter medicine";" Sociedad Suiza de Oftalmolog�a";English;"The use of local antibiotics is not recommended in cases of viral or nonspecific conjunctivitis.";"The use of antibiotics is not necessary in most cases of conjunctivitis and is causing an increase in antibiotic resistance worldwide. Only the rational use of antibiotics can preserve their effectiveness in the long term, so that we can continue to reliably control bacterial infections in the future as well.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5155;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to consider sending a sample from the leg ulcer (after cleaning) for microbiological testing if symptoms or signs of the infection are worsening or have not improved as expected.";.;2020;;;"High value";"antibotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5411;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"At the time of the review (February 2020), one test (Beijing Genome Institute (BGI)) had been approved for use in the clinical setting for rapid diagnosis of COVID-19 and was being widely used in China.";"As research is done to develop or identify diagnostic tests, vaccines and treatments for COVID-19, multiple rapid reviews are being done of these topics. In this rapid systematic review, the authors searched for randomized trials and validation trials for diagnostic tests evaluating rapid diagnostic tests, the impact of drug therapy and vaccine efficacy for coronaviruses generally. In addition, for COVID-19 specifically, they searched for in vitro, animal or human studies published in English between 1 December 2019 and 6 February 2020. They restricted their searches to articles published in English. They did their search on 6 February 2020. They identified 16 studies of diagnostics, 7 of therapeutics and 4 of vaccines. At the time of the review (February 2020), there were several ongoing studies of interventions for COVID-19 but the effects of these were uncertain. ";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5667;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"Patients with long-term immunosuppressants are advised to continue with this treatment during the Covid-19 pandemic.";"The evidence on how to manage people with chronic lung conditions with long-term oral immunosuppression during the Covid-19 pandemic is very limited. There is no evidence to suggest that long-term immunosuppression should be stopped during the current pandemic. If patients show signs of infection, immunosuppression should be discontinued long-term, except for long-term steroids.";2020;;;"High value";"Treatment COVID-19, immunosuppression";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5923;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence to know if formal ethical participation in case management is effective";"They included 4 randomized trials that sought whether formal ethical processes in clinical care are important for decisions about triage and managing limited resources, both for patients with COVID-19 and for those with other conditions suffering from it. to the diversion of resources towards COVID-19. ";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6435;31;"Smarter medicine";"Sociedad Suiza de Enfermedades Infecciosas";English;"Clostridium difficile testing and treatment is not recommended for patients without symptoms.";"Because asymptomatic carriers occur, patients without diarrhea should not be tested or treated. Microbiological laboratories must reject tests of formed feces.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5156;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended when microbiological results are available: review the choice of antibiotic(s) and change the antibiotic(s) according to results if symptoms or signs of the infection are not improving, using a narrow-spectrum antibiotic if possible.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5412;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"Imprisonment is no more effective than community?based sanctions in reducing re?offending.";"Any setting which brings a large number of people into regular contact is an environment in which a respiratory infectious disease, such as COVID-19, can easily spread. Prison is such a setting and evidence on using custodial or non-custodial sentences may inform policies about imprisoning people convicted of a crime. In this Campbell systematic review, the authors searched for research that compared the effects of custodial and non?custodial sentences on re?offending. They did not restrict by type or language of publication and searched for studies published between 1961 and 2013. They included 14 studies. Whether there are differences between imprisonment and community?based sanctions on outcomes related to health, employment, family and social networks, is uncertain. ";2020;;;"Low value";"Patients management ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5668;2;"Choosing Wisely�";"Choosing Wisely�";English;"Do not obtain non urgent labs in separate blood draws if they can be batched together.";"This recommendation expands on the original Society of Hospital Medicine Choosing Wisely recommendation: Don?t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability. Aside from patient harms such as pain and hospital-acquired anemia, the risk of exposure to HCWs who perform phlebotomy (phlebotomists, nurses, and other clinicians), as well as staff who transport, handle, and process the bloodwork in the lab, must be minimized. Most prior interventions to eliminate unnecessary bloodwork focused on the number of lab tests, but some also aimed to batch nonurgent labs together to effectively reduce unnecessary needlesticks (?think twice, stick once?).This concept can be brought into this pandemic to provide safe and appropriate care for both patients and HCWs.";2020;;;"Low value";"patients management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5924;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that technology-based interventions to support informal caregivers of stroke survivors are effective in decreasing depressive symptoms in caregivers.";"In this systematic review, the authors searched for studies of technology-based interventions for adult caregivers of stroke survivors. Five studies were included (2 randomized trials and 1 pilot studies). Technology-based interventions were concluded to have no significant effects on caregivers' perceived burden, problem-solving skills, health status, or perceived social support.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6436;31;"Smarter medicine";"Sociedad Suiza de Radiologia";English;"Routinely performing late-phase acquisition during contrast-enhanced abdominal computed tomography scans is not recommended.";"Abdominal computed tomography scan protocols should only include a late phase (phase following a portal venous, hepatic, or nephrographic phase after contrast administration) if this provides additional diagnostic information. This is the case for the following indications: characterization of kidney injury, adrenal injury, liver injury, in case of hematuria, and if necessary a uroscanner.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5157;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to refer adults with an infected leg ulcer to hospital if they have any symptoms or signs suggesting a more serious illness or condition, such as sepsis, necrotising fasciitis or osteomyelitis.";.;2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5413;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Close monitoring of drug-related adverse effects in patients with COVID-19 is required.";"- The adverse effects associated with the treatments administered to patients with COVID-19 are relatively frequent and can intensify with this disease. - Most of the adverse effects reported to the French ANSM have been serious, with a notable proportion of cardiac adverse effects, many associated with treatment with hydroxychloroquine (alone or in combination with azithromycin).";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5669;2;"Choosing Wisely�";"Choosing Wisely�";English;"Do not use bronchodilators unless there is active obstructive airway disease, and if needed, use metered dose inhalers instead of nebulizers.";"We do not recommend using bronchodilators to treat COVID-19 symptoms unless patients develop acute bronchospastic symptoms of their underlying obstructive airway disease. When needed, use metered dose inhalers (MDIs), if available, instead of nebulizers because the latter potentiates aerosolization that could lead to higher risk of spreading the infection. The risk extends to respiratory technicians and nurses who administer the nebulizer, as well as other HCWs who enter the room during or after administration. The Centers for Disease Control and Prevention (CDC) considers nebulized bronchodilator therapy a ?high-risk? exposure for HCWs not wearing the proper personal protectvie equipment.7 Moreover, MDI therapy produces equivalent outcomes to nebulized treatments for patients who are not critically ill. Unfortunately, the supply of MDIs during this crisis has not kept up with the increased demand. There are no clear guidelines for reuse of MDIs in COVID-19; however, options include labeling patients? MDIs to use for hospitalization and discharge or labeling an MDI for use during hospitalization and then disinfecting for reuse. For safety reasons, MDIs of COVID-19 patients should be reused only for other patients with COVID-19.";2020;;;"Low value";"Treatment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5925;35;"Evidencias COVID-19";"Evidence Aid";English;"Active surveillance of lower-risk tumors, such as low-risk prostate cancer, low-grade bladder cancer, and small renal masses, is recommended.";"The COVID-19 pandemic is placing a strain on healthcare systems leading to changes in how patients with other conditions are managed. Guidelines have been produced for the management of patients with existing urological conditions. In this rapid review, the authors searched for guidelines on urology standards of care published during the COVID-19 pandemic. They restricted their searches to guidelines published in English between November 2019 and 17 April 2020. They identified 15 guidelines from Australia and New Zealand, Brazil, Canada, Europe, and the USA, and noted that the quality of the evidence was low to moderate.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5158;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to consider referring or seeking specialist advice for adults with an infected leg ulcer ";"if they: have a higher risk of complications because of comorbidities, such as diabetes or immunosuppression, have lymphangitis, have spreading infection that is not responding to oral antibiotics, cannot take oral antibiotics exploring locally available options for giving intravenous or intramuscular antibiotics at home or in the community, rather than in hospital, where appropriate. ";2020;;;"High value";"antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5414;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There is uncertainty on the use of chloroquine and hydroxychloroquine as potential therapies against COVID-19";"- There is currently no validated effective treatment for COVID-19. - Chloroquine and hydroxychloroquine have shown in vitro efficacy against COVID-19, but to date, the available data do not confirm their usefulness in the clinic. - Currently, we have information from three clinical trials (two not yet published) and three studies with observational design (one not yet published). - Two of the clinical trials show no benefits with hydroxychloroquine compared to standard care. A third clinical trial suggests data in favor of hydroxychloroquine in variables of limited clinical relevance, presenting important methodological problems and biases that condition its credibility. - The three observational studies demonstrate a low quality of evidence and reach diametrically opposite conclusions. - Serious adverse events (QT prolongation and arrhythmias, some with fatal outcome) have been described as associated with the concomitant use of hydroxychloroquine and azithromycin.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5670;2;"Choosing Wisely�";"Choosing Wisely� ";English;"Do not use posteroanterior and lateral chest X-ray as initial imaging. Use a portable chest X-ray instead.";"The CDC does not currently recommend diagnosing COVID-19 by chest X-ray (CXR). When used appropriately, CXR can provide information to support a COVID-19 diagnosis and rule out other etiologies that cause respiratory symptoms. Posteroanterior (PA) and lateral CXR are more sensitive than portable CXR for detecting pleural effusions, and lateral CXR is needed to examine structures along the axis of the body. Portable CXR also may cause the heart to appear magnified and the mediastinum widened, the diaphragm to appear higher, and vascular shadows to be obscured.10 The improved ability to detect these subtle differences should be weighed against the increased risk to HCWs required to perform PA and lateral CXR. A portable CXR exposes a relatively smaller number of staff who come to the bedside versus the larger number of people exposed in transporting the patient out of the room and into the hallway, elevator, and the radiology suite for a PA and lateral CXR.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5926;35;"Evidencias COVID-19";"Evidence Aid";English;"There is no evidence that training supervisors improves the health and well-being of employees. ";"Randomized trials and controlled studies were included before and after supervisory training on psychomental stress, absenteeism and employee well-being. It was investigating whether training supervisors in human resource management to improve the health and well-being of employees could provide useful information for policy makers. ";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5159;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended when prescribing antibiotics for an infected leg ulcer in adults aged 18 years and over, follow the recommendations in table 1.";"go to the recommendation website to see table 1.";2020;;;"High value";"antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5671;2;"Choosing Wisely�";"Choosing Wisely� ";English;"Avoid in-person evaluations and promote virtual communication, unless necessary during the COVID-19 pandemic.";"To minimize HCW exposure to COVID-19 and optimize infection control, the CDC recommends the use of telemedicine when possible.Telemedicine refers to the use of technology to support clinical care across some distance, which includes video visits and remote clinical monitoring. At the time of writing, the Centers for Medicare & Medicaid Services had waived the rural site of care requirement for Medicare beneficiaries, granted 49 Medicaid waivers to states to enhance flexibility, and (at least temporarily) added inpatient care to the list of reimbursed telemedicine services. Funding for expanded coverage under Medicare is included in the recent Coronavirus Preparedness and Response Supplemental Appropriations Act. These federal changes open the door for commercial payers and state Medicaid programs to further boost telemedicine through reimbursement parity to in-person visits and other coverage policies. Hospitalists can ride this momentum and learn from ambulatory colleagues to harness the power of telemedicine and minimize unnecessary face-to-face interactions with patients who are suspected or confirmed to have COVID-19.Even if providers have to enter the patient?s room, telemedicine may still allow for large virtual family meetings despite strict visitor restrictions and physical distance with loved ones. If in-person visits are necessary, only one designated person should enter the patient?s room instead of the entire team.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5927;35;"Evidencias COVID-19";"Evidence Aid";English;"Systemic therapies or cytoreductive nephrectomy are not recommended in some advanced cases.";"The COVID-19 pandemic is placing a strain on healthcare systems leading to changes in how patients with other conditions are managed. Guidelines have been produced for the management of patients with existing urological conditions. In this rapid review, the authors searched for guidelines on urology standards of care published during the COVID-19 pandemic. They restricted their searches to guidelines published in English between November 2019 and 17 April 2020. They identified 15 guidelines from Australia and New Zealand, Brazil, Canada, Europe, and the USA, and noted that the quality of the evidence was low to moderate.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6439;31;"Smarter medicine";"Sociedad Suiza de Radiolog�a";English;"Systematic follow-up imaging studies using computed tomography or magnetic resonance imaging are not recommended in case of incidental discovery of unsuspicious adnexal cysts smaller than 5 cm in women of childbearing age.";"Simple and hemorrhagic cysts are almost always functional in women of childbearing age. Ovarian cancer, usually cystic, does not develop from these types of benign-looking cysts. A good-quality ultrasound in a woman of childbearing age should not lead to a recommendation for follow-up imaging for a corpus luteum or simple cyst with a maximum diameter of less than 5 cm.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5672;2;"Choosing Wisely�";"Choosing Wisely�";English;"Do not delay goals of care conversations for hospitalized patients who are unlikely to benefit from life-sustaining treatments.";"The COVID-19 pandemic amplifies the need for early goals of care discussions. Mortality rates range higher with acute respiratory distress syndrome from COVID-19, compared with other etiologies, and is associated with extended intensive care unit stays.The harms extend beyond the patient and families to our HCWs through psychological distress and heightened exposure from aerosolization during resuscitation. Advance care planning should center on the values and preferences of the patient. Rather than asking if the patient or family would want certain treatments, it is crucial for clinicians to be direct in making do-not-resuscitate recommendations if deemed futile care. This practice is well within legal confines and is distinct from withdrawal or withholding of life-sustaining resources.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5928;35;"Evidencias COVID-19";"Evidence Aid";English;"Treating unobstructed kidney stones as an emergency is recommended.";"The COVID-19 pandemic is placing a strain on healthcare systems leading to changes in how patients with other conditions are managed. Guidelines have been produced for the management of patients with existing urological conditions. In this rapid review, the authors searched for guidelines on urology standards of care published during the COVID-19 pandemic. They restricted their searches to guidelines published in English between November 2019 and 17 April 2020. They identified 15 guidelines from Australia and New Zealand, Brazil, Canada, Europe, and the USA, and noted that the quality of the evidence was low to moderate.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5417;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There are no reliable studies that have evaluated the efficacy of lopinavir-ritonavir (LPV / r) in patients with COVID-19 infection.";"- The combination of antivirals lopinavir-ritonavir (LPV / r) has shown efficacy in vitro and in animal models against the SARS-CoV and MERS-CoV viruses. - The LOTUS China study is the first clinical trial to explore the efficacy and safety of LPV / r in patients with COVID-19 infection and associated pneumonia. The trial has failed to demonstrate that the addition of LPV / r to standard care provides a clinical benefit in the analyzed patient profile. - Several clinical trials investigating LPV / r against COVID-19 are underway, among which the WHO-sponsored SOLIDARIDAD project stands out.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5929;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended that for patients who had been admitted to the hospital with COVID-19, hydroxychloroquine / chloroquine be used only under the context of a clinical trial. ";"A variety of therapies have been suggested as treatments for COVID-19 patients. In the systematic review, it used 13 studies as the evidence base for its recommendations.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6441;31;"Smarter medicine";"La Sociedad Suiza de Dermatolog�a y Venereolog�a. ";English;"Withdrawal of anticoagulation is not recommended for dermatosurgical procedures in the general population";"The risk of bleeding is generally low with skin surgery, including simple flap plasters, and no life-threatening bleeding has been reported. Therefore, the risk of thromboembolic and thrombotic complications after stopping or changing platelet aggregation inhibitors and anticoagulants should generally be greater than the surgical risk associated with bleeding. Available scientific data support this approach, especially in the case of monotherapy with anticoagulants or inhibitors of platelet aggregation. For combination therapies associated with an increased risk of bleeding (eg, ASA and clopidogrel) and for newer oral anticoagulants (factor Xa inhibitors), which have been less studied in this regard, an individual and appropriate procedure is required. at risk in consultation with coagulation specialists. It agrees not to mention that the previous ""anpass"" technique of oral anticoagulation with heparin actually increases the risk of bleeding. Therefore, scientific evidence shows that in most situations, anticoagulation should not be interrupted for skin surgery. In exceptional cases (""major surgery""), an individualized approach is needed.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5674;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain that longer prescriptions will have to be provided for patients with long-term conditions during a pandemic";"During the current COVID-19 pandemic, the possible benefits of providing prescriptions for 3 months? duration, as opposed to shorter durations, may include: reducing person to person contact in order to slow transmission rates, reducing anxiety among patients with long-term conditions who require repeat prescriptions, reducing health services burden and costs. However, during a global pandemic it is possible that interruptions in manufacturing and other activities may exacerbate medicines shortages that have occurred in the UK over the last few years. Other considerations include potential medication wastage; the potential risk of holding large amounts of medication in the home; the cost of a longer duration prescription may be prohibitive for some patients. The evidence base on this is very limited and there is no definitive answer on this issue. Evidence on duration of repeat prescriptions is necessary, particularly on health outcomes, to facilitate best practice ";2020;;;Uncertain;"Prevention COVID-19, prescription, pandemic";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5930;35;"Evidencias COVID-19";"Evidence Aid";English;"Procedures that include sprays are not recommended during urologic surgeries.";"The COVID-19 pandemic is placing a strain on healthcare systems leading to changes in how patients with other conditions are managed. Guidelines have been produced for the management of patients with existing urological conditions. In this rapid review, the authors searched for guidelines on urology standards of care published during the COVID-19 pandemic. They restricted their searches to guidelines published in English between November 2019 and 17 April 2020. They identified 15 guidelines from Australia and New Zealand, Brazil, Canada, Europe, and the USA, and noted that the quality of the evidence was low to moderate.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5675;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"Using the Roth score to assess breathlessness over the phone is not advised.";"There are no validated tests for assessing breathlessness over the phone in an acute primary care setting. Measuring a patient?s respiratory rate over the phone using the Roth Score does not provide an accurate assessment of hypoxia and may lead to false reassurance. Experts recommend an overall clinical assessment, including questions about the nature and rate of change of the breathlessness.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5931;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended that for patients who had been admitted to hospital with COVID-19, hydroxychloroquine / chloroquine plus azithromycin should only be used in the context of a clinical trial.";"A variety of therapies have been suggested as treatments for COVID-19 patients. In the systematic review, it used 13 studies as the evidence base for its recommendations.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6443;31;"Smarter medicine";"Sociedad Suiza de Radiolog�a";English;"Diagnosing pelvic congestion syndrome is recommended only if patients meet clinical and imaging criteria.";"Dilated pelvic veins on computed tomography or magnetic resonance imaging sections may be an incidental finding of no clinical relevance. Ovarian vein reflux, ovarian vein dilatation, and parauterine vein dilatation can occur in asymptomatic patients. In order to diagnose pelvic congestion syndrome, the clinical symptoms must be taken into account when interpreting the images.";2020;;;"High value";-;"Link to the recommendation on the website of the iniciative" 5676;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"Non-pharmacological treatment is advised when treating people with COVID-19 and delirium while maintaining safety.";"Management of delirium in Covid-19 is particularly challenging where availability of PPE and access to remote consultation technology is likely to be severely restricted. Poorly developed mental health services and lack of training of health care professionals in management of psychiatric conditions including delirium will further compound this. The principles of management outlined in this review should be followed as far as possible but pharmacological management may be required early. Delirium may be part of the spectrum of COVID-19 symptoms that patients present with. In some cases, the delirium may be severe and have a rapid onset. Clinicians should have a high level of suspicion of COVID-19 when considering a possible cause of the delirium. Non-pharmacological interventions are the mainstay for the management of delirium in all settings.";2020;;;"High value";"Treatment COVID-19, delirium, PPE";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5932;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended that for patients who had been admitted to hospital with COVID-19, lopinavir / ritonavir should only be used in the context of a clinical trial.";"A variety of therapies have been suggested as treatments for COVID-19 patients. In the systematic review, it used 13 studies as the evidence base for its recommendations.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6444;31;"Smarter medicine";"La Sociedad Suiza de Dermatolog�a y venereolog�a ";English;"Forgoing perioperative antibiotic prophylaxis is recommended for cutaneous operations without additional risk factors in the general population.";"The risk of wound infection in dermatological procedures is generally low. Perioperative antibiotic prophylaxis should be evaluated, especially for contaminated or infected wounds and for certain risk factors. In colaplasty in certain locations, such as the lower half of the nose, lips, ear, groin, leg, and foot, antibiotic prophylaxis reduces the risk of surgical wound infection. This also applies to two-step procedures and ulcerated or cortical lesions. Antibiotic prophylaxis is also recommended in cases of immunosuppression in the context of medication, systemic disease and malnutrition. Another reason may be infections at other sites or carriers of MRSA / ASM. In addition, congenital heart disease) requires specific prophylaxis in case of operations on the mucous membranes and operations of discovery of contaminated skin. ";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5933;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended an early postponement of elective surgery, creation of COVID-free facilities, and identification of dedicated COVID operating rooms and teams in cancer patients and surgical patients i to minimize the risk of COVID-19 infection.";"In this rapid systematic review the authors searched for studies on the treatment of cancer and surgical patients during the COVID-19 pandemic, including 28 studies. Cancer patients and surgical patients were confirmed to be particularly at risk of infection and negative outcome. To ensure adequate care for these patients, minimizing the risk of infection, the early postponement of elective surgery, the creation of COVID-free facilities and the identification of operating rooms and teams dedicated to COVID have been proposed.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5678;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain whether administration of mast cell stabilizers in COVID-19 is beneficial.";"There have been no studies examining the use of mast cell stabilisers, leukotriene antagonists or anti-histamines in COVID-19. Lung damage and ?cytokine storm? observed in SARS-CoV-2 infection are associated with raised pro-inflammatory cytokines. Mast cells are the main source of these. It has been speculated that mast cell stabilisers may attenuate pulmonary complications, fatal inflammation and death in COVID-19. It is unclear whether administration of mast cell stabilisers in COVID-19 would be beneficial. Clinical trials would be required to establish whether these drugs may be repurposed for treatment of this disease.";2020;;;Uncertain;"Treatment COVID-19, mast cell, cytokine";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5934;35;"Evidencias COVID-19";"Evidence Aid";English;"The use of corticosteroids is not recommended for patients who had been admitted to the hospital with COVID-19 pneumonia. ";"A variety of therapies have been suggested as treatments for COVID-19 patients. In the systematic review, it used 13 studies as the evidence base for its recommendations.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5679;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"The use of azithromycin as a COVID-19 treatment is not advised.";"There have been no reports of the results of well-designed clinical trials of the use of azithromycin in COVID-19. It is more likely to reduce the risk of secondary bacterial infection than to have a direct antiviral effect, but other antibacterial agents are preferable for this purpose. It should not be used in combination with hydroxychloroquine. Until the results of adequately powered, double-masked, randomized controlled trials appear, if any, it should not be used to treat COVID-19 except as part of such trials.";2020;;;"Low value";"Treatment COVID-19, azithromycin";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5935;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended that for patients who had been admitted to hospital with acute respiratory distress syndrome (ARDS) due to COVID-19, corticosteroids should be only used in the context of a clinical trial. ";"A variety of therapies have been suggested as treatments for COVID-19 patients. In the systematic review, it used 13 studies as the evidence base for its recommendations. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5424;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones. Universidad de Antioqu�a";Spanish;"The evidence on antiviral therapy with lopinavir / ritonavir, oseltamivir, and ganciclovir in seriously ill patients with COVID-19 is weak and contradictory, its effectiveness in reducing the risk of progression to ARDS and reducing mortality is unclear.";"Nineteen new studies meeting eligibility criteria, four systematic reviews, two clinical trials, and 13 observational studies were included. In total, this rapid synthesis includes 36 studies, two clinical practice guidelines, six systematic reviews, five clinical trials, and 23 observational studies. The available evidence on pharmacological treatments for the control of COVID-19 infection is still limited and of low quality.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5680;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";Spanish;"The effects of oxygen therapy in the treatment of dying patients with COVID-19 are uncertain.";"Oxygen in many LMIC settings has limited availability. Even when available health care facilities may have to be selective in its use due to limited supply. Its use may have substantial cost implications for the health care facility and for the patient and their relatives. There is no existing research evidence involving patients with COVID-19 to directly inform the use of oxygen therapy in the management of breathlessness for dying patients. For patients with COVID-19, there is no evidence of benefit of oxygen therapy in the absence of hypoxemia. There may be a role for its use to wean patients with COVID-19 from ventilator support. If oxygen therapy is used, existing guidelines contain recommendations for the management of oronasal face masks, the potential adverse effects of oxygen therapy in the palliative care setting (e.g. impaired communication between patient and family) and the need to balance patient factors with cost effectiveness, resources and safety.";2020;;;Uncertain;"Treatment COVID-19, hypoxemia, oxygen therapy";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5936;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended that for patients who had been admitted to hospital with COVID-19, tocilizumab should only be used in the context of a clinical trial ";"En la revisi�n sistem�tica se incluyeron 13 estudios como base de evidencia para sus recomendaciones. Se ha sugerido una variedad de terapias como tratamientos para pacientes con COVID-19.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5425;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"The evidence on the effectiveness of chloroquine and hydroxychloroquine, besides being contradictory, is scarce and of low quality.";"One clinical trial report that hydroxychloroquine decreases the clinical recovery time by 2 days, while another reports that there is no difference in viral clearance between patients receiving and not receiving the antimalarial drug. The included systematic reviews have conflicting conclusions, but all highlight the low quality of the evidence. An important precaution is that the combination of antimalarials with azithromycin, lopinavir/ritonavir and remdesivir, has been associated with an increased risk of QTc interval prolongations and arrhythmias.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5681;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain that the activities delivered at home by family carers improve cognitive function in people with dementia social isolating during covid-19 ";"There is a small body of evidence to suggest that activities delivered at home by family carers may have some positive effects on cognition (and mood) All activities should be tailored to meet the individual needs and preferences of people with dementia, in order to ensure all activities are engaging and enjoyable.";2020;;;Uncertain;"Prevention COVID-19, home aactivities, dementia";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5937;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended convalescent plasma only in the context of a clinical trial to treat patients who have been admitted to hospital with COVID-19. ";"Se ha sugerido una variedad de terapias como tratamientos para pacientes con COVID-19. En la revisi�n sistem�tica se incluyeron 13 estudios como base de evidencia para sus recomendaciones.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6449;31;"Smarter medicine";"Sociedad Suiza de Reumatolog�a";English;"Testing for specific antinucleoprotein antibodies is not recommended without first obtaining a positive antinuclear antibody result and clinical suspicion of immune-mediated disease.";"Tests for specific antinucleoprotein antibodies (including anti-DNA, Smith, anti-centromere antibodies) are usually negative if antinuclear antibody is negative. Exceptions include anti-Jo1, which can be positive in some forms of myositis, sometimes anti-Sj�gren's Syndrome related Antigen, in lupus or Sj�gren's syndrome. Performing an autoantibody panel without well-founded clinical suspicion should be avoided; rather, the choice of autoantibodies should be guided by the specific disease being considered.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5426;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"The use of low or moderate doses of glucocorticoids in patients with severe COVID-19 disease is suggested to reduce the possibility of progression of mild / moderate to severe disease and mortality.";"We included 19 new studies that met eligibility criteria, four systematic reviews, two clinical trials, and 13 observational studies. In total, this rapid synthesis includes 36 studies, two clinical practice guidelines, six systematic reviews, five clinical trials, and 23 observational studies. The available evidence on pharmacological treatments for the control of COVID-19 infection is still limited and of low quality. Of these, two observational studies report beneficial effects of glucocorticoid use in patients with severe COVID-19 disease.";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5682;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain the effectiveness of tocilizumab in patients with COVID-19";"Patients with severe COVID-19 can develop cytokine release syndrome (?cytokine storm?) and are reported to have high circulating IL-6 concentrations. Tocilizumab is a recombinant humanized anti-human IgG1 monoclonal antibody directed against the interleukin-6 receptor (IL-6R). Tocilizumab has been used to treat cytokine release syndrome due to CAR-T cell therapy. However, its use in COVID-19 is experimental. It should not be used except in the context of clinical trials to establish whether the benefits outweigh the harms of treatment.";2020;;;Uncertain;"Treatment COVID-19, tocilizumab, citokine";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5938;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended elective surgeries, routine patient screening, PPE use, scheduling longer shifts to minimize exposure to COVID-19, and screening of healthcare workers to minimize the risk of infection in cancer patients and surgical patients.";"Twenty-eight studies on the treatment of cancer and surgical patients during the COVID-19 pandemic were included in this systematic review. Cancer patients and surgical patients were confirmed to be particularly at risk of infection and negative outcome. To ensure adequate care for these patients, minimizing the risk of infection, it has been proposed to postpone elective surgeries, routine screening of patients, use of PPE, schedule longer shifts to minimize exposure to COVID-19, and screening of workers Of the health.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5427;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"Drugs such as remdesivir, tocilizumab, and convalescent plasma have been evaluated in low-quality observational studies, and it is not possible to determine the effectiveness and safety when administered in patients with COVID-19";"We found 19 new studies that met eligibility criteria, four systematic reviews, two clinical trials, and thirteen observational studies. In total, this rapid synthesis included 36 studies, two clinical practice guidelines, six systematic reviews, five clinical trials, and 23 observational studies. The evidence available on pharmacological treatments for the control of the infection COVID- 19 is yet limited and low quality";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5683;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain whether vitamin D deficiency predisposes to COVID-19";"We found no clinical evidence on vitamin D in COVID-19. There was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19. There is some evidence that daily vitamin D3 supplementation over weeks to months may prevent other acute respiratory infections, particularly in people with low or very low vitamin D status. This evidence has limitations, including heterogeneity in study populations, interventions, and definitions of respiratory infections that include upper and lower respiratory tract involvement. The current advice is that the whole population of the UK should take vitamin D supplements to prevent vitamin D deficiency. This advice applies irrespective of any possible link with respiratory infection.";2020;;;Uncertain;"Prevention COVID-19, vitamin D, supplementation";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5939;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended the use of telemedicine in the postoperative follow-up of patients.";"Twenty-eight studies on the treatment of cancer and surgical patients during the COVID-19 pandemic were included in this systematic review. Cancer patients and surgical patients were confirmed to be particularly at risk of infection and negative outcome. A more extensive use of telemedicine is recommended for the protection of both medical oncologists and patients themselves. Follow-up visits should also be limited to the essentials.";2020;;;"High value";"management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5428;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";English;"Based on the non-randomized studies, people with influenza who receive additional steroid treatment may have a greater risk of death compared to those who do not receive steroid treatment";"Corticosteroids are widely used for people with severe influenza, but there is uncertainty about their potential benefits or harms. Corticosteroids have shown evidence of benefit in sepsis and related conditions, which is most likely due to their anti-inflammatory and immunomodulatory properties. Their effects in patients with influenza might indicate their likely effects in people seriously ill with COVID-19. In this Cochrane systematic review, the authors searched for research (randomized trials, quasi-randomized trials and observational studies) which compared additional steroid treatment with no additional steroid treatment in people with influenza. They did not restrict by date, type or language of publication and did their searches in October 2018. They identified one randomized trial with two treatment groups and 29 observational studies. The randomized trial evaluated 24 participants with confirmed influenza infection but contained relatively few of the sickest patients, and none of the participants were in an intensive care unit at the time of randomization ";2020;;;Uncertain;"COVID 19 treatment ";"Link to the recommendation on the website of the initiative/ " 5684;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service";English;"It is uncertain that smoking is related to having a greater or lesser risk of COVID-19";"Smoking is a known risk factor for acute respiratory infections in general and for a variety of comorbidities, many of which are associated with poorer COVID-19 outcomes. It is also a risk factor for people who smoke as well as for those around them. Data is still emerging on COVID-19, with conflicting evidence on whether people who smoke have a higher or lower risk of COVID-19.";2020;;;Uncertain;"Prevention COVID-19, smoking, comorbidities, risk factor";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5940;35;"Evidencias COVID-19";CEBM;English;"Travel Policy during COVID-19 should not be based on a metric, case rate, which is also a function of government policy. ";"Alternative or combined measures should be sought to avoid creating perverse incentives in policy development e.g. penalising countries with the best testing regimen.For countries in Europe we were able to obtain from the European Centre for Disease Control 1) (7-day covid-19 case rate (2)7-day covid-19 hospital admission rate. We took population size from the same data source. ";2020;;;"Low value";Mangement;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5429;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"Oxygen therapy is recommended as necessary depending on hypoxia and starting with a nasal cannula and progressing to high-flow oxygen sources, according to the Wuhan University guide and the ""Surviving Sepsis"" guide.";"To answer the question: In people with acute respiratory infection COVID-19, what pharmacological treatments can be offered, in addition to standard care, to reduce mortality and complications? A search was carried out that included 19 new studies that met the criteria of eligibility, four systematic reviews, two clinical trials, and 13 observational studies. In total, this rapid synthesis includes 36 studies, two clinical practice guidelines, six systematic reviews, five clinical trials, and 23 observational studies. The available evidence on pharmacological treatments for the control of COVID-19 infection is still limited and of low quality.";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5941;35;"Evidencias COVID-19";"Evidence Aid";English;"There is uncertainty about the effects of herbal and traditional Chinese medicine on the mortality of patients with Covid-19 or other respiratory diseases.";"Systematic reviews have been conducted on the usefulness of traditional chinese medicine based on herbal medicina in patients with Covid-19. The conclusions are that they may improve the symptoms and other outcomes of these patients, but this systematic review has included few studies and has been limited to the effect of traditional chinese medicine in patients with mild-moderate infection.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6453;31;"Smarter medicine";"Sociedad Suiza de Reumatolog�a";English;"Searching for Lyme disease as a cause of nonspecific musculoskeletal symptoms is not recommended.";"Musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia or intermittent or persistent episodes of arthritis, in one or a few large joints, typically the knee. In the absence of these clinical features, Lyme disease testing increases the likelihood of false-positive results, which can lead to unnecessary treatment. Diffuse arthralgia or myalgia or isolated fibromyalgia are not criteria that should suggest Lyme disease with musculoskeletal manifestations";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5430;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"Restrictive resuscitation with intravenous fluids (mainly crystalloid) is recommended for both ventilated and non-ventilated patients.";"The use of high volumes of intravenous fluids can worsen the degree of pulmonary edema, prolong days on the ventilator, stay in the ICU, and mortality in patients with ARDS.";2020;;;"Low value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5942;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"Some travel-related control measures during the COVID-19 pandemic may have a positive impact on infectious disease outcomes.";"Forty records reporting 36 unique studies were included. They reported that in general, travel restrictions can limit the spread of the disease across national borders. However, it is likely that entry and exit screening measures alone are not effective in detecting a significant proportion of cases in order to avoid seeding new cases in the protected region, but in combination with quarantine, observation and subsequent PCR tests, effectiveness is likely to improve. There was insufficient evidence to draw firm conclusions about the efficacy of quarantine alone. Some studies suggest that the effects are likely to depend on factors such as the stage of the epidemic, the interconnectedness of countries, local measures taken to contain transmission in the community, and the degree of implementation and compliance.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5431;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"There is not enough evidence to recommend specific pharmacological treatment for COVID infection in pregnant women and children, beyond the recommendations associated with oxygen therapy, vasoactive support, and an antibiotic, if necessary.";"We included 19 new studies that met eligibility criteria, four systematic reviews, two clinical trials, and 13 observational studies. In total, this rapid synthesis includes 36 studies, two clinical practice guidelines, six systematic reviews, five clinical trials, and 23 observational studies. The available evidence on pharmacological treatments for the control of COVID-19 infection is still limited and of low quality.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5943;35;"Evidencias COVID-19";"Cochrane - Revisi�n sistem�tica";Spanish;"There is uncertainty about the use of antimicrobial mouthwashes and nasal sprays in patients with suspected or confirmed COVID-19 infection and in healthcare workers";"They planned to include the following types of studies: randomized controlled trials (RCTs); quasi-randomized; non-randomized controlled trials; prospective cohort studies; retrospective cohort studies; cross-sectional studies; controlled before and after studies. They searched for studies comparing antimicrobial mouthwash and / or nasal spray (alone or in combination) at any concentration, administered at any frequency or dose to patients with suspected / confirmed COVID-19. No completed studies were found for inclusion in this review. They identified 16 ongoing studies (including 14 RCTs), which purport to include almost 1250 participants. This is not surprising given the relatively recent emergence of COVID-19 infection.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6199;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"It is not recommended to do a contralateral prophylactic mastectomy (CPM) for average risk women with early stage unilateral breast cancer.";"CPM for early stage breast cancer lacks evidence for survival benefit in average risk women with unilateral breast cancer. CPM can be associated with chronic pain, poor cosmetic outcome, and doubles the risk of post-operative infection and bleeding. Recommended surgical options for treatment for a unilateral early breast cancer in average risk women include lumpectomy and nodal staging or unilateral mastectomy and nodal staging. CPM is recommended for women with unilateral breast cancer and previous Mantle field radiation or a BRCA 1/2 gene mutation. CPM can also be considered by the surgeon on an individual basis for women with unilateral breast cancer and a genetic mutation in the CHEK2/PTEN/p53/PALB2/CDH1 genes, and in women who may have difficulty achieving symmetry after unilateral mastectomy. In all cases, the rationale, risks, and benefits of CPM should be discussed with patients and carefully considered based on each individual patient?s particular situation.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative
" 5688;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is uncertainty about whether telerehabilitation is a more effective or equally effective way of providing rehabilitation in cerebrovascular disease.";"There is low or moderate level evidence looking at whether telerehabilitation is a more effective or equally effective way of providing rehabilitation in cerebrovascular disease. Short-term telerehabilitation programs after hospital discharge have not been shown to reduce depressive symptoms, improve quality of life, or improve independence in activities of daily living compared to usual care. Studies comparing telerehabilitation and face-to-face therapy have also found no significantly different results between groups, suggesting that telerehabilitation is not inferior. Some studies reported that telerehabilitation is less expensive to provide, but information on its cost-effectiveness is lacking. Only two trials reported on whether or not adverse events had occurred; These trials found no serious adverse events related to telerehabilitation. This field is still emerging and more studies are needed to draw more definitive conclusions.";2020;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 5177;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend adopting Virtual Touch Quantification (VTq) software to diagnose and monitor liver fibrosis. VTq is as accurate as transient elastography in diagnosing and staging liver fibrosis, and may offer other benefits in terms of imaging the liver and sampling selected areas to assess fibrosis and identify associated pathologies. ";"By avoiding liver biopsies, it may also benefit people whose liver fibrosis needs monitoring. Cost savings through adopting VTq will be greater in hospitals in which liver biopsy is the primary method for diagnosing and monitoring liver fibrosis. VTq should be considered as an option for people with chronic hepatitis B or C who need assessment of liver fibrosis. Cost modelling suggests that using VTq is cost saving compared with transient elastography and liver biopsy, whether or not a compatible Siemens ultrasound machine needs to be purchased. ";2020;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5433;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones - Universidad de Antioquia";Spanish;"The effectiveness of non-pharmacological interventions may be limited, while combined interventions have been shown to be effective and have a high impact on COVID-19 and health systems";"The effectiveness of any isolated non-pharmacological intervention may be limited, while the combined interventions have been shown to be effective and have a high impact in reducing the transmissibility of the disease, the collapse of health care services, and mortality. Seven of nine included studies specifically suggest the early use of combined and strict measures; mainly, quarantine, social distancing, suspension of public transport, early detection of cases and home isolation of minor cases. Without the implementation of non-pharmacological interventions, one study claims that the number of COVID-19 cases would have increased rapidly in China, with a 51-fold increase in Wuhan, a 92-fold increase in other Hubei cities and 125 times increase in other provinces. These combined strategies could cut maximum demand for health care and mortality in half or even two thirds. A simulation study for Britain and the United States shows that, in an uncontrolled epidemic, demand for intensive care beds is predicted to exceed as early as the second week of April, with peak demand for care beds Intensive greater than 30 times the maximum offer in both countries. After the peak of the disease, and when the number of new cases has been controlled, it is necessary to maintain social distancing measures, control of public transport, work-at-home measures, case detection and isolation of these, and contact tracing. Contact tracing and case isolation is highly effective in controlling a new COVID-19 outbreak in 3 months. The probability of control decreases with: 1) long delays from the onset of symptoms to isolation, 2) fewer contacts are tracked per case, and 3) increases transmission before symptoms. In most of the simulation scenarios and from the public health experience of previous epidemics, it is identified that, if the personal contact of the population resumes to normal levels, the contagions could increase again. Therefore, several non-pharmacological interventions, including social distancing, should be continued for several months, (12) it is even proposed that restrictive measures should be maintained until a vaccine is available (potentially 18 months or more), since it is predicted that transmission will recover quickly if interventions are relaxed. For the dismantling of non-pharmacological measures, when the number of new cases demonstrates control of the disease, the evidence suggests that measures such as border closures, case detection procedures at airports, and the closings of schools and kindergartens They could be measures to be disassembled at first. The evidence also shows that the establishment and removal of non-pharmacological measures depends on the interaction of political, social and cultural factors, not only on the behavior of the disease.";2020;;;"High value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5434;35;"Evidencias COVID-19";"Hospital Universitario Donostia ? Unidad de Epidemiolog�a Cl�nica";Spanish;"The reuse of the FFP2 (or N95) mask is recommended after adequate disinfection with air at 75 � C or UV light";"Hot air at 75�C for 30 'without deleterious effects on the masks after 20 disinfection cycles Disinfection with UV light also had no detrimental effect after 10 disinfection cycles. Disinfection with hot water vapor did not impair the properties of the mask during the first 3 cycles. Subsequently, yes. Both bleach and alcohol modify the static charge of polypropylene microfibers, causing masks to lose their protective efficacy.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6202;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"It is not recommended to use prolonged opioid analgesia beyond the immediate postoperative period or other acute pain episode";"Opioid use poses considerable health risks to patients including opioid use disorder, overdose, and side-effects such as psychomotor impairment. While opioid analgesia may be appropriate in select circumstances, prolonged use of opioids beyond the immediate postoperative period and for chronic non-cancer pain is not recommended. Instead, clinicians and patients should consider alternative therapies, such as non-opioid pharmacologic therapy or non-pharmacologic therapies. If opioid analgesia is required, the lowest effective dose, potency, and number of doses required to address the acute pain episode should be prescribed.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6458;31;"Smarter medicine";"Sociedad Suiza de Reumatolog�a";English;"Magnetic resonance imaging of peripheral joints is not recommended for monitoring inflammatory arthritis.";"Research data on the use of Magnetic resonance imaging for the diagnosis and prognosis of rheumatoid arthritis is currently insufficient to justify the widespread use of this method in clinical practice. Although the presence of bone edema demonstrated by Magnetic Resonance Imaging can be predictive of the evolution of structural joint damage in certain populations of Rheumatoid Arthritis, the systematic use of Magnetic Resonance Imaging is not justified in relation to routine clinical follow-up, which includes the evaluation of the clinical activity of the disease and plain radiography.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 4923;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It's recommended selective internal radiation therapy (SIRT) for unresectable colorectal metastases in the liver shows there can be serious complications, but these are well recognised and infrequent.";"In people who cannot tolerate chemotherapy or have liver metastases that are refractory to chemotherapy, there is evidence of efficacy but this is limited, particularly for important outcomes such as quality of life. Therefore, in these people, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. In people who can have chemotherapy, evidence on overall survival and quality of life is inadequate in quality. Therefore, in these people, this procedure should only be used in the context of research.";2020;;;"High value";"C�ncer colorectal"; 5435;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;" There is no reliable information available on the use of cotton or surgical masks to prevent the dispersion of SARS-Cov-19 particles";"Recent studies have shown that both exhalations, sneezing, and coughing not only contain droplets with short-range ballistic behavior, but can be composed of a multilayer turbulent gas cloud. This is important because the droplet groups would form a continuum of different sizes, and as a consequence some droplets could contaminate the surfaces, while others can evaporate producing small residues that could remain in the air for hours. Some studies in patients with COVID-19 support this observation. For example, during the isolation of 13 COVID-19 positive individuals, air samples were collected and on surfaces from eleven isolation rooms. SARS-CoV-2 positive samples were collected from most of the patients' personal items (76.5%), and room air samples were positive by 63.2%, as were the samples taken in corridors (66.7%). These data give special importance to the role that the use of masks can have, either by the general population or in those cases of patients with a confirmed infection, as a measure to reduce the potential transmission of COVID19. Here we summarize two recently published studies that have evaluated the use of masks (surgical and cotton cloth) in different situations to reduce the dispersion of viral particles from SARS-CoV-2. In a clinical trial, a group of 246 patients was randomized, in whom a viral disease was confirmed in half of them. Participants were randomized to wear a surgical mask or not to wear it during an exhaled air assessment. Among these patients, 11 were positive for seasonal OC43, HKU1 and NL63 type coronaviruses (the latter uses the same ACE2 receptors as the new SARS-CoV-2). These patients were the ones who coughed the most during exhalation tests, with an average of 17 occasions (DS 30 occasions). These patients had a higher viral load in the nasal samples than in the throat samples (8.1 and 3.9 registry copies per sample, respectively). Among these patients with coronavirus infection, viral RNA was identified in 30% of the respiratory drops and in 40% of the aerosols collected without wearing a surgical mask. However, no viral particles were detected in either respiratory drops (P = 0.09) or aerosols (P = 0.04) collected from patients wearing surgical masks. Importantly, four of these participants did not spontaneously cough at any time during the exhalation exam, and no viral RNA was recovered in any sample in these patients. The researchers concluded that facemasks in symptomatic patients can prevent coronavirus transmission. It should be noted that this study recruited participants in the time period between 2013 and 2016 and therefore the results on the limited number of patients with coronavirus may not be applicable to those of patients infected with SARS-CoV-2. In another study, the efficacy of cotton and surgical masks was evaluated in four participants affected with COVID-19 who were asked to cough repeatedly on a Petri dish located 20 cm from their faces in the following order: without mask , wearing a surgical mask, wearing a cotton mask, and again without a mask. A smear was also made of the external and internal surfaces of both types of masks. The median viral load of the samples taken from the nasopharynx and saliva of the four participants was 5.66 log copies / mL and 4.00 log copies / mL respectively. After coughing without a mask, with a surgical mask or with a cotton mask, the median viral load was 2.56, 2.42 and 1.85 registry copies / mL, respectively. All swabs on the outer surfaces of the masks were positive for SARS-CoV-2, while most of the swabs on the inner surfaces of the masks were negative. Based on these results, the researchers concluded that surgical or cotton cloth masks do not prevent the spread of the SARS-CoV-2 virus. These studies show inconsistent results, which could be explained by its methodology (spontaneous exhalation versus active cough) or by the limited number of participants in each of them. Thus, although the results suggest that surgical masks under normal exhalation conditions (with or without spontaneous cough) may limit the transmission of SARS-CoV-2, additional studies are required in different settings to assess the potential benefit of their use.";2020;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5947;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The use of colchicine is recommended for the regression of clinical symptoms of covid 19.";"In this article, a 48-year-old man with covid 19 was studied, who on the 10th day began to experience stabbing pain in his first right metatarsal joint, the patient had no history of gout until this presentation. Colchicine is a safe oral anti-inflammatory drug that is widely used in systemic inflammatory diseases such as acute gout. The use of colchicine in this patient not only alleviated the gout flare, but also caused the regression of all clinical symptoms and inflammatory markers.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5436;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";Spanish;"There is evidence of the use of personal protective equipment for the prevention of highly infectious diseases from exposure to contaminated organic liquids in healthcare personnel.";"In addition to other infection control measures, consistent use of full?body personal protective equipment (PPE) can diminish the risk of infection for healthcare workers (HCW). EN (European) and ISO (international) standards for protective clothing and fabric permeability for viruses are helpful to determine which PPE should technically protect sufficiently against highly infectious diseases. However, the risk of contamination depends on more than just these technical factors. In simulation studies, contamination happened in almost all intervention and control arms. For choosing between PPE types, there is very low?certainty evidence, based on single?exposure simulation studies. Covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning (putting on) or doffing (taking off) and user comfort, and may therefore even lead to more contamination. A powered, air?purifying respirator (PAPR) with a hood may protect better than an N95 mask with a gown but is more difficult to don. A long gown may be the best compromise between protection and ease of doffing. Coveralls may be more difficult to doff. A more breathable fabric may still lead to similar levels of contamination protection to less breathable fabric, and may be preferred by users. For changes to PPE, there is low? to very low?certainty evidence that adding tabs to gloves or masks or closer fit of gowns at the neck or the wrist may decrease contamination, even though one study could not show a decrease in donning or doffing errors. For different procedures of donning and doffing, there is very low?certainty evidence that double gloves, as part of PPE and following Centers for Disease Control and Prevention (CDC) guidelines, and providing users with help or spoken instructions during donning and doffing may reduce the risk of contamination. Extra disinfection of gloves with bleach or quaternary ammonium may decrease hand contamination but not alcohol?based hand rub. For various training procedures there is very low?certainty evidence that more active training (including video or computer simulation or spoken instructions) may increase compliance with instructions compared to passive training (lectures or no added instructions). No studies compared methods to retain PPE skills needed for proper donning and doffing in the long term. The certainty of the evidence is low to very low for all comparisons because conclusions are based on one or two small studies and a high or unclear risk of bias in studies, indirectness of evidence, and small numbers of participants. This means that we are uncertain about the estimates of effects and it is therefore possible that the true effects may be substantially different from the ones reported in this review.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5948;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Treatment with JAK inhibitors is recommended in patients with COVID- 19 since it is significantly associated with positive clinical results in terms of mortality, ICU admission and discharge";"A systemic review and meta-analysis were performed to assess the role of Janus-kinase (JAK) inhibitors and type I interferons in COVID-19 patients, as they are potential antiviral candidates for COVID-19 patients. for its proven efficacy against diseases with excessive cytokine release and for its ability to promote viral shedding. We searched 733 studies, ultimately including four randomized and eleven non-randomized clinical trials.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6204;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Disease";English;"It is not recommended to repeat CD4 measurements in patients with HIV infection with HIV-1 RNA suppression for >2 years and CD4 counts >500/�L, unless virologic failure occurs or intercurrent opportunistic infection develops.";"The 2014 recommendations of the International Antiviral Society ? US Panel state that measurement of CD4 count is optional among patients with suppressed viral loads for >2 years and CD4 counts >500/�L. CD4 measurement in these patients is of low-value and may create unnecessary patient concern in response to normal variation of CD4 counts. In prospective studies of patients who have responded to antiretroviral therapy with HIV-1 RNA suppression and rises in CD4 cell count >200 cells/?L, there was little clinical benefit from continued routine measurement of CD4 counts.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5437;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"The combination of quarantine with other prevention and control measures is recommended for an effect on the number of infections and deaths caused by COVID-19.";"29 studies were included; ten modeling studies on COVID ? 19, four observational studies and 15 modeling studies on SARS and MERS. Due to the various methods of measurement and analysis of the results of interest, it was not possible to carry out a meta-analysis and a narrative synthesis was written. Due to the type of evidence identified for this review, the certainty of the evidence was considered low to very low according to GRADE. Modeling studies uniformly reported a beneficial effect of simulated quarantine measures. For example, the quarantine of people exposed to confirmed or suspected cases prevented between 44% and 81% of incident cases and between 31% and 63% of deaths, compared to no measure, according to different scenarios ( incident cases: four modeling studies on COVID ? 19, SARS; mortality: two modeling studies on COVID ? 19, SARS, evidence of low certainty). Very low certainty evidence indicates that the earlier quarantine measures are applied, the greater the cost savings (two modeling studies on SARS). Very low certainty evidence indicated that the effect of quarantining travelers from a country with a declared outbreak on reduced incidence and deaths was small (two modeling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closings, travel restrictions, and social distancing, the models demonstrated a greater effect in reducing new cases, transmission, and deaths than individual measures alone. (Incident cases: four modeling studies on COVID ? 19; subsequent transmission: two modeling studies on COVID ? 19, mortality: two modeling studies on COVID ? 19, evidence of low certainty). The SARS and MERS studies were consistent with the findings of the COVID ? 19 studies.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5949;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Treatment with type I interferon is recommended in COVID-19 patients as it is associated with positive clinical results in terms of mortality and discharge.";"A systemic review and meta-analysis were performed to assess the role of Janus-kinase (JAK) inhibitors and type I interferons in COVID-19 patients, as they are potential antiviral candidates for COVID-19 patients. for its proven efficacy against diseases with excessive cytokine release and for its ability to promote viral shedding. We searched 733 studies, ultimately including four randomized and eleven non-randomized clinical trials. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5438;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There is no reliable information on the use of Remdesivir as a potential therapy against COVID-19.";"From a clinical perspective, it is only possible to highlight the case series described in the study by Grein et al. (7). This uncontrolled study provides information on 53 patients analyzed with confirmation of COVID-19 and who needed supplemental oxygen supply or at least an O2 saturation of less than 95%. All received RDV through the compassionate use circuit for a maximum of 10 days, with doses of 200 mg the first day and 100 mg the following 9 days, with a follow-up of 28 days from the start of treatment (or until hospital discharge). or death if they occurred before). Regarding the results, 68% of the patients improved in the need for oxygen supply and 15% worsened, being the most frequent improvement in those patients with less severity. 13% of the participants died after completing RDV treatment, with those over 70 years of age, those with the highest serum creatinine and those requiring invasive ventilation having the highest risk. The most frequent adverse effects of RDV were elevated liver enzymes, diarrhea, rash, kidney failure, and hypotension. 8% discontinued RDV treatment prematurely. The limitations of the study are important, starting with the poor methodological quality of a cohort without a control group. Also notable are the small sample size, the short duration of follow-up, the absence of information on viral load or the lack of knowledge about 8 patients initially treated, but without additional information. Beyond the interest aroused by the article as it is the first to describe patients infected with COVID-19 treated with RDV, we are still waiting for results with true relevance from properly designed comparative studies.";2020;;;Uncertain;"Treatment COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5950;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The use of canaglifozin in type 2 diabetes presents an unfavorable benefit-harm balance";"As of 2019, glucose-lowering drugs belonging to the gliflozin class (sodium-glucose co-transporter 2 inhibitors) have an unfavourable harm-benefit balance in type 2 diabetes. However, they did not include the gliflozins in their 2020 list of drugs to avoid, because dapagliflozin has been authorised for use in type 1 diabetes, and their analysis of its harm-benefit balance in this situation is in progress.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6462;31;"Smarter medicine";"Sociedad Suiza de Reumatolog�a";English;"Routine repeat of dual energy x-ray absorptiometry densitometric analysis more than once every two years is not recommended.";"Initial screening for osteoporosis should be done in accordance with current clinical guidelines. The optimal interval for repeat densitometry (dual-energy X-ray absorptiometry) is uncertain, but since changes in bone density over shorter intervals are typically smaller than the measurement error of most densitometry scans, More frequent evaluations are not needed in most patients. Even in high-risk patients receiving pharmacological treatment for osteoporosis, changes in dual-energy X-ray absorptiometry do not always correlate with the probability of fracture. Therefore, densitometry should only be repeated if the result could influence clinical management or if rapid changes in bone density are expected. Recent data also suggest that healthy women, age 67 and older, with normal baseline bone mass, are unlikely to need additional densitometry testing for 10 years, as long as risk factors for osteoporosis do not change significantly.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5439;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"The transition from a situation of generalized transmission in the community to a stable state of low level or without transmission, supported by data and to be implemented gradually is recommended.";"In the absence of a safe and effective vaccine, the best result to be expected in the short and medium term in countries with a community transmission scenario is to achieve a sustained state of low or no transmission of COVID-19. Achieving this goal will depend on the authorities' ability to ensure that six key criteria are met: 1- Transmission of COVID-19 is controlled at a level of sporadic cases and grouped cases, all from known or imported contacts, and the incidence of new cases remains at a level that the health system can manage with a substantial reserve capacity. 2- There are sufficient capacities and resources in the health system to allow the main orientation change, mainly from the detection and treatment of serious cases to the detection and isolation of all cases, regardless of their severity and origin: a- Detection: Suspicious cases can be detected quickly after the onset of symptoms through active case finding, self-notification, screening on admission or other approaches; b- Screening tests: In all suspected cases, screening tests can be performed within 24 hours of their identification and sampling, and there should be sufficient capacity to verify the virus-free status of patients who have recovered; c- Isolation: all confirmed cases can be effectively isolated (in hospitals and / or designated facilities for mild and moderate cases, or at home with sufficient support if the designated facility is not available) and immediate until no longer are infectious; d- Quarantine: all close contacts can be tracked, quarantined and monitored for 14 days, either in a specialized facility or at their homes. Their monitoring and support can be done through a combination of visits by community volunteers, phone calls or messages. 3- The risk of outbreaks in highly vulnerable environments is minimized, which requires that all the main controllers and / or amplifiers of the COVID-19 transmission have been identified, with the implementation of appropriate measures to minimize the risk of new outbreaks. and nosocomial transmission (for example, adequate infection prevention and control, including triage and the provision of personal protective equipment in health facilities and residential centers). 4- Establish preventive measures in the workplace to reduce risk, including appropriate guidelines, capacities, and resources to promote and facilitate the application of COVID-19 standard preventive measures such as physical distancing, handwashing , respiratory hygiene and, potentially, temperature control. 5-Risk management of imported cases through an analysis of the possible origin and import routes, and available measures to quickly detect and manage suspicious cases among travelers (including the ability to quarantine people arriving from areas with community transmission). 6- The community is fully committed and understands that the transition implies an important change, from the detection and treatment only of serious cases, to the detection and isolation of all cases, that measures based on preventive behaviors must be maintained, and that all individuals in the community have a key role in empowerment and in some cases in the implementation of new control measures.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5951;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The use of selexipag has shown more risks than benefits in patients with pulmonary arterial hypertension.";"The oral prostacyclin receptor agonist selexipag, authorised for pulmonary arterial hypertension, has been dropped from this year?s list.It was added to the list of drugs to avoid in 2018. It was removed in 2019 and it has not been put back on 2020 list, even though its harm-benefit balance is highly uncertain, and the risk that it hastens the death of certain patients during the first months of treatment has not been ruled out";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5952;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"There is uncertainty about the use of antimicrobial mouthwashes and nasal sprays used by healthcare workers to protect themselves when treating patients with suspected or confirmed COVID-19 infection.";"There is currently no evidence of the benefits and risks of healthcare workers using antimicrobial mouthwashes or nasal sprays to protect themselves when treating people with COVID-19. No completed studies were found for inclusion in this review. Three ongoing studies (including two RCTs) were identified, claiming to include almost 700 participants. The interventions included in these trials are povidone iodine, nitric oxide and GLS-1200 oral spray. Once these studies are completed, their conclusions can be analyzed and included.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5953;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The antiviral efficacy of the antineoplastic agent Plitidepsin (PTD) has not been demonstrated for the treatment of COVID-19.";"Plitidepsin (PTD) is an antineoplastic drug licensed in Australia for the treatment of relapsed or refractory multiple myeloma. It does not have a marketing authorization from the European Medicines Agency. The laboratory responsible for its commercialization ensures that PTD has shown antiviral activity in a human hepatoma cell line infected with the HCoV-229E-GFP virus, a virus similar to SARS-CoV-2. At the moment there is no evidence to make it effective for the treatment of COVID-19 and the safety profile of PTD in these patients is unknown. The PTA currently has a single ongoing clinical trial on COVID-19. The use of PTD should not be considered outside of this clinical trial.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5698;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is insufficient evidence to determine the safety of self-administration of early medical abortion procedures compared to the administration of medications in the presence of the supervision of a healthcare professional.";"Self-administration of the second stage of early medical abortion procedures is as effective as professionally administered procedures for the successful outcome of the abortion. There may be no difference in the outcome of the ongoing pregnancy, although the evidence for it is uncertain for this outcome. There is very low certainty evidence of the risk of complications requiring surgical intervention. Data is limited by the paucity of high-quality research study designs and the presence of risks of bias.";2020;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 5954;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The use of Ginko biloba is not recommended for cognitive impairment in elderly patients.";"Ginkgo biloba, used in cognitive impairment in elderly patients, has no proven efficacy beyond that of a placebo, but can cause haemorrhage, gastrointestinal disorders, skin disorders, seizures and hypersensitivity reactions.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6466;31;"Smarter medicine";"Sociedad Suiza de Reumatolog�a";English;"Opioid analgesics are not recommended for nonspecific low back pain.";"Currently, there is no evidence to support the prescription of opioid analgesics for patients with acute nonspecific low back pain, and only moderate pain relief with opioid analgesics has been shown in patients with chronic low back pain. In addition, there is growing concern about the adverse effects of opioids, including overdoses and deaths. The management of chronic low back pain includes primarily non-pharmacological treatments and, in case of failure, pharmacological treatment with non-steroidal anti-inflammatory drugs, limiting weak opioids only in third intention.";2020;;;"Low value";-;"Link to the recommendation on the website of the iniciative" 5699;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"It is not recommended the use of telerehabilitation for the remote provision of rehabilitation services to people with low vision.";"Due to the disease burden and the growing interest in telemedicine, the two ongoing studies, once completed, may provide evidence to understand the possibilities of telerehabilitation as a platform to provide services to people with low vision.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative" 5955;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Early treatment with IFN? 2b has been associated with a reduction in hospital mortality among COVID-19 patients from severe to critical.";"A retrospective cohort study was conducted with data from medical centers in China. 29.4% of the total confirmed COVID-19 cases in two cities were studied. Acute inflammation, often seen in critically ill patients with COVID-19, was reported to be the result of type I IFN expression and the subsequent unbalanced IFN response with excessive cytokine production, which could be corrected by IFN administration therapeutic. It is therefore plausible that early administration of IFN in COVID-19 patients with viral loads or compromised immune systems delayed viral replication and disease progression. However, no significant benefit has been associated with the use of IFNa 2b in moderately ill patients. Randomized controlled trials are still needed to evaluate the clinical efficacy of IFN in COVID-19 patients.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6211;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to collect more blood than what is needed. Use short draw tubes, consider add-on testing, and reduce or combine duplicate orders.";"Phlebotomy is not a risk-free event for the patient or the healthcare worker. While rare, injury from needlestick and/or pathogen exposure can occur. Cumulative blood loss due to multiple phlebotomy episodes can result in iatrogenic anemia, particularly in the elderly, children, or those with medical conditions. This anemia can lead to worsened patient outcomes. Employing mechanisms that limit the amount of blood taken has been shown to lessen the severity of iatrogenic anemia. This can range from using smaller-volume collection tubes, consulting about the possibility of add-on testing to previously drawn samples, or adopting a maximum blood volume policy. Addressing duplicate requisitions can limit a patient from being phlebotomized twice.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5956;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The use of pentoxyverine for cough is not recommended";"Pentoxyverine, a centrally-acting cough suppressant, can cause cardiac disorders including QT prolongation, and serious allergic reactions";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5957;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The use of attapulgite (a medicinal clay) to treat intestinal disorders is not recommended.";"The medicinal clays attapulgite (marketed alone or in multi-ingredient preparations), which have been used to treat various intestinal disorders, including diarrhoea, heartburn and gastroesophageal reflux disease. They should be avoided due to the lead they contain. These toxic effects increases with the dose to which patients are exposed. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5958;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Convalescent plasma therapy added to standard treatment has not shown significant improvements in time to clinical improvement among patients with severe or life-threatening COVID-19.";"One RCT and four non-randomized studies were included in this report, providing limited quality evidence regarding the clinical effectiveness of convalescent plasma (CP) therapy added to standard treatment, compared to standard treatment alone, in adults with COVID - 19 serious or life threatening. CP therapy did not significantly improve the time to clinical improvement in 28 days. No evidence was found regarding the effectiveness of CP therapy in pediatric populations, the effectiveness of CP therapy compared to placebo or other active treatments (hydroxychloroquine, remdesivir), or the effectiveness of CP therapy in reducing viral loads of the SARS-CoV-2. Interpretation is limited by the early termination of the trial, which may have been underpowered to detect a clinically important difference.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5191;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE) ";English;"Do recommend keeping all surgical instruments that come into contact with high-risk tissues during an interventional procedure moist and separated from other instruments until they are cleaned, and then disinfected and sterilised (decontaminated). This improves the efficacy of the decontamination process and is highly cost effective.";" ";2020;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5959;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"The use of dapagliflozin has shown more risk than benefit in patients with type II diabetes.";"As of 2019, hypoglycemic drugs belonging to the gliflozin class (sodium-glucose cotransporter 2 inhibitors) have an unfavorable benefit-harm balance in type 2 diabetes. Those currently marketed in Europe are canagliflozin (alone or in combination with metformin), dapagliflozin (alone or in combination with metformin or saxagliptin), empagliflozin (alone or in combination with metformin or linagliptin) and ertugliflozin. However, gliflozins are not included in the 2020 list of drugs to avoid, because dapagliflozin has been authorized for use in type 1 diabetes, and our analysis of its benefit-harm balance in this situation is in progress.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6215;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to proceed with testing or reporting when sample quality or identification is suspect.";"The quality of specimens received in the laboratory is paramount to obtaining accurate results. Proceeding with testing in the presence of poor sample quality may give misleading results. This contributes to delays and unnecessary repeat examinations. Any level of error should be avoided to decrease negative impact on clinical decisions and patient care. Laboratory professionals should be proactive in ensuring that all types of specimens are collected in a high quality manner with correct identification, regardless of which health professional group is performing the act.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6471;6;"Less Is More Collection - JAMA Network";"Rastogi R. JAMA Intern Med.";English;"Treatment of hypertension during admission and enhancement of antihypertensive treatment at discharge are not recommended in adult patients with non-cardiac admissions.";"This cohort study found that 78% of adult patients admitted for noncardiovascular diagnoses had at least 1 hypertensive blood pressure measurement, but fewer than 1 in 3 had their medication intensified. More surprisingly, only 8% of hypertensive blood pressure readings prompted medication escalation, and even systolic readings greater than 220 mm Hg were treated less than half the time. Paradoxically, the treatment, defined as administration of an intravenous antihypertensive drug or a new class of oral antihypertensive therapy and presumably aimed at preventing end-organ damage, was associated with higher rates of acute kidney failure and myocardial injury. In fact, no benefit was found associated with any treatment route or in any blood pressure range. The findings suggest that hypertension among hospitalized medical patients should be managed conservatively. The intensification of treatment at discharge does not seem to be useful either.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5192;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend moving surgical instruments that come into contact with high-risk tissues from one set to another (they must remain within their individual sets). Maintaining set integrity reduces the risks associated with instrument migration (including infection) and makes it easier to trace instruments back to the patients they were used on.";" ";2020;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5960;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"The use of ertugliflozin has shown more risk than benefit in patients with type II diabetes.";"As of 2019, hypoglycemic drugs belonging to the gliflozin class (sodium-glucose cotransporter 2 inhibitors) have an unfavorable benefit-harm balance in type 2 diabetes. Those currently marketed in Europe are canagliflozin (alone or in combination with metformin), dapagliflozin (alone or in combination with metformin or saxagliptin), empagliflozin (alone or in combination with metformin or linagliptin) and ertugliflozin. However, gliflozins are not included in the 2020 list of drugs to avoid, because dapagliflozin has been authorized for use in type 1 diabetes, and our analysis of its benefit-harm balance in this situation is in progress. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5193;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend keeping supplementary instruments that come into contact with high-risk tissues within the individual set to which they have been introduced. Supplementary instruments are those that are not part of a specific instrument set.";"If supplementary instruments are used with different sets, this would compromise set traceability and increases the risks associated with instrument migration.";2020;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5961;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"The use of naftidrofuryl has shown more risks than benefits for intermittent claudication associated with peripheral arterial disease.";"Naftidrofuryl is a vasodilator that was licensed for intermittent claudication associated with peripheral arterial disease, increasing walking distance by a few dozen meters, but can cause headache, esophagitis, mouth ulceration, skin disorders, kidney stones and potentially serious liver disorders. A walking exercise program is an effective treatment with less risk.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5194;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE) ";English;"Do recommend rigid neuroendoscopes (rather than flexible neuroendoscopes). They should be of a type that can be steam sterilised and must be thoroughly cleaned and steam sterilised after each use.";" ";2020;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5706;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Grupo de Trabajo de Salud Mental. SoMaMFyC";Spanish;"It is not recommended to use iatrogenic communication strategies in health care during the COVID-19 pandemic.";"Listening, keeping quiet, welcoming and accompanying is recommended, rather than trying to embrace emotion.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5962;35;"Evidencias COVID-19";"Cochrane - Revisi�n sistem�tica";Spanish;"There is no evidence that the usage of antimicrobian mouthwashers and nasal sprays by patients who are having an aerosol-generating procedure are avoiding the infection of healthcare workers, whether the patient isn't known or suspected to be infected by Covid-19";"There is currently no evidence of the benefits and risks of patients using antimicrobial mouthwashes or nasal sprays to protect workers performing aerosol-generating procedures in patients without known or suspected COVID-19 infection. Further studies are to be performed to shed light on the measures.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6218;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to collect extra blood tubes in anticipation of test orders.";"Frequently called ?just-in-case?, ?rainbow draws? or simply ?extra tubes?, blood collected before tests are ordered is frequently unused and ultimately discarded. This represents a waste of laboratory resources and a challenge for specimen management. Excessive phlebotomy is a recognized contributor to iatrogenic anemia, which is linked to worsened patient outcomes.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6474;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"It is not recommended to consider viral load to assess the presence of COVID-19 symptoms in patients with a positive RT-PCR for SARS-CoV-2.";"The viral load detected in SARS-CoV-2 infected individuals with a positive RT-PCR result is independent of the presence or absence of symptoms at the time of sample collection. The relationship between viral load and level of severity of COVID-19, nor the relationship between the viral load identified in asymptomatic carriers and the subsequent period of transmissibility, is not known. Viral load was very similar (although it reached statistical significance) between populations with and without symptoms and between the subcategories examined (age, race, ethnicity, gender, older adult/healthcare personnel).";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5195;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using sets of single-use instruments to reduce the risk of Creutzfeldt?Jakob disease (CJD) transmission on a cost-effectiveness basis.";" ";2020;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5963;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"There is no evidence to determine the effect interferon ? (1a or 1b) has in the treatment of patient's hospitalized by Covid-19.";"More studies should be done to determine the effect that interferon-? has on hospitalized patients for COVID-19. The existing studies are made from therapeutic schemes of great variation among them, which could explain the heterogeneity of the results. Other items that should be dated are the effect in mild patients who do not require hospitalization and the pharmacokinetic and dynamic aspects of interferon -? or inhaled or sublingual route. Despite this, it should be noted that early administration of Interferon-? in the first 7 days of symptoms could be associated with lower mortality on day 28.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6475;35;"Evidencias COVID-19";"Facultad de Medicina, Universidad de Antioquia";Spanish;"The application of individual interventions such as self-care is recommended for the promotion and prevention of mental health in university students during the COVID-19 pandemic.";"Regular disclosure of information is suggested (healthy lifestyles, common emotional reactions in epidemics, advice on coping with isolation and quarantine periods, and warning signs that require individualized evaluation or even emergency care). Likewise, it would be appropriate to encourage peer support to foster a sense of connection and allow experiences to be shared. Also, the university can promote spaces for social interaction that are not only focused on academic aspects but also on leisure and mental health; promote blended learning as much as possible and advising/accompanying students during admission and graduation). Finally, frequent screening and monitoring of symptoms with the use of mobile applications (Headspace, Unmind, Student Health) is suggested, especially in students with foreseeable psychosocial risk (exchange, with COVID-19, low socioeconomic status, personal history of mental disorders, caregivers or residents of rural areas or with children).";2020;;;"High value";-;"ink to the recommendation on the website of the initiative/" 5196;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend introducing systems to maintain separate sets of neuroendoscopes and reusable surgical instruments for use on high-risk tissues for people born after 1996, on a cost-effectiveness basis.";"Removing the requirement to use different instruments on high-risk tissues for people born after 1996 would not markedly increase the risk of surgical transmission of CJD. ";2020;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5964;35;"Evidencias COVID-19";"Evidence Aid";English;"There is uncertainty about the comparative effects of worker stress management in person versus computer interventions.";"Some people may experience stress, anxiety and depression during the COVID-19 pandemic. In this Cochrane systematic review, the authors searched for randomized trials that compared computer-based versus in-person interventions for preventing and reducing stress in workers.They included 2 studies (total: 159 participants).The comparative effects of computer-based versus in-person interventions for stress management in workers are uncertain.";2020;;;Uncertain;"Patient management ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6476;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"The routine use of interferon-? 1a or 1b is not recommended as part of the treatment for patients hospitalized for COVID-19.";"Current evidence does not allow determining the effect on mortality or other important clinical outcomes of the use of interferon-? 1a or 1b. However, it could have some beneficial effect on the rate of hospital admission on day 14 and decrease the time for RT-PCR to become negative. A similar antiviral response has been found after IV or SC use, despite differences in bioavailability (greater for IV). The choice of route of administration would depend on the severity of COVID-19. Quality of evidence: low to moderate (serious imprecision, serious risk of bias). The great variation in interferon (IFN) ? treatment schemes could explain the heterogeneity of results on some outcomes. Early in-hospital administration (within the first 7 days after symptom onset) might be associated with lower mortality at day 28. Reported adverse events were of low frequency, mostly already known and self-limited. The most common were injection site reactions and elevated transaminases. The effect of treatment in patients in mild or moderate stages who do not require hospitalization is not known. The bioequivalence in terms of pharmacodynamics and pharmacokinetics of the use of IFN by inhalation or sublingual route is not known.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5965;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"Hospital usage of statins in the treatment of COVID-19 patients is significantly associated with lower death risk";"Statins are lipid-lowering therapeutics with favorable anti-inflammatory profiles and have been proposed as an adjunct therapy for COVID-19. However, statins may increase the risk of SARS-CoV-2 viral entry by inducing ACE2 expression. Usage of statins compared to non-statin use is significantly associated with a lower risk of death and a less inflammatory response during the entire hospitalisation period.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6221;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to support repeat test ordering (re-testing) at a frequency that is not backed by evidence.";"Many analytes have known stability profiles or minimum retesting intervals. In most cases, values will not change during this time. These intervals may be longer than traditional or historical test repeat ordering frequency. Ordering tests more frequently is unlikely to provide clinically meaningful results, and may contribute to iatrogenic anemia. Iatrogenic anemia can worsen patient outcomes. Laboratorians can play an active role in drawing awareness to and/or acting to reduce these types of orders.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6477;35;"Evidencias COVID-19";"Cochrane Portugal - Instituto de sa�de baseada na evid�ncia";Spanish;"The use of personal protection equipment and general infection control methods are recommended for the risk of contracting Sars-CoV-2 in health care professionals. ";"Health professionals (HCPs) are often at higher risk of contracting infections, in particular from Sars-CoV-2.The results of this study indicate that HCPs constitute a significant proportion of those infected, with a high incidence of contagion in unprotected contacts. However, they present less severe symptoms. The highest risk of infection was found in the context of nasotracheal intubation, in direct contact with patients and/or body fluids. The most significant reduction in risk factors was verified with the correct use of PPE (masks, gloves, suits, goggles, and hand washing). There are no studies that have analyzed the reuse of PPE.";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5454;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"Although ribavirin was beneficial for SARS and MERS, it is uncertain if it will be an effective treatment for patients with COVID-19.";"Like COVID-19, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) are acute respiratory diseases caused by a coronavirus. Ribavirin was used to treat patients with these earlier coronaviruses and might be considered as a treatment for COVID-19. In this systematic review, the authors searched Chinese and English literature databases for research of any design testing ribavirin as a treatment of SARS or MERS. They did their search in February 2020. They identified 8 retrospective cohort studies, 8 case reports and 2 systematic reviews. Nine of these were for SARS 9 were for MERS.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5966;35;"Evidencias COVID-19";CEBM;English;"Advance Care Planning (PCA), on video and on the web, is recommended for people with limited English proficiency, poor health literacy and / or from disadvantaged communities, in the context of COVID-19.";"The COVID-19 pandemic highlights the importance of Advance Care Planning (ACP) and presents opportunities to expand access to its benefits, in the context of increased public awareness of how health can suddenly and unexpectedly deteriorate. Advance Care Planning (ACP) is a process that helps people ""at any age or stage of health to understand and share their personal values, life goals, and preferences regarding future medical care,"" with the goal of to help ""ensure that people receive medical care in accordance with their values, goals and preferences during serious and chronic diseases."" However, there are inequalities in PCA, with barriers associated with belonging to an ethnic minority group, lower educational level and a diagnosis non-cancer, among others. Carrying out PCA in the community rather than in the hospital plays an essential role in helping patients and their families plan preferred care, agree on treatment boundaries, and, where appropriate, make decisions to decline treatment earlier. of a crisis situation. They are not only essential to ensure that those with significant potential to recover receive appropriate care, but also that those with a very low chance of survival receive appropriate end-of-life care. Conducting PCA in community settings such as primary care and nursing homes can play a crucial role during the pandemic, as professionals in these settings often have the opportunity to get to know patients much better than physicians in those settings. hospitals, facilitating adequate opportunities for sensitive conversations that might be difficult to achieve in busy inpatient settings. A rapid review of the evidence was performed with a narrative synthesis of the published literature. In the context of COVID-19, and to reduce inequalities in access to the ACP, we recommend national investment in public and evidence-based resources and systems to support the ACP.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6222;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to routinely do serologic testing post-immunization (i.e. Hepatitis B and Measles).";"Post-immunization titres to determine immunity following a complete vaccine series are often not necessary. For example, anti-HBs titres following completed hepatitis B virus vaccination series are unnecessary in the general population. Similarly, serologic testing for measles, mumps and rubella immunity following two doses of MMR is not necessary.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6478;35;"Evidencias COVID-19";"Cochrane Iberoam�rica";Spanish;"There is no evidence that physical distancing alone protects against COVID-19.";"Current recommendations on safe physical distancing (one to two meters) are based on outdated evidence. In a systematic review carried out in the context of the covid-19 pandemic, it was observed that the distribution of viral particles is affected by numerous factors such as airflow, ventilation, type of activity, viral load and duration of exposure. The exhibition. In the highest risk situations, a physical distance of more than two meters should be considered and the occupation time minimized. Physical distancing must be implemented together with other strategies, such as hand hygiene, cleaning of environments, occupation, management of closed spaces, ventilation and adequate protective equipment such as masks.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5967;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"The use of the non-steroidal anti-inflammatory drug tenoxicam has shown more risks than benefits.";"When used systemically, expose patients to an increased risk of gastrointestinal and skin disorders (including Stevens-Johnson syndrome and toxic epidermal necrolysis) but they are no more effective than other NSAIDs.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6479;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"There is no evidence that targeting oxygen needs in the intensive care unit during mechanical ventilation improve ARDS.";"It is are uncertain whether a higher or lower oxygen target is more beneficial in patients with ARDS receiving mechanical ventilation in an intensive care setting. There was no evidence of a difference between the lower and higher target groups in the mean number of days on ventilation, number of days of catecholamine use, or participants receiving renal replacement therapy. A single RCT with a total of 205 participants exploring this question was identified, and we rated the risk of bias as high and the certainty of the findings as very low. More well-conducted studies are needed to improve the certainty of the evidence for the findings reported here. This review should be updated when more evidence becomes available.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5456;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"During high risk exposures the use of respirators and evidence-based hand hygiene techniques to prevent the transmission of respiratory infection is recommended. ";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5968;35;"Evidencias COVID-19";"IHCAI ? DIME. Informaci�n seleccionada sobre intervenciones para el tratamiento de COVID-19";Spanish;"The use of remdesivir, among all the selected antivirals (described below), accompanied by oxygen therapy, fluid maintenance, electrolyte balance and intestinal microbiological modulators with nutritional support suggests that it may be useful to combat COVID-19";"Comparison of remdesivir with ribavirin, favipiravir, oseltamivir, and umfenovir as treatment for COVID-19 infection. In addition to antiretrovirals, evidence suggests that these should be accompanied by oxygen therapy, fluid maintenance, electrolyte balance, and intestinal microbiological modulators with nutritional support";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6480;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"The early application of quarantine with other public health measures is recommended for the prevention of Sars-CoV-2 infection in people who had contact with confirmed cases of COVID-19.";"Modeling studies consistently reported the beneficial effect of simulated quarantine measures. Quarantine of people exposed to confirmed or suspected cases prevented between 44% and 81% of incident cases and between 31% and 63% of deaths. Very low-certainty evidence suggests that the effect of quarantining travelers from a country with a declared outbreak on reducing incidence and deaths was small. When the models combined quarantine with other prevention and control measures, including school systems, travel restrictions, and social distancing, the models demonstrated a greater effect in reducing new cases, transmissions, and deaths than the individual measures alone. alone. ";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5457;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"A medical/surgical mask should always be worn when providing direct patient care to a patient with known or suspected respiratory infection.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5969;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"The use of medicinal clays diosmectite, hydrotalcite and montmorillonite beidellitique aka monmectite for intestinal disorders should be avoided due to the lead they contain.";"The medicinal clays attapulgite, diosmectite, hydrotalcite, and montmorillonite beidellitique aka monmectite and kaolin are used alone or in multi-ingredient products to treat various intestinal disorders including diarrhea, heartburn, and gastroesophageal reflux disease. They should be avoided due to the lead they contain. Lead has neurological effects, hematological, renal, cardiovascular and reproductive toxicity, and the severity of most of these toxic effects increases with the dose to which patients are exposed. In diarrhea, clays alter the appearance of stool without reducing fluid loss or the risk of dehydration. In gastroesophageal reflux, when drug treatment seems the best option, other drugs have a positive benefit-harm balance. The first option in the absence of complications would be a short treatment with a clay-free antacid, used in moderate doses, such as sodium bicarbonate + sodium alginate.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6225;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to routinely repeat critical results for most common analytes before reporting.";"With modern instrumentation, analytical precision is very high when the result is within the reportable range and no delta checks have failed. Providing that sample integrity and performance validity has been confirmed, repeating critical values rarely changes the result. However, turnaround time is significantly increased. This can delay clinical action, negatively impact patient care, and increase the likelihood of unnecessary investigations.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6481;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"It is recommended to continue with ACEI or ARA-II treatment in those patients with comorbidities to reduce the risk of SARS-CoV-2 infection and the development of severe forms of COVID-19.";"In people with comorbidities who have been receiving treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), there may be a lower risk of SARS-CoV-2 infection and the development of severe forms of COVID-19. Evidence quality: moderate (from observational studies with moderate risk of bias, lack of precision in some outcomes, and lack of consistency in the direction of the association with different outcomes). Current evidence does not support the need to suspend the use of ACE inhibitors or ARBs when diagnosed with COVID-19. The information available comes from patients with prior treatment with ACE inhibitors or ARBs, the effect of de novo treatment with these drugs as preventive therapy for infection or adjuvant in the management of patients with COVID-19 is not known. Apparently ethnic origin modifies the association between the previous use of ACE inhibitors or ARBs and the risk of SARS-CoV-2 infection or a relevant clinical outcome associated with the development of COVID-19. This finding requires further investigation for further understanding of its biological plausibility. Previous use of ACE inhibitors and ARBs was not associated with ICU admission.";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5458;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"An N95 respirator (or equivalent) should be worn continuously during high-risk situations such as aerosol-generating procedures with patients known to have a respiratory infection.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5970;35;"Evidencias COVID-19";CEBM;English;"There is uncertainty about the use of interferons as a treatment for acute viral infections, such as COVID-19.";"With other cytokines, interferons are responsible for some of the symptoms of viral infection, including fever and muscle pain. Microbial products and chemical inducers can also stimulate interferon production. Interferons also have effects on tumour cell survival via TLRs. Most available formulations are for subcutaneous injection. The licensed subcutaneous formulations are contraindicated in patients with current severe depression or suicidal ideation or both. Interferons have not, up to now, proved useful treatments for acute virus infections. So far the data from small studies, only one of which appears to have been masked and randomized satisfactorily, show few beneficial effects and no convincing effect on mortality. Large, masked, randomized controlled trials would be needed to show whether inhaled or any other form of interferon reduces mortality in COVID-19. Only three trials currently planned are likely to be large enough and none of them is masked.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6226;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to give rabies post-exposure prophylaxis unless indicated by a structured assessment of risk.";"Rabies post-exposure prophylaxis (including rabies vaccine and immunoglobulin) should only be offered to individuals with known or highly probable contact with the saliva of a potentially infected animal. Risk assessment should be based on type of exposure, local rabies epidemiology, symptoms of the animal, ability to test or observe the animal for rabies, prior rabies immunization of the animal and exposed person, and if necessary, consultation with local public health officials. In general, the risk of rabies from domestic animals (e.g., pets) is extremely low.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5971;35;"Evidencias COVID-19";CEBM;English;"There is uncertainty about the use of remdesivir in COVID-19 patients.";"We are currently aware of 11 trials of remdesivir in COVID-19. The number of patients to be studied in the masked trials is 2,061 out of 22,437 in total (9.2%). The results of the remdesivir use program suggest, but do not prove, that the benefits of remdesivir may outweigh the harm it might cause. However, the death rate from COVID-19 is relatively low, so an open, uncontrolled trial will never be able to define benefits or harms. Does Remdesivir Save COVID-19 Patients? A definitive answer will only come from a large enough randomized trial, with mortality as the primary endpoint. Meanwhile, suggestions for improved or faster recovery have led to the use of remdesivir without certain information on its effectiveness or cost effectiveness.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6483;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"There is insufficient evidence that the use of antimicrobial mouthwashes and nasal sprays in apparently healthy patients undergoing aerosol-generating procedures can protect healthcare workers from Sars-CoV-2 infection.";"Covid?19 infection poses a serious risk to patients and, due to its contagious nature, to healthcare workers treating them. The risks of infection transmission are higher when a patient undergoes an aerosol-generating procedure. Not everyone who has covid-19 is symptomatic, or suspected of being infected. Irrigating the mouth and nose of the patients in question with antimicrobial solutions could be a method to reduce the risk of transmission of a possible hidden infection to health workers. However, the use of these antimicrobial solutions may be associated with damage related to the toxicity of the solutions themselves or to alterations in the natural microbial flora of the mouth or nose. No completed studies were found to include in this review, so an assessment of uncertainty is given.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5972;35;"Evidencias COVID-19";"Evidence Aid";English;"There is uncertainty about the effectiveness and safety of using short stay units located near emergency departments (compared to hospital care).";"The COVID-19 pandemic is putting pressure on health services. Existing research on the effects of having short-stay units located near emergency departments could provide useful information for policymakers. In this systematic review, the authors searched for randomized trials comparing short stay units with usual care. They restricted their searches to articles published in English and French between 1993 and 2015. They included five trials. All included trials were from the USA and had compared short stay units versus hospital care. The authors assessed all trials as moderate risk of bias and generally of low quality. It was concluded that the effectiveness and safety of the use of short-stay units located near emergency departments (compared to hospital care) are uncertain.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6228;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to support ordering system mechanisms that contribute to over-testing. Encourage the development of an evidence-based utilization management program that may include interventions such as unbundling order sets, reflex testing algorithms, and decision-support technology.";"Over-testing is a recognized problem, and evidence supports multi-faceted interventions that capitalize on advances in computer-based ordering technology. Bundling of tests may provide results that are not necessary for the ordering professional and may lead to duplication of testing or unnecessary follow-up. Order sets should be regularly reviewed. Research supports increased collaboration of all healthcare providers, including laboratory personnel, in combating over-testing. Laboratory professionals can be involved at all stages of interventions from problem recognition, feedback provision, to participation in the creation of supportive education materials and ordering guidelines.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6484;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil";Spanish;"The use of favipiravir is recommended in the treatment of patients hospitalized for moderate forms of COVID-19 and without risk factors.";"Quality of evidence: very low. This recommendation based on new studies could vary. Regarding safety, the results in various studies were not consistent. In the study by Chen et al. (9) The composite rate of elevated aminotransferases, increased serum uric acid, psychiatric symptoms, and gastrointestinal symptoms were higher in the favipiravir group compared to the control group (32 vs 23.3%, RR 1.37, 95% CI 0.90-2.08). In contrast, Cai et al. (11) reported a lower rate of adverse events for favipiravir compared to the control group (11.3 vs. 55.6%, RR 0.21, 95% CI 0.08-0.54) similar to Ivashchenko et al. (10 vs. 17.5%) (10). It is also important to know that the effect of favipiravir treatment in patients with severe or critical forms of the disease, including those on mechanical ventilation, is unknown.";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5973;35;"Evidencias COVID-19";"Evidence Aid";English;"Quarantine measures during the COVID-19 pandemic have shown benefits in reducing the risk of virus transmission.";"The authors researched on the effects of quarantine (alone or in combination with other measures) of people who had contact with confirmed COVID-19 cases, who had traveled from countries with a declared outbreak, or who live in regions with high transmission. of the illness. They included 4 observational studies and 28 modeling studies on COVID-19, and four observational studies and 15 modeling studies on SARS and MERS. Modeling studies consistently reported a benefit from sham quarantine measures, although there is uncertainty about the magnitude of the effect. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6229;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to prescribe medications or recommend a management plan where there are financial and social barriers that might make the plan impractical for patients.";"Understanding a patient?s perspective with a thorough social history will provide valuable information about their determinants of health, which is critical for nuanced diagnoses and a better adapted management plan. As barriers are identified and addressed management plans can be re-evaluated in collaboration with the patient.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6485;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"There is insufficient evidence that the use of antimicrobial mouthwashes and nasal sprays in COVID-19 patients improves patient outcomes or protects healthcare workers treating them from Sars-CoV-2 infection.";"Covid?19 infection poses a serious risk to patients and, due to its contagious nature, to healthcare workers treating them. Irrigating the mouth and nose of these patients with antimicrobial solutions could be a method to reduce the risk of transmission of a possible infection to health workers. However, the use of these antimicrobial solutions may be associated with damage related to the toxicity of the solutions themselves or to alterations in the natural microbial flora of the mouth or nose. No completed studies were found at the time of publication of the review to be included, so an assessment of uncertainty is given.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5462;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"From a technical point of view, it is feasible to ventilate several patients with a single respirator, but the results in patients that may derive from this practice are unknown.";"= The information that is currently available is very scarce, since there is only a single study in two healthy volunteers in which ventilation with a face mask was applied, and therefore the applicability of the studies in practice is minimal. = If, due to the challenges posed by the current situation, it is decided to use a respirator for ventilation of more than one patient, the following specifications should be considered to guarantee an adequate procedure: - Ventilation of multiple patients with a single ventilator administering the programmed Vt when the characteristics of the patients are similar (ideal weight, compliance, resistance) - When patients have different characteristics, the Vt administered must also be different (the more difference in their compliance and / or resistance, the more difference Vt, PCO2 and PaO2 will apply) - Multiple ventilation should be in pressure controlled mode (VCP) as it is safer ";2020;;;Uncertain;"Treatment COVID - 19";"Link to the recommendation on the website of the initiative" 5974;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"Usage of Mephesenin as a muscular-relaxing drug is not recommended.";"The French Health Products Agency with- drew marketing authorisation for products containing this drug in mid- 2019, due to its unfavourable harm-benefit balance. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6230;19;"Choosing Wisely Canada";"Canadian Society for Medical Laboratory Science";English;"It is not recommended to allow standing orders for repeat testing without a stop or review date. ";"Standing orders without an expiry or review date allow testing to be performed repetitively for extended periods of time. This type of testing is rarely clinically necessary without regularly reviewing the validity of the order. This contributes to overutilization of laboratory tests, and may exacerbate the development of iatrogenic anemia. ";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6486;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"The use of Favipiravir as a treatment in patients hospitalized for COVID-19 is not recommended.";"The available evidence on favipiravir for the treatment of COVID-19 is of very low certainty. It is not possible to establish if it is an effective medicine for this disease. There are numerous ongoing studies, including randomized and nonrandomized clinical trials, that advise against its use. However, in selected seriously ill patients it could be weakly recommended.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5463;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"If a mask is worn, it should be placed to cover the mouth and nose and tied securely to minimize any gaps.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5719;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"It is recommended adequate guidance for the proper performance of molecular diagnostic tests by clinical laboratories for the COVID-19 pandemic.";"The indications and handling of the tests must be established according to the recommendations of the professional associations of laboratory specialists, which will also be different depending on the time of the pandemic. 1. Future processes for the massive purchase of equipment / reagents must always be accompanied by a technical report prepared by specialists from the Clinical Laboratory. 2. We consider it pertinent to introduce Regulation UE2017 / 746 as an additional criterion in the selection process for laboratory equipment / reagents. 3. The specifications of use provided by the manufacturer must be taken into account, especially regarding the type of sample required. For any use on unspecified samples, prior internal validation must be performed. 4. In case of doubts about the performance of the tests, laboratory professionals should internally validate their performance in their healthcare environment before using them. 5. It is the direct responsibility of the laboratory to establish POCT management protocols at the departmental level and ensure compliance. 6. Collaboration between laboratory medicine specialties should be encouraged when reorganizing and planning healthcare processes. 7. The indications and handling of the tests must be established according to the recommendations of the professional associations of laboratory specialists, which will also be different depending on the time of the pandemic. 8. Laboratory professionals must actively participate in the design of information collection and dissemination systems to other professionals and to the competent authorities, unifying and standardizing data matrices at the national level. 9. From the laboratory it is necessary to agree and protocolize in coordination with the Occupational Health services the detection, diagnosis, monitoring and discharge process of health professionals. 10. The creation by other external entities (eg companies, municipalities, groups) of temporary or concerted laboratories must comply with the existing criteria in the different Decrees approved by the Autonomous Communities on the opening and operation of diagnostic centers. Likewise, in these cases, all those aspects related to control measures, security and data transmission must be clarified, as well as establishing the actions to be carried out in the event of positive results. 11. We demand the creation and maintenance of a pool of properly accredited national research laboratories that meet a series of minimum requirements so that they can be made available to the national health system by supporting healthcare activities.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5975;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"Empogliflozin usage (both alone or with metformin or saxagliptin) is to be avoided as a drug for Type 2 Diabetes";"Gliflozins: harm-benefit balance unfavourable in type 2 diabetes, but under review in type 1 diabetes.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5464;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"A mask should not be touched while wearing or when removing; if inadvertently touching the mask, hands must be immediately cleaned with soap and water, or alcohol-based hand rub.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5720;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is essential to divide emergency and hospitalized patients into a suspicion group and a confirmation group as a precautionary measure in case a patient needs to have a surgery during the pandemic COVID-19";"This document explains the main measures to take into account in case of care for COVID-19 patients or suspicion both during their evaluation and in case of requiring surgical treatment. The route of entry of patients to the General Surgery Service is based on two branches: emergency and hospitalization. Both routes will have a pre-established location in advance according to the protocols of each hospital for the location of this type of patient. It is essential to divide the patients into two groups: suspicion group and confirmation group. Although the measures to be taken when evaluating them are very similar, the diagnostic confirmation can modify the therapeutic options.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5976;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"?-amylase is not recommended as treatment for sore-throat";"An enzyme with no proven efficacy against sore throat beyond that of a placebo, can cause severe cutaneous or allergic disorders, in- cluding urticaria, pruritus, angi?dema, maculopap- ular rash and erythema";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6488;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"There is insufficient evidence that the use of antimicrobial mouthwashes and nasal sprays protects against infection in healthcare workers treating patients with suspected or confirmed Covid-19 infection.";"Covid?19 infection poses a serious risk to patients and, due to its contagious nature, to healthcare workers treating them. Irrigating the mouth and nose of healthcare professionals who treat them with antimicrobial solutions could be a method to reduce the risk of infection to healthcare providers. However, the use of these antimicrobial solutions may be associated with damage related to the toxicity of the solutions themselves or to alterations in the natural microbial flora of the mouth or nose. It is especially important to understand these potential side effects when caregivers are fit and well. No studies completed at the time of publication of the review were found to be included, so an assessment of uncertainty is given.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5465;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Medical/Surgical masks should not be worn for more than six hours and should be changed immediately when they become damp ";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5721;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is recommended do routine testing for COVID-19 before urgent or elective surgery.";"The test to be carried out will depend largely on the means available. Ideally, a diagnostic PCR will be performed, although its results may take hours, which in the case of a non-delayed emergency, can be critical. So-called quick ?tests? provide results in minutes, but their limited current disposition and the considerable false negative rate mean that, unfortunately, they cannot be indicated in a generalized way. On the other hand, a simple chest radiograph in patients with typical symptoms can help determine a highly suspected diagnosis that would act as a confirmed case. However, the profitability of this test depends largely on the experience of the radiologist. In addition, it has been observed that the reliability of chest computed tomography (CT) is quite high and offers very characteristic radiological patterns, making it a valid alternative, especially in urgent cases where the delay of laboratory tests is not Acceptable given that, in addition, a large number of patients with urgent surgical pathology usually require an abdominal CT so that the study can be extended to the chest. It is important to note that the maximum number of false negatives for both PCR and chest CT accumulate within 2-3 days of the onset of symptoms.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5977;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"Pentosan polyfosfate is not recommended for bladder pain syndrome (intersticial cistitis)";"It is an heparin derivative authorised for bladder pain syndrome (interstitial cystitis), has uncertain efficacy in relieving the symptoms of this condition and serious adverse effects, including immune-mediated thrombocyto- penia with a consequent risk of arterial thrombosis and pigmentary maculopathy. In the absence of a better alternative, it is more prudent to offer these patients analgesic medication and non-drug measures with a low risk of adverse effects, such as applying heat or cold to the bladder or perineum, and avoiding foods or activities that exacerbate symptoms.";2020;;;"Low value";Treatment;"

Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 6489;35;"Evidencias COVID-19";"Cochrane Iberoam�rica";Spanish;"A restrictive use of empirical antibiotic therapy is recommended in patients with confirmed or suspected Covid-19.";"Coinfection was defined as bacterial pneumonia added in a patient with covid-19 in people 48?72 hours after admission for covid-19. Secondary infection was defined as cases of bacterial pneumonia 48?72 days after admission for covid-19. In general, a restrictive use of antibiotic therapy is suggested in patients with high probability or confirmation of covid-19. This is especially true for patients who have mild to moderate disease at admission (weak recommendation; very low-quality evidence). It is suggested that exceptions can be made for the restrictive use of antibiotic therapy in patients with a high probability or confirmation of covid-19 who have radiological findings and/or inflammatory markers consistent with bacterial co-infection. Other exceptions are severely ill or immunocompromised patients (weak recommendation, no evidence). It is recommended that every effort be made to obtain sputum and blood culture samples, as well as pneumococcal antigen tests in urine before the start of empiric antibiotic therapy in patients with high probability or confirmation of covid-19 at the time of hospital admission (strong recommendation, no of evidence). In case of suspicion of bacterial co-infection, it is suggested not to administer empirical antibiotic therapy covering atypical pathogens in patients with confirmed or high probability of covid-19 hospitalized in the general ward. Legionella urinary antigen testing should be performed according to local and/or national community-acquired pneumonia guidelines (weak recommendation; very low-quality evidence). Empirical antibiotic therapy regimens for suspected bacterial co-infection are recommended depending on the severity of the disease and in accordance with local and/or national guidelines. For those patients who meet the criteria for mild and moderate-severe community-acquired pneumonia, it is recommended to follow the recommendations of local and/or national guidelines on antibacterial treatment for community-acquired pneumonia (weak recommendation; quality of evidence). very low evidence). It is recommended to follow the recommendations of local and/or national guidelines on antibiotic therapy for patients with covid-19 and suspected secondary bacterial infection (strong recommendation; lack of evidence). It is suggested to stop antibiotics when sputum samples, blood cultures, and urinary antigen tests taken before the start of empiric antibiotic therapy in patients with high probability or confirmation of covid-19, do not show bacterial pathogens after 48 hours of incubation. A duration of antibiotic treatment of five days is suggested in patients with covid-19 and suspected bacterial infection by improving signs, symptoms and inflammatory markers.";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5466;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Cloth (e.g. cotton or gauze) masks are not recommended under any circumstances. ";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review of six RCTs and 23 observational studies, including two meta-analyses; one of RCTs and other of observational studies. ? A systematic review of six randomized controlled trials (RCTs) involving 9,171 participants. ? The pooled results of two RCTs: continuous use of N95 respirators (pooled data from both trials; n=1,530; targeted N95 respirator use (data from trial 2 only; n=516); continuous use of medical masks (pooled data from both trials; n=1,064) and a control group (data from trial one only; n=481). ? Clinical Practice Guidelines. ? A descriptive study involving 12 doctors and nurses from infectious diseases, respiratory/chest wards, and intensive care units (ICU).";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5722;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"Recommendations for surgery in patients with highly fluid transmissible viral diseases recommend minimally invasive access to minimize contagion to members of the surgical team.";"During gastrointestinal surgery the use of the scalpel and the opening of the digestive tract can generate aerosols. Likewise, among the other energy sources, the use of the ultrasonic scalpel is not recommended as it causes greater aerosolization. Laparoscopy involves the interposition of a physical barrier between the surgeon and the possible source of infection, avoiding occupational exposure and cross infection. In addition, efforts will be made to avoid the prolonged Trendelenburg position as much as possible. Regarding surgeries in which TaTME, TAMIS or TEM approaches have been used, although it was carried out with extreme precautions in China, the current scenario discourages its use due to the high risk of aerosolization and prolonged direct exposure of the surgeon during the perineal time. Therefore, it is recommended to prioritize the approach that is most beneficial for the patient, regardless of their COVID-19 infection. In the case of using the laparoscopic route, the protection measures of the airway and mucous membranes will always be extreme and special precaution should be taken not to make direct exposures during the moments when there is some type of gas leak.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5978;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";Spanish;"Xylometazoline is not recommended as an oral or nasal decongestant.";"It can cause serious and even life-threatening cardiovas- cular disorders (hypertensive crisis, stroke, and arrhythmias, including atrial fibrillation), as well as ischaemic colitis. These adverse effects are unac- ceptable for drugs indicated for minor, rapidly self-resolving symptoms such as those associated with the common cold";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6490;35;"Evidencias COVID-19";"Instituto de Sa�de Baseada na Evid�ncia (ISBE)";Spanish;"The detection of saliva samples and nasopharyngeal swabs is recommended in the detection of SARS-CoV-2 infection during hospital stay.";"The results indicate that the correlation between the diagnostic accuracy of symptomatic patients undergoing a PCR test with a saliva sample collected by the patients themselves, compared to nasopharyngeal or oropharyngeal swabs, collected by professionals, is good. On days 1-5 after the diagnosis of Covid-19, it was found that the percentage of positivity was higher in salivary samples (81% vs. 71%), maintaining this difference until the end of the 10-day hospitalization period. It was also found that, during the clinical course of these patients, there was less variation in the concentration of SARS-CoV-2 RNA in saliva compared to nasopharyngeal swabs. Even so, the results should be considered with caution, since there are studies that have shown that nasopharyngeal samples were more sensitive than salivary samples in the diagnosis of SARS-CoV-2 infection. This study, however, had limitations: lack of a diagnostic test accepted worldwide, problems in evaluations in the 2 laboratories involved (one analyzed NF and the other S) and a small sample.";2020;;;"High value";-;"Link to the recommendation on the website of the initiative" 5723;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"A Personal Protective Equipment (PPE) must be used under surgical clothing to ensure adequate protection for operating room personnel in the event of intervention on a confirmed COVID-19 positive patient.";"Elements of Personal Protective Equipment (PPE). PPE will be necessary in any procedure considered as ?close contact?, which includes surgical intervention, as well as other operating room procedures (intubation, regional anesthesia, canalization of the airways, etc.). Personal protective equipment, as established by Royal Decree 773/1997 regarding its use, will provide effective protection against the risks that motivate its use, without assuming or causing additional risks or unnecessary inconvenience.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5979;35;"Evidencias COVID-19";CEBM;Spanish;"Further studies must be done in order to determine the benefits and risks of tocilizumab in the treatment of COVID-19 infection";"Patients with severe COVID-19 can develop cytokine release syndrome (?cytokine storm?) and are reported to have high circulating IL-6 concentrations. Tocilizumab is a recombinant humanized anti-human IgG1 monoclonal antibody directed against the interleukin-6 receptor (IL-6R). It has therefore been proposed to be of value in the management of severe COVID-19. Serious and sometimes fatal infections have been reported. The manufacturer therefore recommends that treatment should not be started during an active severe infection, or with conditions that can predispose to infections (e.g. diverticular disease, diabetes mellitus, interstitial lung disease). It is not clear how these restrictions would affect its use in acute infection with SARS-CoV-2.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6235;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"Screening TB skin testing of employees and volunteers in non-healthcare settings is not recommended.";"Pre-placement screening tuberculin skin tests (TSTs) should not be a universal requirement of employees and volunteers in settings where healthcare services are not delivered. Workplace tuberculosis screening policies should only be implemented based on the findings of an organization-specific tuberculosis risk assessment. If implemented, workplace tuberculosis screening should avoid universal TST/IGRA (interferon-? release assays) testing by screening for individual tuberculosis risk factors first. Screening tuberculin skin tests should not be used on patients suspected of having active disease as they are unhelpful and unnecessarily delay diagnosis.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5980;35;"Evidencias COVID-19";CEBM;English;"4-aminoquinolines chloroquine and hydroxychloroquine should not be used in the treatment of COVID-19";"Data suggest that the harms from using the 4-aminoquinolines, chloroquine and hydroxychloroquine, to treat established covid-19 outweigh their benefits and that there is no benefit in post-exposure prophylaxis";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5725;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is recommended to use a checklist of the entire surgical procedure which explicitly includes the patient's COVID-19 situation";"It is suggested to designate an operating room and all its equipment (respirator, etc.) exclusively for COVID-19 patients, which will be used for this use throughout the epidemic. Ideally it should be independent or away from other operating rooms. An adequate transfer circuit for these patients must be planned from the corresponding isolation area (in ICU, plant, etc.) to the designated surgical area. Important considerations to keep in mind during the course of surgery. ? Limit the number of professionals in the operating room and their movements as much as possible to reduce the risk of contamination. ? Limit to the maximum the number of people who carry out maneuvers that carry the risk of generating aerosols. ? Use as much disposable material as possible. ? Keep the doors of the operating room closed, except for the circulation of personnel, patients and instruments. When absolutely necessary to do so, keep them open as little as possible.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5981;35;"Evidencias COVID-19";"Cochrane - Revisi�n sistem�tica";Spanish;"Quarantine is an effective measure to prevent COVID-19 infections ";"Quarantine of people exposed to confirmed or suspected cases prevented between 44% and 81% of incident cases and between 31% and 63% of deaths, compared to no measure, according to different scenarios (incident cases: four modeling studies on COVID-19, SARS; mortality: two modeling studies on COVID-19, SARS, low-certainty evidence) ";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6493;35;"Evidencias COVID-19";"Cochrane Library";Spanish;"There is no strong evidence for point-of-care rapid antigen and molecular testing for the diagnosis of SARS?CoV?2 infection";"The findings currently have limited applicability, as there is no certainty that testing is done in the same way in clinical practice, either based on COVID?19 symptoms, duration of symptoms, or in asymptomatic people. Rapid tests allow for earlier detection of those who test positive. However, the current evidence is not strong enough to determine its usefulness in clinical practice.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5726;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is recommended to use the guidelines of the Group ""Surgery-Spanish Association of Surgeons-COVID19"" which are divided into five phases according to the evolution of the COVID-19 pandemic for the management of oncological pathology cases.";"In response to the rapid evolution that hospitals face in relation to the COVID-19 pandemic, and to the doubts that arise about the performance in oncological patients who need surgery, the Spanish Association of Surgeons (AEC) wants to respond to the questions that arise in this situation. For decision-making, a scale has been developed (pending validation) with five phases in the evolution of the COVID pandemic 19, based on the literature5 and on the experience accumulated in our environment and after analyzing the situation at the international level. This scale is dynamic, being able to follow an ascending direction during the expansion of SARS-CoV-2 infection, and a descending one at the time that hospitals are returning to normal.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5982;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"Mesenchymal stromal cell treatment appears to improve lung function in patients with acute respiratory distress syndrome (ARDS) and may decrease the immunophysiological pathways that mediate ARDS mesenchymal stromal cells and all mild adverse events related to mesenchymal stromal cell treatment resolved spontaneously.";"No serious adverse events were reported for treatment with mesenchymal stromal cells and all minor adverse events related to mesenchymal stromal cell treatment resolved spontaneously.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5471;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Healthcare professionals should perform effective hand hygiene before direct contact with a patient including aseptic procedures, after direct contact with a patient, immediately after exposure to body fluids, after touching a patient?s surroundings, and immediately after glove removal.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines; ? A scoping review of the literature using a five-stage methodological framework including 21 papers";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5727;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n de Enfermer�a Comunitaria";Spanish;"The use of masks in the community is recommended as a complementary measure and not as a substitute for established preventive measures, for example, physical distance, respiratory label, hand hygiene and avoiding touching the face, nose, eyes and mouth.";"- The use of masks in the general population can serve as a means of controlling the source of infection by reducing the spread in the community since it reduces the excretion of respiratory drops from infected individuals who have not yet developed symptoms or who remain asymptomatic. - The use of face masks in the community could be considered, especially when going to crowded areas, closed spaces such as supermarkets, shopping centers, or when using public transport, etc. - The use of medical (surgical) masks by healthcare workers should have priority over use in the general healthy population. The proper use of masks is key to the effectiveness of the measure and can be improved through educational campaigns. - Recommendations on mask use in the community should take into account gaps in evidence, availability, and possible negative side effects.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5983;35;"Evidencias COVID-19";"Evidence Aid";English;"There is uncertainty about the accuracy of chest imaging tests for the diagnosis of COVID-19.";"In this Cochrane rapid review,They included 71 studies in confirmed cases of COVID?19 (6331 participants) and 13 studies in people with suspected COVID?19 (1948 participants). These studies evaluated chest CT-scans (78 studies), chest X?ray and chest ultrasound. The authors judged risk of bias to be high in most studies.They reported that Chest CT-scans are not capable of making a distinction between people with and without COVID-19. The accuracies of chest X?ray and ultrasound of the lungs for the diagnosis of COVID?19 are uncertain.";2020;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6495;35;"Evidencias COVID-19";"Instituto de Sa�de Baseada na Evid�ncia (ISBE)";Spanish;"There is no evidence that intensive care unit oxygen targets during mechanical ventilation improve ARDS in patients infected with SARS-CoV2.";"The objectives of this rapid review were to define target levels of oxygen therapy in ARDS patients infected with SARS-CoV-2 and requiring admission to an ICU for mechanical ventilation. The impact on mortality, the duration of assisted ventilation, the number of days of catecholamine use, the need for renal replacement therapy and quality of life were analyzed. We are uncertain whether a higher or lower oxygen target is more beneficial in patients with ARDS receiving mechanical ventilation in an intensive care unit. A single RCT with a total of 205 participants exploring this question was identified, and we rated the risk of bias as high and the certainty of the findings as very low. More well-conducted studies are needed to improve the certainty of the evidence for the findings reported here. This review should be updated when more evidence becomes available.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5472;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Hand hygiene should be performed using soap and water when hands are visibly dirty or soiled and when exposure to spore-forming pathogens are known or suspected to be present.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines; ? A scoping review of the literature using a five-stage methodological framework including 21 papers.";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5728;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cardiolog�a.";Spanish;"The guidelines prepared by the Cardiopulmonary Resuscitation Working Group (CPR) of the Spanish Society of Cardiology are recommended for cardiopulmonary resuscitation during the COVID-19 pandemic.";"Regarding care for cardiorespiratory arrest (CRP) in a highly contagious situation such as the COVID-19 pandemic, it is important to highlight: -The forecast continues to depend on the speed of action. Attention to CRP requires urgent and coordinated care in order to improve the prognosis. -The risk of contagion during CPR is extremely high, due to the risk of generating aerosols during the procedure (isolation via area, chest compressions, etc.). Viral particles can also remain suspended in the air with a half-life of one hour, with the risk of being inhaled by the care team, which usually consists of several operators working in a small space and in direct contact with the patient, even, depending on the duration of the maneuvers, relief of personnel, and finally the possibility of not being sufficiently protected given the speed of action in cases of emergency, and stress leads to relaxation and forgetfulness of preventive measures of infection. -Poor prognosis of patients with positive COVID-19. Severe patients with positive COVID-19 who undergo PCR have a very poor prognosis; in a registry in China a survival of 2.9% and only one patient with a favorable neurological prognosis at 30 days was observed. -High probability of asymptomatic carriers. A patient without a diagnosis of COVID-19 can be positive and contagious, so in CPR, all patients should be considered as COVID-19 positive.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6240;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to provide antibiotic prophylaxis to all contacts of severe invasive Group A Streptococcus infections.";"Antibiotic prophylaxis for iGAS is currently offered routinely for household and other close contacts of those infected with severe iGAS. However, it may not be necessary for all such contacts. Individuals in which prophylaxis should be considered are those who are immunocompromised or may be more susceptible to infection, particularly neonates. Prevention and monitoring measures should be discussed with all household and close contacts of confirmed iGAS cases.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5473;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Fingernails should be kept clean, short and free of artificial fingernails or jewelry for a correct hand hygiene.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines; ? A scoping review of the literature using a five-stage methodological framework including 21 papers";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5729;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is considered necessary to defer surgery and complementary treatment in COVID-19 positive patients due to the high risk of serious postoperative complications.";"Serious pulmonary complications seem especially frequent in unipulmonary ventilation, so transthoracic esophagectomy should be postponed until virus negative. Currently there is no indication to perform cancer surgery in a COVID + patient except urgent surgery, so it is only considered in the case of perforation, airway compromise, hemorrhage, or surgical complications with hemodynamic instability that cannot be controlled by others. media.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5474;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"The recommended technique for appropriate hand washing involves wetting hands, applying soap and vigorously rubbing hands together to ensure all surface areas are covered, then drying hands with a single-use towel.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines; ? A scoping review of the literature using a five-stage methodological framework including 21 papers ";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5730;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association for Endoscopic Surgery (EAES) advise extreme individual protection measures in all surgical interventions during the pandemic regardless of the patient's status.";"There is little doubt about the indication to perform a preoperative test in high-risk cases (fever> 37.5oC, cough, dyspnea, or exposure to patients with such symptoms or infected), although some centers prefer to request a RT-PCR and / or a thoracic CT scan of all patients 24 hours before elective surgery, which should be delayed if positive. In the operating room, the number of people and the circulation in it must be minimized. It is necessary to take extreme measures of protection, particularly in the gestures that generate the formation of aerosols, such as the manipulation of the airway (staying out of the operating room -except the strictly necessary and adequately protected personnel-) during the 10 minutes following intubation and extubation) or laparoscopy. Also if a bronchial blocker is used, due to the presence of an open circuit in the ventilator. Regarding the best surgical approach, laparoscopy provides advantages over respiratory function and hospital stay, so it would be the choice provided that you have the appropriate experience and that you take a series of precautions that lead to reducing the risk of personnel exposure. to pneumoperitoneum leaks during the intervention or to air drainage at the end of the intervention: ? Verify the proper functioning of the system ? Incisions adjusted to the diameter of the trocars (if available, better with a balloon) ? Aspirate the smoke using the vacuum cleaner and / or through filters ? Completely empty the pneumoperitoneum with the same precautions before make an assist incision or remove trocars.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5475;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"The recommended technique of hand rubbing involves rubbing an alcohol-based solution to all surface areas of the hands until dry.";"This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? Evidence-based clinical practice guidelines; ? A scoping review of the literature using a five-stage methodological framework including 21 papers ";2020;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5731;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"Restrict transplant activity to patients in emergency situations and of greater severity, as well as to patients with greater difficulties in transplanting, postponing the performance of activities with less priority during the COVID-19 pandemic.";"- Patients with greater difficulties to transplant: paedriatic patients, hyperimmunized kidney) - Activities with less priority: transplant of certain tissues, kidney transplant, including living donor transplant, pancreas transplant.";2020;;;"High value";"Management ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5987;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recomended to make use of early salvage radiation therapy for prostate cancer in patients not infected with COVID-19.";"In this rapid review the authors suggest that resources can be reduced for all stages of prostate cancer during the pandemic. Eearly salvage radiation therapy is preferable to adjuvant radiation therapy during the pandemic and when radiation therapy is necessary, the shortest fractionation schedule supported by evidence of efficacy and safety should be implemented.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative." 5732;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"Prioritize the donation of organs from suitable donors in brain death and controlled asystole and temporarily suspend intensive care programs aimed at donation and donation in uncontrolled asystole during COVID-19 pandemic.";"In Donation in uncontrolled asystole due to its complex logistics and safety criteria, with the impossibility of screening SARS-CoV-2 in time.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5988;35;"Evidencias COVID-19";"Evidence Aid";English;"It is not recommended Brachytherapy for prostate cancer in patients not infected with COVID-19";"In this rapid review the authors searched for systematic reviews, national guidelines and randomized trials of radiation therapy for prostate cancer . They suggest resources can be reduced for all stages of prostate cancer during the pandemic. At the time of this review, the authors suggest that brachytherapy should be avoided during the peak of the pandemic, unless it can be performed with local anesthesia.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative." 5733;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"Whenever possible, hematopoietic transplants should be deferred. Regarding donations of umbilical cord blood, it is recommended to temporarily suspend the activity, except in the case of directed donations during the COVID-19 pandemic.";"Recommendations for donors, recipients and professionals are detailed by clicking on the link";2020;;;"High value";"Management patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5478;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";Spanish;"Oral amoxicillin is an alternative to co-trimoxazole for treating children younger than five years of age with non-severe pneumonia outside hospital.";"We included 29 trials, which enrolled 14,188 children, comparing multiple antibiotics. None compared antibiotics with placebo. Assessment of quality of study revealed that 5 out of 29 studies were double?blind and allocation concealment was adequate. Another 12 studies were unblinded but had adequate allocation concealment, classifying them as good-quality studies. There was more than one study comparing co?trimoxazole with amoxicillin, oral amoxicillin with injectable penicillin/ampicillin and chloramphenicol with ampicillin/penicillin and studies were of good quality, suggesting the evidence for these comparisons was of high quality compared to other comparisons. In ambulatory settings, for treatment of World Health Organization (WHO) defined non?severe CAP, amoxicillin compared with co?trimoxazole had similar failure rates (odds ratio (OR) 1.18, 95% confidence interval (CI) 0.91 to 1.51) and cure rates (OR 1.03, 95% CI 0.56 to 1.89). Three studies involved 3952 children. In children with severe pneumonia without hypoxaemia, oral antibiotics (Amoxycillin/co?trimoxazole) compared with injectable penicillin had similar failure rates (OR 0.84, 95% CI 0.56 to 1.24), hospitalisation rates (OR 1.13, 95% CI 0.38 to 3.34) and relapse rates (OR 1.28, 95% CI 0.34 to 4.82). Six studies involved 4331 children below 18 years of age. In very severe CAP, death rates were higher in children receiving chloramphenicol compared to those receiving penicillin/ampicillin plus gentamicin (OR 1.25, 95% CI 0.76 to 2.07). One study involved 1116 children.";2020;;;"High value";"COVID 19 treatment ";"Link to the recommendation on the website of the initiative" 5734;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"It is recommended that patients with breast cancer go as little as possible to health centers without significantly reducing their therapeutic plan, and they must be adapted to the epidemiological situation and the specific possibilities of each center. It is also essential to weigh Covid-19 mortality against cancer mortality of each individual patient.";"Breast cancer in our setting is one of the most frequent cancers, but fortunately in most cases it does not occur aggressively in the short to medium term. But cancer patients, in general, are at higher risk of infection as they are immunosuppressed. From the data available to us from China, these patients have a higher risk of COVID-19 infection, regardless of the type of tumor, and they present with more severe symptoms (2). Therefore, it is important to take extreme measures to prevent infection in our cancer patients in those areas with high epidemiological risk, such as Spain today. To date there is not much literature on COVID-19 and breast cancer";2020;;;"High value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5735;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"The Spanish Association of Surgeons has developed a guide with general recommendations for action and basic organization of surgery services in areas with low involvement due to the COVID-19 pandemic. ";"For more information visit the link.";2020;;;"Not applicable";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5736;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Cirujanos";Spanish;"The Spanish Association of Surgeons has developed a guide with general recommendations for action and basic organization of surgery services in areas highly affected by the COVID-19 pandemic.";"For more information visit the link.";2020;;;"Not applicable";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5737;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Fisioterapeutas.";Spanish;"The Spanish Association of Physiotherapists in Primary Care and Community Health recommend the use of the tool for the handling / management of patients affected by COVID-19 from the point of view of Primary Care physiotherapy.";"As the COVID 19 Pandemic has progressed, it is observed that the needs of Physiotherapy increase, due to the number of cases and the complexity of the pathology in critical cases. It has been observed that the benefit of physiotherapy would be directly related to respiratory physiotherapy and functional recovery, which will play a vital role in helping in this crisis. His goal is to return these patients to their previous functional level with the ability to become independent again. This process can take weeks or months. ";2020;;;"Not applicable";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5993;6;"Less Is More Collection - JAMA Network";"Jin Qin, ScD. JAMA Intern Med. 2020;180(2):274-280.";Spanish;"It is adviced to reduce the performance of bimanual pelvic examination and Papanicolau test in 15-20 year old women. ";"This cross-sectional analysis of the National Survey of Family has been carried out to estimate prevalence of potentially unnecessary BPE and Papanicolaou (Pap) tests performed among adolescent girls and women younger than 21 years. This analysis found that more than half of BPEs and almost three-quarters of Pap tests performed among young women aged 15 to 20 years during the years 2011 through 2017 were potentially unnecessary, exposing women to preventable harms. The results suggest that compliance with the current professional guidelines regarding the appropriate use of these examinations and tests may be lacking. ";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative." 5738;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"The Spanish Neonatal Society does not recommend separating mothers with COVID-19 from their newborn, although the decision to maintain joint accommodation should be individualized, taking into account the clinical situation of the mother and child and the logistics hospitable and always maintaining contact isolation measures and drops between the two.";"There is no clear evidence of vertical transmission (before, during or after breastfeeding) of SARS-CoV-2, although all children born to a mother with COVID-19 should undergo virological tests and clinical follow-up. There is a possibility of postnatal transmission (most frequently) by respiratory and / or contact routes.";2020;;;"Low value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5739;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"Symptomatic neonates should be admitted to the Neonatal Units with strict isolation measures, taking into account that if there is the possibility of aerosol formation, the personnel must be specially protected during the COVID-19 pandemic.";"The guide provides guidance on on respiratory support and urgent transport of the newborn with suspected or confirmed COVID-19 infection";2020;;;"High value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5740;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"In asymptomatic children (both negative and positive) children of a positive COVID-19 mother, hospital discharge can be assessed after 48 hours and continue in home isolation regimen under telephone / face-to-face monitoring.";"Discharge criteria will depend on the neonatal clinic and the results of the virological tests. Both during hospitalization and after discharge, family information and support is important.";2020;;;"High value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5741;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"The Spanish Society of Pediatric Emergencies (SEUP) proposes a series of general recommendations on the organization of care in pediatric emergency services and the management of patients suspected of having SARS-CoV-2 infection.";"In this situation, the Spanish Society of Pediatric Emergencies (SEUP) proposes a series of general recommendations: 1. It is recommended to create a pre-triage system, to establish two patient flows: patients with fever and / or symptoms of respiratory infection (from now on, ?possible COVID-19 patients?) and the rest of patients. It is also recommended that pre-triage be performed in facilities located outside the hospital building. 2. It is recommended that the two patient flows do not share physical space and are attended by different healthcare teams. ?Possible COVID-19 patients? and their companions must wear a mask. If possible, ?possible COVID-19 patients?, especially those with mild severity, should be evaluated in facilities outside the hospital. 3. A single companion per child is recommended. 4. It is recommended to have two triage stations, one for each patient flow, as well as two waiting rooms. Personnel performing pre-triage or triage must be protected by mask and gloves. 5. It is recommended to have two different areas for evaluation and treatment for each flow of patients, as well as separate radiology rooms. 6. Health personnel attending to ?possible COVID-19 patients? must carry adequate PPE . It is essential to know the correct order and mode of both placement and of withdrawal of each of its components. 7. Taking into account the difficulties that exist to achieve a perfect separation of the flow of both patient flows, it is recommended that the measures of Basic protection for the evaluation of all patients. 8. Given the difficulty in establishing differentiated flows for seriously ill patients who stabilization is required, it is recommended that the health personnel attending them systematically wear PPE.";2020;;;"Not applicable";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5997;6;"Less Is More Collection - JAMA Network";"Alan Ge, MA.JAMA Intern Med. 2020;180(4):586-589.";Spanish;"It is not adviced to make use of cardiovascular dignosis tests as a screening method in asyntomatic patients.";"In this survey study data were obtained via telephone call and from the best hospitals for cardiology and heart surgery in the US. It was requested information regarding the availability of executive screening programs offered to individuals, specific tests offered, and costs. The top-rated US News & World Report cardiology programs commonly provide cardiovascular tests as part of executive screening programs that are not recommended by current guidelines for indiscriminate use among asymptomatic individuals. The premise of using these tests is that the results may help reduce mortality from cardiovascular disease through earlier disease detection or more precise risk assessment. However, no data support that premise as reflected in the guidelines of the ACC/AHA, USPSTF, and ACPM.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative." 6509;33;"Choosing Wisely � : Things we do for no reason";"PharmD, Barlow B.";English;"It is not recommmended the use of Venous Thromboembolism Chemoprophylaxis in Low-Risk Hospitalized Medical Patients.";"Venous thromboembolism is positioned as one of the main and preventable causes of morbidity and mortality in hospitalized patients. Deep vein thrombosis rapidly evolves into pulmonary embolism, which account for 5% to 10% of in-hospital deaths. Negative sequelae include prolonged admissions, increased healthcare costs, and increased risk associated with pharmacological treatment. There are different recommendations that support the use of chemoprophylaxis in high-risk hospitalized patients. However, recommendations and treatment are not patient-centered. Therefore, it is recommended to stratify the risk using the validated recommendations to identify patients with low risk, to avoid the prescription of chemoprophylaxis in patients classified in this range and to emphasize the importance of early mobilization in hospitalized patients.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5742;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"The Spanish Society for Child Psychiatry (SPI) proposes a series of recommendations for children and their families about the COVID-19 pandemic";"Given the current situation caused by the COVID-19 coronavirus pandemic, and the measures established by official agencies, it is common for children and adults around them to express uncertainty, fear and indecision in the face of a constantly changing situation. After an initial reaction of possible enthusiasm for the suspension of classes, boredom, impatience, loneliness, and the parents' difficulty in making childcare compatible with work, or in setting limits, will begin to appear. This guide tries to explain some concepts and tips are suggested.";2020;;;"Not applicable";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5743;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Pediatr�a";Spanish;"The Spanish Society of Pediatric Intensive Care (SECIP) has developed some treatment recommendations in case of respiratory infection by SARS-CoV2 in pediatric patients with high-risk chronic diseases and in hospitalized patients";"There is currently no evidence from controlled clinical trials to recommend a specific treatment for the SARS-CoV-2 coronavirus in patients with suspected or confirmed COVID-19. However, this could change rapidly due to the results of several ongoing clinical trials. The results obtained in adults in a trial with Lopinavir / ritonavir show little or no efficacy given late (12 days of evolution), so if it arises, it should only be considered early. The indication and choice of antiviral treatment will be agreed, if possible, with the Pediatric Infectology team.";2020;;;"Not applicable";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5488;34;"WHO recommendations";"Infection Prevention and Control guidance for Long-Term Care Facilities in the context of COVID-19 ";Spanish;"Ensure adequate supplies of alcohol-based handrub (ABHR) (containing at least 60% alcohol)and availability of soap and clean water. ";"Increase emphasis on hand hygiene and respiratory: Ensure adequate supplies of alcohol-based handrub (ABHR) (containing at least 60% alcohol)and availability of soap and clean water. Place them at all entrances, exits and points of care";2020;;;"High value";preventive;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5744;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cardiolog�a.";Spanish;"The Spanish Society of Cardiology recommends prescribing Low Molecular Weight Heparin as prophylaxis to all patients with COVID-19 requiring hospital admission, with weight-adjusted doses for patients with a body mass index >35 and after assessing the bleeding risk and the baseline platelet count.";"Likewise, the patient's thromboembolic risk and the severity of the disease due to COVID-19 should be evaluated, with which an intermediate / extended or therapeutic LMWH dose will be prescribed; however, there is no evidence in this regard, since the series reporting a reduction in mortality with LMWH used intermediate doses. It is also proposed to monitor proinflammatory and hemostatic parameters every 24-48 h (depending on the clinical severity of the patient), according to which the patient's risk will be re-evaluated and, consequently, the LMWH dose. When patients are in a stable situation that allows them to be discharged from the hospital, they will often also undergo an important phase of convalescence at home, which can increase thromboembolic events and the mortality that this immobilization entails, which is why it is considered prudent to prolong their use. of LMWH in prophylactic doses for 7-10 days after discharge. If the diagnosis of VTE is established, LMWH should be administered at therapeutic doses; A determination of anti-Xa 48 h after the start of anticoagulation could be interesting, to ensure efficacy and minimize bleeding risk.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6000;35;"Evidencias COVID-19";"Evindece Aid";English;"It is encouraged to use information leaflets to reduce antibiotic prescriptions to patients consulting for common infections.";"In this systematic review, the authors searched for randomized trials and non-randomized studies of the effects of patient information leaflets on antibiotic use and reconsultation rates in general practice for common infections. The study concluded that the use of information leaflets in general practice consultations reduces antibiotic prescription by general practitioners, actual antibiotic use by patients, and patients? intention to reconsult for future similar episodes of illness, although actual reconsultation rates remain uncertain. ";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative" 4977;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lusutrombopag is recommended, within its marketing authorisation, as an option for treating severe thrombocytopenia (that is, a platelet count of below 50,000 platelets per microlitre of blood) in adults with chronic liver disease having planned invasive procedures.";"People with chronic liver disease often have low blood platelet levels. This means that they are more likely to bleed during invasive medical procedures, including surgery. Currently, they have a platelet transfusion before invasive procedures to help reduce their chances of bleeding. Avatrombopag and lusutrombopag are oral therapies that raise platelet levels, the aim being to reduce (but not eliminate) the chances of a patient needing a platelet transfusion. Platelet transfusions rely on donors and are given intravenously, so the possibility of replacing them with an oral treatment is an improvement. The drugs have several other benefits, including: the convenience of fewer transfusions fewer hospital stays a decreased chance of having transfusion-related complications. In addition, platelets are a limited resource and can only be stored for a short time. This means that there can be problems getting them to people in time for their procedure, which can delay surgery. On the other hand, avatrombopag and lusutrombopag need to be taken more than a week before a procedure, so can be used only for planned procedures. Clinical trial evidence shows that fewer people need a platelet transfusion if they have avatrombopag or lusutrombopag rather than a placebo treatment. But whether the drugs improve survival compared with platelet transfusions has not been measured. There is also no clinical evidence that either drug is better than the other.";2020;;;"Low value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5489;34;"WHO recommendations";"Infection Prevention and Control guidance for Long-Term Care Facilities in the context of COVID-19";Spanish;"Encourage hand washing with soap and water for a minimum of 40 seconds or with alcohol-based handrub for a minimum of 20 seconds.";"Increase emphasis on hand hygiene and respiratory";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5745;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cardiolog�a.";Spanish;"The Spanish Society of Cardiology proposes the change to parenteral anticoagulation for patients with oral anticoagulation prior to SARS-CoV-2 infection admitted due to COVID-19 infection due to the serious situation or due to drug-drug interactions to treat COVID- 19";"Patients with an indication for anticoagulation prior to SARS-CoV-2 infection usually have atrial fibrillation or VTE and are carriers of a mechanical valve prosthesis. There is no clear evidence on the maintenance of oral anticoagulation in patients admitted for SARS-CoV-2 infection, although a priori it could be maintained in patients who are stable and who do not take any drug potentially causing an interaction. Therefore, the possible interactions and the severity of the patient should be carefully evaluated to proceed, according to the different algorithms, to the change from oral anticoagulation to LMWH in anticoagulant doses to minimize thromboembolic and hemorrhagic events from incorrect bridging treatment. This change should also be made when antiviral treatment ends and it is possible to re-administer oral anticoagulation.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6257;19;"Choosing Wisely Canada";"Society of Rural Physicians of Canada";English;"It is not recommended to send a patient for a specialist visit that requires several hours of transport if the visit can be done virtually or by a local physician.";"Due to the location of many rural communities, it is very challenging for rural patients to easily access many specialist physicians who typically practice in more urban centres. Travel away from a community removes patients from their support systems, induces financial burdens and can create safety concerns for patients, especially in the winter months. Telemedicine provides a cost-effective solution to improve access to care closer to home. Thus, if the option is available, and in consultation with the patient, physicians should consider utilizing telemedicine. Another option is to have the out-of-town specialist communicate with the local physician who can provide follow up care. Local physicians should receive explicit detailed instructions as to what issues need to be addressed, and the appropriate time frame for follow-up.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4978;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patiromer is recommended as an option for treating hyperkalaemia in adults only if used: in emergency care for acute life-threatening hyperkalaemia alongside standard care or for people with persistent hyperkalaemia and stages 3b to 5 chronic kidney disease or heart failure. ";"Stop patiromer if RAAS inhibitors are no longer suitable. his recommendation is not intended to affect treatment with patiromer that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Patiromer is a treatment for people with high blood potassium levels (hyperkalaemia). It can be used for adults with chronic kidney disease or heart failure, either: in emergency care alongside standard care for acute life-threatening hyperkalaemia or for persistent hyperkalaemia if they are able to have RAAS inhibitors. Treating acute life-threatening hyperkalaemia in emergency care is established clinical practice. Other potassium-lowering treatments are rarely used in this setting because they are poorly tolerated. Patiromer could be a useful addition to emergency care. Clinical trials show that patiromer lowers serum potassium. But there is no clinical evidence that it extends life or improves quality of life. Patiromer may allow people to stay on RAAS inhibitors (drugs used to treat heart failure and kidney disease) for longer or at a higher dose. This may extend life and improve quality of life.";2020;;;"Low value";"Blood conditions ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5490;34;"WHO recommendations";"Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspe";Spanish;"Health Community Workers should apply WHO?s My 5 Moments for Hand Hygiene approach before touching a patient, before any clean or aseptic procedure is performed, after exposure to body fluid, after touching a patient, and after touching a patient?s surroundings.";"This is the first edition of guidance on infection prevention and control (IPC) strategies for use when infection with a novel coronavirus (2019-nCoV) is suspected. It has been adapted from WHO?s Infection prevention and control during health care for probable or confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, based on current knowledge of the situation in China and other countries where cases were identified and experiences with severe acute respiratory syndrome (SARS)-CoV and MERS-CoV.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5746;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cardiolog�a.";Spanish;"The antiplatelet treatment for the non-COVID-19 infected patient should not be modified.";"The indications are the same as before the pandemic, although what changes is the way we are connected to our patients and that the indications and modifications of the treatment they require can be made less in person. A distinction must be made between new indications for antiplatelet therapy and extensions of treatment. The current pandemic has led to the cancellation of most elective procedures and to the recommendation of conservative treatment for chronic patients.";2020;;;"Low value";"Pacients management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6258;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to order routinely a plain film x-ray in the evaluation of pediatric nasal fractures.";"Nasal fractures are one of the most common facial fractures in the pediatric population. The decision to perform a closed reduction procedure in the operating room is based on factors such as breathing difficulty and external deformity, which are not assessed effectively by x-ray. Plain film x-rays are unable to accurately evaluate nasal fractures given its low sensitivity and specificity, at 72% and 73% respectively. Physical examination is often sufficient to make a diagnosis for children with displaced nasal fractures. Overall, x-rays do not add value to the diagnosis or treatment plan for children with nasal fractures and should not be ordered to avoid their associated costs and radiation exposure.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4979;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is currently insufficient evidence to recommend the routine adoption in the NHS of the SepsiTest assay for rapidly identifying bloodstream bacteria and fungi. ";" The test shows promise and further research to provide robust evidence is encouraged, particularly to demonstrate the value of using the test results in clinical decision?making";2020;;;"Low value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5491;34;"WHO recommendations";"Recomendaciones a los Estados Miembros para mejorar las pr�cticas de higiene de manos ";Spanish;"Healthcare professionals should practice hand hygiene measures using the proper technique and following the instructions known as ""My 5 moments for hand hygiene.""";"Healthcare professionals should practice hand hygiene measures using the appropriate technique 7 and following specific instructions such as ""My 5 moments for hand hygiene"". In particular, they should be done before putting on PPE and after taking it off, when changing gloves, after any contact with a suspected or confirmed case of COVID-19, with its waste or with its immediate environment, as well as after contact with respiratory secretions, before preparing food or eating, and after going to the bathroom.";2020;;;"High value";Preventiva;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6259;19;"Choosing Wisely Canada";"Society of Rural Physicians of Canada";English;"It is not recommended to send a low risk patient to a distant centre for a screening test (i.e. mammography) if the risk of injury from transportation to the centre is higher than the benefit of the test and if there are other screening options available in the local community (i.e. mobile mammography, mobile ophthalmology, fecal immunochemical test).";"In 2018, for every billion kilometers travelled by a motor vehicle in Canada there were 4.9 fatalities and 390 total injuries (including 24.2 serious injuries). The risk of travel in rural communities is greater than urban areas. Despite rural areas accounting for only 18% of the population, 54% of fatal motor vehicle collisions in Canada occur on rural roads. The danger of rural roads has been attributed to multiple factors including greater distances to medical facilities, inclement weather, higher speed limits, animal crossings, poor lighting, and poor maintenance. Screening is important for disease prevention. It is important to weigh the risk of transportation with the benefit of the test, patient specific risk factors and patient preferences. Arranging screening tests when the patient is already visiting the centre for another reason is efficient.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5492;35;"Evidencias COVID-19";"JBI COVID - 19 Special Collection";English;"Interventions used to improve compliance to hand hygiene should be multi-faceted.";"(Grade A) Strategies to improve compliance to hand hygiene (e.g. the introduction of, and accessibility to, alcohol-based hand rub; education; psychological theory; and quality improvement strategies) should be implemented; however, evidence is insufficient at this time to recommend which intervention, and what delivery method, is most effective. ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative" 6004;35;"Evidencias COVID-19";"Evidence aid";English;"It is advised the use of mobile technologies to support communication between healthcare providers and management of care";"""En esta revisi�n Cochrane, los autores buscaron ensayos aleatorios de tecnolog�as m�viles para apoyar la comunicaci�n y las consultas entre los proveedores de atenci�n m�dica. Las intervenciones que incluyen un componente de tecnolog�a m�vil para ayudar a los proveedores de atenci�n m�dica a comunicarse y administrar la atenci�n pueden reducir el tiempo entre la presentaci�n y el manejo de la condici�n de la persona cuando los proveedores de atenci�n primaria o los m�dicos de emergencia los utilizan para consultar con especialistas. Estas intervenciones pueden aumentar la probabilidad de que los participantes con diabetes y los que necesitan una ecograf�a reciban un examen cl�nico. Estas intervenciones pueden reducir el n�mero de personas que asisten a la atenci�n primaria y que son derivadas a la atenci�n secundaria o terciaria en algunas afecciones, como algunos problemas de la piel y la enfermedad renal cr�nica. Hay poca evidencia de los efectos de estas intervenciones sobre el estado de salud y el bienestar, la satisfacci�n o los costos de los participantes.""";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5493;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"The current evidence for the effectiveness and safety of antiviral therapies for coronavirus is inconclusive and suffers from a lack of well-designed prospective trials or observational studies, preventing any treatment recommendations from being made. ";"The results of the included studies proved inconclusive on the effectiveness of antiviral drugs in treating coronavirus infections and prevent any particular treatments from being recommended for use. The existing body of evidence is weighted heavily towards studies of ribavirin which has shown no particular efficacy in treating coronavirus and may, in fact, cause harmful adverse effects particularly the possible development of anemia and altered liver function.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6005;35;"Evidencias COVID-19";evidenceaid;English;"It is uncertain the use of antimicrobial mouthwashes and nasal sprays in COVID-19 patients. ";"In this Cochrane rapid review, the authors searched for studies of use of antimicrobial mouthwash or nasal spray by patients with confirmed or suspected COVID-19 infection. They did not restrict their searches by date, language or status of publication. They did the search on 1 June 2020 but did not find any completed studies. They identified 16 ongoing studies (including 14 randomized trials). The results show that the effects of antimicrobial mouthwashes and nasal sprays on patient outcomes and transmission of COVID-19 to healthcare workers are uncertain.";2020;;;Uncertain;Treatments.;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6261;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to order imaging to distinguish acute bacterial sinusitis from an upper respiratory infection.";"Acute bacterial sinusitis (ABS) is a diagnosis that is made based on clinical criteria and has a low prevalence amongst children presenting with respiratory symptoms. Although a normal radiograph, CT, or MRI can help to rule out ABS, an abnormal result does not confirm the diagnosis. Given that many children will have abnormal imaging due to a viral upper respiratory infection during certain times of the year, combined with the potential for exposure to radiation, routine imaging is not recommended. Instances in which imaging would be warranted include if the child is immunocompromised, or if orbital, central nervous system, or other suppurative complications are present. The American Academy of Pediatrics recommends diagnosing pediatric ABS when (1) cough, nasal discharge or both are persistent for >10 days without improvement; (2) there is worsening or new onset of cough, nasal discharge, or fever; or (3) there is a severe onset, with a fever greater ?39?, concurrently with purulent nasal discharge for at least 3 consecutive days.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6006;35;"Evidencias COVID-19";Evidenceaid;English;"There is uncertainty about the possible benefits and harms of using prophylactic antocoagulants for pacients hospitalized with COVID-19.";"This systematic Cochrane revision has been focused on collecting studies that analyse the usage of prophylactic anticoagulants in patients hospitalized with COVID-19 regardless of the date, type and language of publication. They included 7 non-randomized, retrospective studies (5929 participants), and 22 ongoing studies (including 20 randomized trials)";2020;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6262;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to transfer a palliative patient to a facility far from their friends and family without considering if their goals of care can be achieved locally.";"Advanced care planning is an important part of primary care to establish individual patient?s goals of care. This is especially true for rural patients who may need to be transferred to an alternate community for care. Studies have shown that rural patients prefer to die in their home communities. It is important to consider the patient?s goals when contemplating sending them away from the community for medical treatment at the end of life. If the patient is transferred to an alternate community, ensure an updated, written advanced directive accompanies them to the receiving community.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5495;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Several in vitro studies report antiviral activity of chloroquine and hydroxychloroquine against SARS-CoV-2. At present, there is insufficient in Vivo evidence to recommend their use for the current pandemic outside of clinical trials. Further, high-quality studies are urgently needed to provide guidance to clinicians and policy-markers.";"In vivo data, although promising, is currently limited to one study with considerable limitations. On the basis of the weak evidence available to date, treatment guidelines have already incorporated the usage of chloroquine/hydroxychloroquine for certain patients with COVID-19. Further research should address the optimal dose and duration of treatment, and explore side effects and long-term outcomes. There is a higher risk of side effects in the presence of renal and liver impairment, and there have been isolated reports of COVID-19 disease-causing renal and hepatic injury.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6007;35;"Evidencias COVID-19";"evidence aid";Spanish;"There is uncertainty about the antimicrobial mouthwashes and nasal sprays use by healthcare workers";"Uncertain effects on COVID-19 infection of healthcare workers using antimicrobial mouthwashes and nasal sprays when treating patients with suspected or confirmed COVID-19 infection ";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6263;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to place tympanostomy tubes in most children for a single episode of uncomplicated otitis media with effusion of less than 3 months? duration.";"Although tympanostomy tube insertion can be associated with short-term quality of life improvements, the natural history of otitis media with effusion (OME) is sufficiently favorable and most OME in children will spontaneously resolve within 3 months. Cases of OME which last longer than 3 months are typically chronic in nature, and less likely to resolve without intervention. Limited data exists regarding the efficacy of tympanostomy tube insertion in children with OME for less than 3 months. By delaying the consideration for tympanostomy tube insertion, potentially unnecessary procedures are avoided, along with the associated risks, tube related side effects, and costs. Children excluded from this recommendation include those who have risk factors for developmental difficulties such as trisomy 21, Autism-spectrum disorder, blindness, and permanent hearing loss independent of OME.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5496;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Effectiveness of quarantine during a viral outbreak relies on the timing and accuracy of the quarantine period, as well as the ability of individuals and health care providers to follow quarantine procedures. ";"Current evidence to inform quarantine is limited, and COVID-19 infection trends raise critical questions about implementation effectiveness. Recent modelling by Imperial College factored in household quarantine as a key intervention to mitigate against increased infection. Researchers defined a home-based quarantine in response to following identification of a symptomatic case in the household, where all household members remain at home for 14 days. Their assumption suggested household contact rates would double during the quarantine period, but contacts in the community would reduce by 75%, if 50% of each household comply with the policy. As countries respond to COVID-19, it is vital we conduct research in this current outbreak to address some of the unanswered questions on quarantine effectiveness, including: timing, implementation procedures, appropriateness, and cost-benefits. Viruses don?t travel, people do. So intuitively, we expect that imposing physical space barriers will work to eradicate infection. However, the effectiveness of quarantine during a viral outbreak relies on the timing and accuracy of the quarantine period, as well as the ability of individuals and health care providers to follow quarantine procedures. ";2020;;;"High value";"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6008;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen, I. BMJ";Spanish;"Delay in treatment of glaucoma patients is not recommended";"Eye services don�t have the capacity to meet demand for glaucoma services. It is said that capacity could be freed up by introducing mechanisms to ensure appropriate referral to and follow-up by hospital eye services, as well as through new ways of working to free up consultants? time, such as redesigning pathways so that other members of the multidisciplinary team could take on some tasks and by using virtual appointments.";2020;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6264;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"Is it not recommended to call in staff for an investigation (i.e. blood test, imaging, operative procedures, etc.) at off-service hours unless it is likely to change management.";"Health personnel are valuable resources in rural communities. It is important that provider well-being is balanced with optimal patient care, especially where human resources are limited.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6520;23;"Cochrane Quality and Productivity topics";"INSTITUTO DE SA�DE BASEADA NA EVID�NCIA";Spanish;"It is not recommended to repeat the PCR in those infected with SARS-CoV-2 after 14 days of isolation.";"This study, lacking scientific evidence, shows that positive tests for SARS-CoV-2 by RT-PCR and viral genome sequencing after 14 days of isolation may not mean persistent infectiousness. Many times, when repeating these tests, they can be positive for four different reasons: relapse of the initial infection, reinfection by SARS-CoV-2, laboratory error and viral fragments of the infected cells (excretion of virus). The combination of a robust serologic response with viral particles suggests very low (or no) infectivity, especially via the respiratory tract.";2020;;;Uncertain;-;"Link to the recommendation on the website of the initiative" 5497;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Current guidance on personal protective equipment (PPE) in the context of COVID-19 does not specifically mention shoe covers.";"The inclusion of protective shoe covers or footwear as a component of PPE for prevention of acquisition and dissemination of pathogenic microbial agents by healthcare staff derives from documentation of extensive floor contamination with bacterial pathogens. The effectiveness of shoe coverings in diminishing bacterial pathogen acquisition in ICUs has not been clearly demonstrated.[1-3]. COVID-19 is spread by four means: contact (direct or via a fomite); droplet infection (droplets from the respiratory tract of an infected individual during coughing or sneezing are transmitted onto a mucosal surface or conjunctiva of a susceptible individual or environmental surfaces); via aerosols (particularly during procedures such as intubation); and faeco-oral [6]. In one recent laboratory study, SARS-CoV-2 survived longer than other respiratory viruses when artificially aerosolised.[7] This review found no relevant trials. In a single observational study, a single positive swab for SARS-CoV-2 was obtained from the shoe of a healthcare worker. General occupational health guidance recommends shoe covers when there is a risk of splashing from infected body fluids.Further research is needed on whether shoe covers should be added to PPE. ";2020;;;Uncertain;"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6009;35;"Evidencias COVID-19";Evidenceaid;English;"There is uncertainty about the real efficacy of travel-related control measures to contain the pandemic of COVID-19";"A systematic Cochrane review has been done in order to check the efficacy of travel-related measures to contain de pandemic of COVID-19. The studies analysed included 40 publications on 36 studies related to COVID-19 (17 modelling studies, 7 observational screening studies and 1 observational ecological study), SARS (4 modelling studies and 6 observational studies) and SARS and MERS (1 modelling study). They rated the certainty of the evidence for most travel?related control measures as very low.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5498;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is yet no trial evidence of efficacy to use angiotensin-converting enzyme inhibitors, and angiotensin receptor antagonists, for preventing and treating the effects of the coronavirus SARS-CoV-2";"We do not know whether the supposed benefits of ACE-1 inhibitors or ARBs during an episode of infection with SARS-CoV-2 outweigh the potential harms. It is generally unwise to institute any pharmacological therapy on the basis of an untested mechanistic hypothesis, since unexpected harms may outweigh hoped-for benefits. Until evidence emerges, based on randomized trials or at least data-mining of patients? records, we suggest that it would be unwise to use either conventional ACE-1 inhibitors or ARBs to treat COVID-19. The most difficult decisions need to be taken in patients with severe hypertension or chronic heart failure, who may deteriorate rapidly if drugs acting on the renin?angiotensin system are withdrawn. ";2020;;;"Low value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6010;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ";English;"It is recomended a CT screening for lung cancer in former or current smokers.";"The NELSON study included 13195 men and 2594 women aged 50-74 from the Netherlands and Belgium. Trial participants were randomly assigned to four rounds of low dose CT screening at baseline and at one, three, and 5.5 years or to a control group with no screening. Results showed that deaths from lung cancer were 24% lower after 10 years of follow-up in men undergoing regular CT screening than in those not screened. Women taking part in the trial showed a 33% reduction in lung cancer deaths at 10 years with CT screening, although this was based on a relatively small subgroup analysis.";2020;;;"High value";Diagnosis.;"Link to the recommendation on the website of the initiative." 6266;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to prescribe intranasal/systemic steroids, antihistamines or decongestants for children with uncomplicated otitis media with effusion.";"In most cases, medical treatment using antihistamines, decongestants, systemic antibiotics and steroids have shown little to no effect on the long-term outcomes of uncomplicated otitis media with effusion (OME) in children. Because of this, and the costs and potential side effects, it is not recommended to prescribe these medical treatments for children with uncomplicated OME. The exception to this would be for children with coexisting conditions in which these medications are indicated for primary management.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5499;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is no evidence that any smartphone technology is accurate for the measurement of blood oxygen saturation.";"The COVID crisis is requiring us to manage patients with as little in-person contact as possible. The assessment of a patient with respiratory problems usually includes measurement of blood oxygen saturation (abbreviated SpO2), using a validated pulse oximeter. This is particularly important in unwell patients with COVID-19, since hypoxia is a serious warning sign for severe pneumonia.1 Whilst in-person assessment would use a standard pulse oximeter on the patient?s finger, few patients have such a technology in their homes. Various technology companies have developed smartphone apps that are marketed as accurate for measuring oxygen saturation. To summarise, the results cannot be trusted because: (a) the training dataset does not appear to have included the full range of skin types (from Fitzpatrick skin type 1 to 6); (b) the training dataset covered a very limited range of oxygen saturation values, mostly in the normal range from 95% to 100%, whereas pulse oximeters should cover the range from 70% to 100%; (c) there is no independent dataset on which the app has been tested. It is not physically possible to measure SpO2 using current smartphone technology. The two published studies which assessed smartphone oximeter apps (Digidoc and Samsung) raise serious questions about the diagnostic accuracy. The Samsung app has been withdrawn, and the claim that oxygen saturation can be measured indirectly through ?stress assessment? is false. ";2020;;;"Low value";"diagnosis Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6267;19;"Choosing Wisely Canada";"Public Health Physicians of Canada";English;"It is not recommended to transfer a patient by ambulance with skilled personnel if the patient is unlikely to require medical intervention en route.";"Health personnel are valuable resources in rural communities. Sending a nurse or physician en route to an urban centre can leave a rural hospital without medical support for significant periods of time. Consider the evidence when deciding whether a patient needs to be accompanied during transport. Consider calling the receiving hospital to mutually agree on the need for skilled personnel during urgent or emergent transport. ";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5500;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Effectiveness of infection control measures is dependent upon a number of factors and a combination of strategies with the most significant being: Hand hygiene, Environmental decontamination, Staff rotation, Visitors, Testing.";"The authors identified the following factors that contributed to the outbreak: ? staff continuing to work while symptomatic; ? staff members working in more than one facility; ? inadequate adherence to standard droplet and contact precautions, and eye protection recommendations; ? poor infection control practices due, in part, to inadequate supplies of personal protective equipment and hand sanitizer; ? delayed recognition of cases, limited testing availability, and difficulty identifying COVID-19 cases based on signs and symptoms alone. These factors, although from a single site, closely match the findings of the available literature";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6012;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mahase E. BMJ";English;"It is recommended to avoid systems of manual labeling in samples of HPV screening.";"General practice staff have been forced to waste hours of clinical time by handwriting labels for HPV cervical screening tests because a new IT system was implemented without the ability to print sticky labels. Since the changes came into effect on 2 December 2019 the service has processed over 100?000 cervical screening tests, potentially equating to thousands of unnecessary hours spent writing out labels that were previously automatically printed. Besides, the possibility human error has been introduced to the system.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5501;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Based on the best available evidence, a restricted strategy may be suitable for diagnosing pneumonia in the community.";"Recommended approach in emergency situation . Such a strategy may be particularly suitable during the current Covid-19 pandemic ? Key equipment includes pulse oximeter,* a thermometer, and stethoscope (along with immediate therapy pack of amoxicillin, doxycycline and clarithromycin).** ? Auscultation not essential if overall clinical judgement (?gestalt? ? gut feeling) of CAP (partly based on temperature >=38, respiratory rate > 20, and heart rate >100 and new confusion) is already met ? Red Flag: Auscultation should be reserved for those where it is crucial to decision making.*** ? Assessing blood pressure significantly increases contact time and should be considered only in those in whom it contributes to essential decision making to admit or not. ? We recommend documenting that on examination a ?limited examination? was performed (abbreviated to O/E LE). *pulse oximeter provides a simple way to measure heart rate and can aid the assessment of the deteriorating patient. Hypoxemia may influence the prognosis of patients with CAP independently of severity scores. **Check NICE guidance for all prescribing recommendations. ";2020;;;"High value";"diagnosis Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6269;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to prescribe oral antibiotics for children with uncomplicated tympanostomy tube otorrhea or uncomplicated acute otitis externa.";"The use of oral antibiotics where they are not necessary can promote antibiotic resistance and increase the risk of opportunistic infections. Topical antibiotics achieve higher concentrations in the ear canal, demonstrate improved patient satisfaction, are associated with fewer adverse events, and are shown to have equal efficacy for treatment of acute tympanostomy tube otorrhea (TTO) and acute otitis externa (AOE) when compared to oral antibiotics. For these reasons, topical antibiotics rather than oral antibiotics should be prescribed as first line treatment for acute uncomplicated TTO and uncomplicated AOE.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6014;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ";Spanish;"It is not advised to do a Dementia screening in patients over 65 years old.";"A systematic review, looked at 287 studies involving more than 280?000 older adults. It found that, while screening tools could adequately detect cognitive impairment, ?there is no empirical evidence... that screening for cognitive impairment improves patient or caregiver outcomes or causes harm.?. In terms of treatment,?It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.?. The findings back those of a review commissioned by the UK National Screening Committee that concluded that no screening tests could accurately identify people in the general population with dementia who did not already have symptoms and that there were no treatments to offer screened populations.";2020;;;"Low value";Diagnosis.;"Link to the website of the initiative." 6270;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to prescribe codeine for post-tonsillectomy/adenoidectomy pain relief in children";"Codeine has been associated with a high rate of adverse drug reactions in children. This includes life-threatening respiratory depression. Appropriate dosing of codeine is challenging due to the genetic heterogeneity amongst patients for the CYP2D6 enzyme, which is responsible for codeine metabolism. Genetic screening of CYP2D6 is not routinely performed and can not reliably identify variations in codeine metabolism rates amongst patients. As such, children who are ultra-fast metabolizers of codeine are placed at increased risk of severe adverse drug reactions. Alternative analgesia should be used post-tonsillectomy/adenoidectomy.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5503;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"There is no direct evidence from randomised trials that eye protection equipment alone prevents transmission of COVID-19";"Indirect evidence suggests that healthcare workers? conjunctivae could be exposed to infective droplets and aerosols from patients during close contact. It is important to assess contagion risk of every encounter and take appropriate precautions Where close contact is required, guidance for full personal protective equipment should be followed. Policy guidance from various bodies (e.g. Public Health England, World Health Organization (WHO)) emphasizes the need to assess the contagion risk of an encounter and use the recommended combination of equipment for that situation. In particular, suitable personal protective equipment (PPE), which typically includes respirator masks, goggles or visor, long-sleeved gown, waterproof aprons have been recommended to protect against small airborne particles in aerosol-generating procedures (AGPs) such as intubation. For non-AGPs, there is no evidence from randomised trials that eye protective equipment provides additional protection. However, evidence emerging in an ongoing review by our group indicates that with close contact, mucous membranes may be explosed to droplets even in the absence of formally classified AGPs. ";2020;;;Uncertain;"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4992;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Olaparib is recommended as an option for the maintenance treatment of relapsed, platinum-sensitive, high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer in adults whose disease has responded to platinum-based chemotherapy.";"Clinical trials show that olaparib extends the time until the cancer progresses compared with routine surveillance, regardless of whether the person has a BRCA mutation. But the company has offered a commercial arrangement that applies to olaparib tablets when used for people with a BRCA mutation who have had 2 or more courses of platinum-based chemotherapy. This means that olaparib is cost effective only when used for the subgroup of people with a BRCA mutation. For people with a BRCA mutation who have had 3 or more courses of platinum-based chemotherapy, olaparib meets NICE's end-of-life criteria. It is cost effective for this group of people and is therefore recommended for routine use in the NHS. For people with a BRCA mutation who have had 2 courses of platinum-based chemotherapy, olaparib does not meet NICE's end-of-life criteria. The cost-effectiveness estimates are uncertain because overall survival data from the most relevant clinical trial are not yet available. Olaparib has the potential to be cost effective if further data confirm the overall survival benefit estimated using the company's alternative model. Olaparib is therefore recommended for use within the Cancer Drugs Fund, for people with a BRCA mutation who have had 2 courses of platinum-based chemotherapy, while more data are collected.";2020;;;"High value";"Ovarian cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5504;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"High quality evidence supports treating residents with antiviral chemoprophylaxis with adamantine, as well as adamantine in combination with personal protective equipment. ";"En general, los resultados de las revisiones sistem�ticas incluidas sugieren que la evidencia de alta calidad respalda el tratamiento en las casas de residencias con quimioprofilaxis antiviral con adamantina, as� como con adamantina en combinaci�n con equipo de protecci�n personal. Para el resto de las estrategias, no hubo evidencia de efectividad o evidencia mixta de efectividad.The results suggest that high quality evidence supports treating residents with antiviral chemoprophylaxis with adamantine, as well as adamantine in combination with personal protective equipment (PPE) There was either no evidence of effectiveness (e.g., social isolation) or mixed evidence of effectiveness (e.g., rimantadine, zanamivir, hand hygiene, personal protective equipment) for other strategies examined in the included reviews However, the mixed evidence on hand hygiene and use of PPE does not imply they should not be employed during an outbreak.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5505;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"The recommendations from current guidelines overall seem to support environmental measures for infection prevention and antiviral chemoprophylaxis for infection management as the most appropriate first-line response to viral respiratory illness in long-term care.";"The most commonly recommended prevention strategies across the clinical practice guidelines were hand hygiene, wearing personal protective equipment, social distancing/isolation, disinfecting surfaces, droplet precautions, surveillance and evaluation, conducting diagnostic testing to confirm suspected respiratory illness, policies and procedures for visitors, policies, and procedures for staff, and respiratory hygiene/cough etiquette For managing respiratory illness in long-term care facilities, the majority of the clinical practice guidelines recommended antivirals for prophylaxis of staff and/or residents Most of the clinical practice guidelines failed to address multiple AGREE-II items, suggesting that they are most likely based on expert opinion.";2020;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6273;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery, Pediatric Otolaryngology Subspecialty Intere";English;"It is not recommended to administer perioperative antibiotics for elective tonsillectomy in children";"Administration of perioperative antibiotics for children undergoing tonsillectomy shows no significant benefits in regard to common post-tonsillectomy morbidities. Overuse of systemic antibiotics increases bacterial resistance and the risk of adverse drug events unnecessarily. These concerns outweigh the reduction in postoperative fever which is the only potential benefit of perioperative antibiotic administration for elective tonsillectomy. Therefore, perioperative antibiotics are not indicated for children undergoing elective tonsillectomy, unless specific indications are present (e.g., cardiac conditions or those with a peritonsillar abscess or acute infection).";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5506;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Exposure simulation studies suggest that the risk of exposure in healthcare workers is greater with aprons than with gowns but do not provide sufficient data to quantify those risks in the context of primary or community care activity.";"This review found no relevant trials comparing the effectiveness of gowns against aprons. The WHO recommends long-sleeved non-sterile gowns and gloves for both aerosol-generating procedures (AGPs) and non-AGPs. The US CDC has suggested using aprons over gowns as an additional measure to provide protection from contamination of garments during aerosol generating procedures. Properly used protective clothing is only one component of a package of personal protective measures (which also includes gloves, mask, eye protection and hand washing / disinfection).";2020;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6018;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mahase E. BMJ";English;"It is recomended asymptomatic screening in high risk settings, such as universities.";"Compared with other members of the population, young adults have a higher chance of asymptomatic infection. Public health experts have therefore called for asymptomatic screening in high risk settings, such as universities. University of Cambridge said that all students living in college accommodation would be eligible to take part in the sreening, which has a capacity of 2000 tests a week and can test around 16?000 students using the pooling method. However, there are downsides to pooling. The US Food and Drug Administration says that, because the samples are diluted, pooling can ?result in less viral genetic material available to detect? and a greater likelihood of false negative results. Allyson Pollock said that ""we should be carefully evaluated so that we know what the costs, harms, and benefits are, because screening like this will be extremely costly"".";2020;;;Uncertain;Management.;"Link to the recomendation on the website of the initiative." 6019;35;"Evidencias COVID-19";"Evidence Aid";Spanish;" It is not recommended universal screening for SARS ? CoV ? 2 due to its low accuracy.";"Universal screening, such as asking people about symptoms, taking their temperature or doing a quick saliva test, has been suggested as a way to detect people who are infected with SARS-CoV-2, which is the virus that causes COVID-19. In this Cochrane rapid review, the authors searched for research into the effects of universal screening for SARS-CoV-2 in various community settings. They included 17 cohort studies and 3 modelling studies that reported on screening test accuracy and 2 modelling studies of the effectiveness of universal screening. They included 17 cohort studies and 3 modelling studies that reported on screening test accuracy and 2 modelling studies of the effectiveness of universal screening.";2020;;;"Low value";Diagnostico;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6275;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery";English;"It is not recommended to perform tonsillectomy for children with uncomplicated recurrent throat infections if there have been fewer than 7 episodes in the past year, 5 episodes in each of the past 2 years, or 3 episodes in each of the last 3 years.";"For children who have a lower number of recurrent throat infections, tonsillectomy has significantly less benefits when compared to those with more frequent infections, and many children with recurrent throat infections naturally improve without intervention. Therefore, where safely possible, avoidance of tonsillectomy for children with lower numbers of acute infections is recommended. This avoids unnecessary tonsillectomy and the costs and complications associated with the procedure (i.e., bleeding, pain, infection). If tonsillectomy is not indicated, children should be closely monitored and reconsidered for tonsillectomy if the infection frequency increases, as they would be less likely to naturally improve, and more likely to benefit from tonsillectomy. Families should be counselled on the limited benefits and potential harms of performing tonsillectomy for children and adolescents with low rates of recurrent throat infections. Shared decision making is of importance when considering tonsillectomy as individual patient and family factors can impact the decision.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5252;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer preoperative radiotherapy to people with early rectal cancer (cT1-T2 cN0, M0), unless as part of a clinical trial.";"Offer preoperative radiotherapy or chemoradiotherapy to people with rectal cancer that is cT1-T2, cN1-N2, M0, or cT3-T4, any cN, M0. There was no evidence for the effectiveness of preoperative radiotherapy for people with early rectal cancer, and based on their experience the committee would not recommend preoperative radiotherapy. However, the ongoing STAR-TREC trial, which is a multicentre randomised controlled trial, compares radiotherapy to TME for early rectal cancer. Because of this, the committee recommended that preoperative radiotherapy for early rectal cancer could be offered, but only in the context of a clinical trial. For rectal cancer cT1-T2, cN1-N2, M0, or cT3-T4, any cN, M0, the evidence from several randomised controlled trials (RCTs) shows that people who have preoperative radiotherapy or chemoradiotherapy have less local recurrence and have better overall and disease-free survival compared to people who did not have preoperative therapy. Although preoperative therapy can potentially have adverse effects, from the evidence the committee did not find a difference in quality of life or treatment-related mortality between those who did or did not receive preoperative therapy.";2020;;;"Low value";"Colorectal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6020;33;"Choosing Wisely � : Things we do for no reason";"Crowe B. J Hosp Med. Published Online First September 23, 2020";English;"Do not routinely use platelet count or INR when preparing for paracentesis, whether diagnostic or therapeutic, because no evidence-based ?cutoff? for safe performance of paracentesis exists.";"Advances in our understanding of coagulation in cirrhosis demonstrate neither INR nor platelet count accurately predict bleeding risk in this population. Additionally, evidence demonstrates the overall safety of paracentesis in cirrhosis?even in the presence of high INR and thrombocytopenia?and the lack of benefit from prophylactic transfusions with FFP or platelets. Substantial evidence in patients with cirrhosis demonstrates that changes in coagulation and platelet function confer a ?balanced coagulopathy? in which patients oscillate between hyper- and hypocoagulable states. In a cirrhotic liver, hepatic synthetic dysfunction results in a complex milieu through reduced production and plasma concentrations of both pro- and anticoagulant factors that can lead to either bleeding or clotting.4 This ?rebalancing? makes prothrombin time (PT) and INR unreliable indicators of bleeding or clotting risk""";2020;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6276;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology?Head & Neck Surgery";English;"Its is not recommended to perform endoscopic sinus surgery for uncomplicated pediatric chronic rhinosinusitis prior to failure of maximal medical therapy and adenoidectomy.";"While endoscopic sinus surgery (ESS) has been found to be an effective therapy in children with chronic rhinosinusitis, comparable outcomes can be achieved with medical therapy and adenoidectomy. A stepwise approach of medical therapy, progressing to adenoidectomy, then to ESS allows children to be treated with a less invasive and more cost-effective interventions as initial therapy, while saving ESS for those who are refractory to primary interventions. Maximal medical therapy should be exhausted prior to surgical intervention for uncomplicated patients. In cases with complications such as orbital or skull base involvement, ESS can be employed more readily.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5254;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer selective internal radiation therapy (SIRT) as first-line treatment for people with colorectal liver metastases that are unsuitable for local treatment. ";"This recommends that SIRT should only be offered: - With special arrangements for clinical governance, consent, and audit or research to people who are chemotherapy intolerant or who have liver metastases that are refractory to chemotherapy - In the context of research to people who can have chemotherapy. ";2020;;;"Low value";"Colorectal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5510;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"Standard surgical masks are as effective as respirator masks (e.g. N95, FFP2, FFP3) for preventing infection of healthcare workers in outbreaks of viral respiratory illnesses such as influenza. No head to head trial of these masks in COVID-19 has yet been published, and neither type of mask prevents all infection.";"Both types of mask need to be used in combination with other PPE measures. Respirator masks are recommended for protection during aerosol generating procedures (AGPs). Trials comparing different kinds of mask have been summarised in a recent high-quality systematic review and provide cautious support for the use of standard surgical masks in non AGPs, though the empirical studies underpinning this conclusion were not in a COVID-19 population, and only one was in a community setting. It is clear from the literature that masks are only one component of a complex intervention which must also include eye protection, gowns, behavioural measures to support proper doffing and donning, and general infection control measures. Rapid reviews on wider PPE measures, and what counts as an AGP, are ongoing.";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5766;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria";Spanish;"The Federation of Associations of Community Nursing and Primary Care (FAECAP), have agreed on a document of practical recommendations for ethical and clinical decision-making in the retirement homes environment in the context of the crisis of COVID-19";"The situation derived from Pandemic-19 specifically affects retirement homes, due to the vulnerability of the global user population (geriatric, disabled or mental health), due to the limitation of resources and pressure from other areas of the system, as well as the impact on professionals - making a traditionally difficult situation worse in terms of resources. This document aims to provide some tools for ethical and clinical decision-making to professionals who, in a context of crisis, with limited internal resources and the environment, are doing everything possible to offer quality care to users.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5511;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"There is no evidence that the combination of hydroxychloroquine with azithromycin has clinical efficacy as a treatment for patients with covid-19, and an increased risk of serious cardiac arrhythmias is predictable with this combination.";"Given the adverse effect profiles of hydroxychloroquine and azithromycin, an increased risk of serious cardiac arrhythmias is predictable with this combination; it is being confirmed by more and more clinical data. A team in New York studied electrocardiographic data from a series of 84 patients who were hospitalised with covid-19 and treated with the hydroxychloroquine + azithromycin combination. During treatment, prolongation of the ECG QT interval exceeding 500 milliseconds was observed in 11% of patients, a threshold above which the risk of cardiac arrhythmia and torsade de pointes is particularly high ";2020;;;Uncertain;"Treatment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5767;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Anestesiolog�a, Reanimaci�n y Terap�utica del Dolor.";Spanish;"The Consell Catal� de Ressuscitaci� does not recommend checking breathing (not hearing or feeling), or performing mouth-to-mouth ventilation by non-medical or out-of-service personnel who witness cardiac arrest. Use an automatic defibrillator (DEA) and follow the instructions it provides.";"The use of DEA can make chest compressions unnecessary if the patient recovers immediately, but only chest compressions if necessary. Whenever possible, wear gloves and always try to protect your mouth and nose. After resuscitation, wash your hands as soon as possible according to the recommendations of the authorities, with soap and water and / or hydroalcoholic solutions.";2020;;;"Low value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6535;33;"Choosing Wisely � : Things we do for no reason";"Hoskins B., Marek S.";English;"Obtaining an Abdominal X-ray to Assess for Constipation in Children is not recommended";"Functional constipation is a common clinical problem in pediatrics and constitutes a large number of admissions into hospitals and visits to clinics and emergency departments. In the United States, up to 36% of children are affected. Associated healthcare costs for children with constipation are estimated at $5.9 billion per year, which is $3.9 billion more than the general pediatric population without constipation. In 2011, American children aged 17 years and younger had more than 270,000 visits to the emergency department for constipation. As many as 70% of children who are given a diagnosis of constipation in the emergency department have an abdominal x-ray completed. The carcinogenic effects of radiation from radiography are well known. Unnecessary imaging places the child at risk for these effects while adding to the overall cost of medical care RECOMMENDATIONS: ? Functional constipation should be diagnosed based purely on a thorough history and physical examination, including a rectal exam. ? Abdominal x-rays (ordered for any reason) should not be used to diagnose or assess for functional constipation. ";2020;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 5512;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"Data show no evidence that hydroxychloroquine has efficacy against covid-19";"The results of a new randomised comparative but non-blinded trial of high-dose hydroxychloroquine versus standard care in 150 patients hospitalised for covid-19 have been published. The only notable difference between the groups was the high incidence of adverse effects in the group treated with hydroxychloroquine. The results of other studies (non-randomised and providing only low-quality evidence) show no evidence that hydroxychloroquine has efficacy against covid-19. The hypothesis that hydroxychloroquine might be an effective treatment for covid-19 emerged because of the drug?s antiviral effect in vitro against the coronavirus Sars-CoV-2. The results of two comparative trials of hydroxychloroquine, released in late March 2020, were inconclusive. Other randomised comparative trials are underway. The results of another randomised comparative trial were released on 14 April 2020. ";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5768;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Anestesiolog�a, Reanimaci�n y Terap�utica del Dolor.";Spanish;"The Consell Catal� de Ressuscitaci� does not recommend performing balloon-mask ventilation until an Advanced Life Support unit arrives in the context of COVID-19. If the team knows prior to arrival that the patient is in cardiac arrest, a team member, if possible, should be equipped with their PPE during the journey";"Basic life support units in an out-of-hospital setting (units of the Medical Emergency System without a doctor): As in the out-of-hospital setting, it should be considered that any patient may be infected with COVID-19, when facing a patient in cardiac arrest, one of the team members with basic personal protective equipment (PPE) (glasses, mask, gloves and gown) ) initiates continuous chest compressions; while the other, also equipped with PPE, places the DEA. In children in cardiac arrest, initial ventilation is crucial: despite the risk of spreading the virus, take 5 initial balloon-mask breaths.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5513;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"No validated tests for assessing breathlessness in an acute primary care setting.";"Pending further research, the recommendations below are based on expert opinion. A rapid survey of 50 clinicians who regularly assess patients by phone (on 20.3.20) recommended not using the Roth score (though opinions were mixed) and gave the following advice: Ask the patient to describe the problem with their breathing in their own words, and assess the ease and comfort of their speech. Ask open-ended questions and listen to whether the patient can complete their sentences. Roth Score. This score has only been tested in one study against pulse oximetry in healthy volunteers and hospital inpatients. It has not been validated in primary care and we have received reports of significant events in which GPs were falsely reassured by a ?normal? Roth score. Ask the patient to take a deep breath and count out loud from 1 to 30 in their native language. Count the number of seconds before they take another breath. If the ?counting time? is 8 seconds or less, this has a sensitivity of 78% and specificity of 71% for identifying a pulse oximeter reading of <95%. If the counting time is 5 seconds or less, sensitivity is 91%. Of 50 experts, only 6 used the Roth score (most had never heard of it). Experts were concerned that if used indiscriminately and as a substitute for holistic clinical assessment in the COVID crisis, this score could lead to harm by missing patients with serious illness and increasing the number of patients called in for physical examination. Smartphone apps for oximetry: Very limited published research. This topic has been addressed in more detail in a special technical review Question: Should smartphone apps be used as oximeters? Answer: No Oximetry devices supplied to patients. Commonly used in respiratory medicine clinics but have not yet been evaluated in a primary care setting. ";2020;;;"Low value";"Diagnosis Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5769;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Anestesiolog�a, Reanimaci�n y Terap�utica del Dolor.";Spanish;"The Consell Catal� de Ressuscitaci� does not recommend starting cardiopulmonary resuscitation without adequate protection in outpatient Advanced Life Support Units (Medicalized Units). With the complete PPE, the team member responsible for the airway will place a supraglottic device (DSG) with a filter directly between it and the resuscitation balloon.";"In the pandemic environment, it is probable that each patient is a COVID-19 case, before a cardiac arrest patient, one of the team members with basic personal protective equipment (PPE) (glasses, mask, gloves and gown) starts continuous chest compressions while the rest of the team dons a full PPE (waterproof suit). Once the team members have donned the full PPE, one of them will take over the chest compressions to allow the first team member to put on the full personal protective equipment. Another member of the team will monitor the heart rate with multifunction patches and, if indicated, will proceed with the initial unwinding.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5514;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Medidas de prevenci�n y control de la infecci�n";Spanish;"There is uncertain information in relation to covering more body parts for a better protection from infectious diseases by exposure to contaminated body fluids in healthcare staff";"The use of protective equipment to cover more parts of the body could lead to further contamination of healthcare personnel. More breathable types of PPE (personal protective equipment) can lead to similar contamination, but can be associated with greater user satisfaction. Modifications to the PPE design to make it more adaptable, such as gripping tabs, can reduce the risk of contamination.";2020;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5770;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Anestesiolog�a, Reanimaci�n y Terap�utica del Dolor.";Spanish;"Do not perform tracheal intubation of a patient in cardiac arrest in the outpatient setting.";"The complexity of intubation increases substantially with personal protective equipment and the proximity to the patient's mouth increases the risk of contagion. Put on a supraglottic device as fast as the PPE kit allows and avoid balloon-mask ventilation to reduce splashes that could transmit COVID-19. Remember to put a filter between the supraglottic device and the resuscitation balloon. If a mechanical chest compressor device is available, two members equipped with a basic PPE can position the chest compressor and then dress in the full PPE, then continue ventilation using a supraglottic device. In the event of high suspicion or confirmation of cardiac arrest prior to arrival, if possible, the full PPE should be worn during the journey. If it is not, it should be placed as soon as possible.";2020;;;"Low value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5515;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Medidas de prevenci�n y control de la infecci�n";Spanish;"There is uncertain information on procedures for placing and removing gloves and robes to reduce contamination and increase compliance among health care staff.";"For donning and doffing procedures, following CDC doffing guidance, a one?step glove and gown removal, double?gloving, spoken instructions during doffing, and using glove disinfection may reduce contamination and increase compliance. Face?to?face training in PPE use may reduce errors more than folder?based training. We need simulation studies with more participants to find out which combinations of PPE and which doffing procedure protects best.";2020;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5771;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Anestesiolog�a, Reanimaci�n y Terap�utica del Dolor.";Spanish;"The Consell Catal� de Ressuscitaci� recommends a prior briefing to assign functions and tasks, in addition to testing and simulating all procedures in order to reduce contamination and reduce the risk of infection in the Medical Emergency System.";"If the Emergency Medical System pre-alerts a victim in cardiac arrest, the entire team will be equipped with a complete PPE and will perform a brie ng assigning the roles of each member and the flow of procedures.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5519;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"The only current COVID-19 specific data comparing oropharyngeal (OP) with nasopharyngeal (NP) swabs for diagnosis of COVID-19 comes from two low quality, non-peer-reviewed studies and should be viewed with caution.";"In short, whilst there is data that detection rates vary by sample site (see Wang 2020) the only current COVID-19 specific data comes from two low quality, non-peer-reviewed studies and should be viewed with caution. It is not possible to accurately assess sensitivity from the existing data and there are no data to assess the diagnostic impact of combining both tests. However, the larger of the two studies we found reported oropharyngeal swabs detected the COVID-19 virus less frequently than nasopharyngeal swabs and should not be used in place of nasopharyngeal swabs, particularly from day 8+ of symptom onset. Notably, both studies were based on hospitalised patients (though Wolfel included some tests from ultimately hospitalised patients who were also tested in the community) so applicability to primary care may be limited. Overall, the data are not robust but we would caution against relying on OP over NP.";2020;;;Uncertain;"Diagnosis Covid-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5775;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cardiolog�a.";Spanish;"The Cardiac Imaging Association of the Spanish Society of Cardiology has prepared some recommendations for conducting cardiac imaging during the outbreak of coronavirus COVID-19";"Visit the link for more information";2020;;;"Not applicable";Diagnostico;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5520;35;"Evidencias COVID-19";"Oxford COVID-19 Evidence Service.";English;"If peripheral thermometers are used they will not detect a fever in about 4 in every 10 children.";"Three reviews were found with the earliest being the 2010 RACGP review which concluded: ?The digital thermometer provides the best agreement with the mercury in glass thermometer. The infrared tympanic thermometer may be a preferable option for the uncooperative patient. The liquid crystal forehead thermometer is best used at home.? In 2012, Healthcare Improvement Scotland produced a technology scoping report that found: Evidence from a range of adult and paediatric patient groups suggests that temporal artery thermometers are insufficiently accurate for clinical use in inpatient settings Six studies compared both temporal artery thermometers (TAT) and infrared in-ear thermometers four studies favoured TAT. infrared in-ear thermometers A 2015 systematic review of 75 studies (n = 8682) on the accuracy of Peripheral Thermometers for Estimating Temperature reported that most studies at high or unclear risk of bias. The main results were: Peripheral thermometers had pooled 95% limits of agreement outside the predefined clinically acceptable range (� 0.5 �C), Especially among patients with fever (-1.44 �C to 1.46 �C for adults; -1.49 �C to 0.43 �C for children) For detection of fever, sensitivity was low 64% but specificity was high (96% [CI, 93% to 97%]; I2 = 96.3%; P < 0.001). Limitations: High-quality data for some temperature measurement techniques are limited. Pooled data are associated with interstudy heterogeneity that is not fully explained by stratified and metaregression analyses. Their performance may be improved by taking repeated measurements over time, and they can be useful for measuring Temperature in children while they are sleeping. Peripheral thermometers should not be relied on by clinicians to influence clinical decision making. If there is no alternative, consider the actual temperature measurement will be at out by at least +/-1.5�C and ask for repeated measurements. ";2020;;;Uncertain;"Diagnosis Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6032;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Do not order troponins for the routine evaluation of pediatric chest pain in the absence of a concerning history or electrocardiogram (ECG) abnormalities.";"Troponin-I levels are a valuable tool for the assessment of adult patients who present with chest pain. However, these levels are not as useful in the pediatric population. Troponin levels in the great majority of pediatric patients presenting with chest pain are normal. Furthermore, troponin levels have not been shown to reliably correlate with disease severity or prognosis in many cardiac diseases known to cause chest pain in pediatric patients. However, in a few circumstances, such as a family history of very early cardiovascular disease or a history suggestive of myocarditis/pericarditis, consideration of troponin levels is reasonable. Therefore, do not order troponin levels for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative " 5009;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence on the safety and efficacy of cyanoacrylate glue occlusion for varicose veins is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.";"The procedure should only be done by clinicians with appropriate training in this procedure and experience in the use of venous ultrasound.";2020;;;"High value";" Varicose veins";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6033;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Do not routinely order a screening ECG as part of a sports preparticipation examination in asymptomatic, otherwise healthy patients with no personal or family history of cardiac disease.";"Routine screening ECGs for preparticipation sports clearance are not currently recommended by the American Heart Association (AHA). Instead, it is recommended that the AHA?s 14-point screening guidelines, or the American Academy of Pediatrics? ?Preparticipation Physical Evaluation? be used in conjunction with a targeted personal history, family history, and thorough physical examination. The goal is to identify warning signs or signs that raise suspicion of cardiovascular diseases that place certain athletes at risk of sudden cardiac death. These individuals should be referred for further evaluation by a pediatric cardiologist who may order an ECG or an echocardiogram as part of the work-up. Routine ECG screening of healthy pediatric patients with no personal or family history of cardiac disease has demonstrated a high false-positive rate and has not been found to reduce mortality from sudden cardiac death. In addition, it can also lead to unnecessary secondary evaluations. ECG screening should be performed in those patients with a strong family history of conditions likely to cause sudden cardiac arrest or death.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6034;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Do not order an echocardiogram for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.";"Chest pain is a common presenting symptom in pediatrics but is rarely life-threatening, and the vast majority of cases are not cardiac in origin. Therefore, the addition of an echocardiogram only adds diagnostic value in very limited circumstances and increases the cost of care. If the patient has a concerning personal (exertional chest pain with an abnormal ECG) or family history of sudden or unexplained death or cardiomyopathy or ECG abnormalities, consultation with a pediatric cardiologist is generally recommended prior to obtaining an echocardiogram. Therefore, it is important to obtain a complete personal and family history,* physical examination, and screening ECG, if the treating physician feels that the chest pain is cardiac in nature, prior to proceeding with cardiac consultation and echocardiography.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative " 6035;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Do not order an echocardiogram for the routine evaluation of pediatric syncope in the absence of a concerning history or ECG abnormalities.";"Syncope is a common complaint in pediatrics and is rarely caused by a cardiac issue in patients with a normal physical examination. If the episode is caused by the heart, it generally is an issue with the heart rhythm. Therefore, an echocardiogram rarely adds diagnostic value and it increases cost of care. In situations in which an echocardiogram may be warranted, (syncope that occurs in the circumstance of an abnormal ECG, exertional syncope, unexplained postexertional syncope, or syncope in the setting of a concerning family history,* consultation with a pediatric cardiologist is recommended prior to obtaining the echocardiogram. Therefore, it is important to obtain a thorough personal and family history,* physical examination, and ECG when indicated prior to proceeding with echocardiography in the initial assessment of pediatric syncope. *Family history should assess specifically for the following types of cardiovascular diseases: ? Connective tissue disorders ? Cardiomyopathies ? Arrhythmias, including need for pacemaker or defibrillator implantation ? Storage diseases ? Sudden unexplained death ? Premature cardiovascular disease prior to the age of 50 years";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6036;2;"Choosing Wisely�";"American Academy of Pediatrics ";English;"Do not order a screening ECG prior to initiation of attention-deficit/hyperactivity disorder (ADHD) therapy in asymptomatic, otherwise healthy pediatric patients with no personal or family history of cardiac disease.";"Many pediatricians obtain ECGs in healthy patients with no personal or family history* of cardiac disease prior to initiating stimulant therapy for ADHD out of fear of triggering an adverse cardiovascular event or worsening a previously undiagnosed cardiovascular disease. However, the probability that such screening will lead to the diagnosis of cardiac disease is low. Furthermore, when ECG abnormalities are identified, they rarely warrant a change in planned ADHD therapy. As a result, obtaining the ECG increases health care costs and can increase stress for both the patient and family. If there is concern based on the history and physical examination, then a pediatric cardiology referral is a reasonable consideration.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5014;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dapagliflozin with insulin is recommended as an option for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if: they are on insulin doses of 0.5 units/kg of body weight/day or more and they have completed a structured education programme that is evidence based";"Stop dapagliflozin if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol). Evidence from the clinical trials shows small improvements in blood glucose (HbA1c levels) and weight loss, and very small improvements in quality of life, when dapagliflozin plus insulin is compared with placebo plus insulin in adults with type 1 diabetes and inadequate blood glucose control despite optimised insulin therapy. The company extrapolates the effects of the small improvement in HbA1c level with dapagliflozin seen at 1 year in the trials to a lower risk of long-term complications over a patient's lifetime. In the company's scenario that assumes no benefit from improved HbA1c levels beyond the trial period (1 year), the cost-effectiveness estimate for dapagliflozin plus insulin compared with insulin alone is within the range that NICE normally considers an acceptable use of NHS resources. Dapagliflozin with insulin is therefore recommended as an option for type 1 diabetes in adults. Because of the increased risk of diabetic ketoacidosis, dapagliflozin should be stopped if blood glucose control does not improve.";2020;;;"High value";"Diabetes and other endocrinal, nutritional and metabolic conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5015;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dapagliflozin with insulin is recommended as an option for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if: they are on insulin doses of 0.5 units/kg of body weight/day or more and they have completed a structured education programme that is evidence based";"Stop dapagliflozin if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol). Evidence from the clinical trials shows small improvements in blood glucose (HbA1c levels) and weight loss, and very small improvements in quality of life, when dapagliflozin plus insulin is compared with placebo plus insulin in adults with type 1 diabetes and inadequate blood glucose control despite optimised insulin therapy. The company extrapolates the effects of the small improvement in HbA1c level with dapagliflozin seen at 1 year in the trials to a lower risk of long-term complications over a patient's lifetime. In the company's scenario that assumes no benefit from improved HbA1c levels beyond the trial period (1 year), the cost-effectiveness estimate for dapagliflozin plus insulin compared with insulin alone is within the range that NICE normally considers an acceptable use of NHS resources. Dapagliflozin with insulin is therefore recommended as an option for type 1 diabetes in adults. Because of the increased risk of diabetic ketoacidosis, dapagliflozin should be stopped if blood glucose control does not improve.";2020;;;"High value";"Diabetes and other endocrinal, nutritional and metabolic conditions";"<a href=""http:/www.nice.org.uk/guidance/ta597/chapter/1-Recommendations"" target=""_blank"">Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa</a>" 6040;33;"Choosing Wisely � : Things we do for no reason";"Moss, BJ. ";English;"It is not recommended to provide supplemental oxygen to patients without hypoxemia.";"Significantly hypoxemic patients should receive supplemental oxygen. Instances, where the use of supplemental oxygen in normoxemic patients may be beneficial, are carbon monoxide poisoning, decompression injury, gas embolism, cluster headaches, sickle cell crisis, and pneumothorax. Hyperoxemia can be associated with adverse outcomes and increased mortality. Oxygen administration has direct and indirect financial costs, including those of supplies, care coordination, and monitoring.";2020;;;"Low value";"Supplemental oxygen, hypoxemia, normoxemia. ";"Link to the recommendation on the website of the initiative" 5017;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"1.1 Sotagliflozin with insulin is recommended as an option for treating type 1 diabetes in adults with a body mass index (BMI) of at least 27 kg/m2, when insulin alone does not provide adequate glycaemic control despite optimal insulin therapy, only if: sotagliflozin is given as one 200 mg tablet daily hey are on insulin doses of 0.5 units/kg of body weight/day or more and they have completed ";"Stop sotagliflozin if there has not been a sustained improvement in glycaemic control (that is, a fall in HbA1c level of about 0.3% or 3 mmol/mol). These recommendations are not intended to affect treatment with sotagliflozin that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Sotagliflozin (one 200 mg tablet daily) is an option for some people who cannot manage their type 1 diabetes with insulin alone. Evidence from clinical trials run for 1 year in this population shows improvements in blood glucose (HbA1c) and weight loss, and improvements in quality of life, with sotagliflozin plus insulin compared with people on placebo plus insulin. The company assumes that the improvement in HbA1c results in a lower risk of long-term complications over a person's lifetime. It's reasonable to assume some relationship between lowering HbA1c and reducing diabetic complications, and between lowering BMI and improving quality of life. ";2020;;;"High value";"Diabetes and other endocrinal, nutritional and metabolic conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6041;33;"Choosing Wisely � : Things we do for no reason";"Vijapura, P. ";English;"It is not recommended to use antipyretic medication for stable patients on general medical units with infection solely to reduce temperature or achieve normothermia. ";"Treatment with antipyretic medication can alleviate fever-related symptoms in patients with headaches, body aches, chills, or severe sweats, and in pediatric patients with malaise, irritability, or poor oral intake. There is debate about the use of antipyretics in the ICU in critically ill patients with severe cardiopulmonary compromise, whose condition does not ensure that they can tolerate the additional hemodynamic stress produced by fever. Other adverse effects include: NSAIDs or acetaminophen may adversely affect patients with renal or hepatic insufficiency, masking fevers may impair the clinician's ability to diagnose or evaluate response to treatment, and unnecessarily waking a sleeping patient to monitor temperature or administer unneeded antipyretics can contribute to hospital-associated problems, including delirium, insomnia, and falls.";2020;;;"Low value";"Fever, infection, antipyretic medication.";"Link to the recommendation on the website of the initiative" 6043;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Ricotta, BJM";English;"It is recommended bedside rounding instead of card flipping rounds";"?Rounds? is an inpatient care model in which teams of practitioners assess patients, determine care plans, and communicate with patients, families, and other healthcare professionals. Bedside rounding is different from ?card flipping? or ?table rounding? that involves presentations of a case separately without a team-patient encounter. Expectations should be set early with both trainees and patients. Patients should be informed that the team can come back later for more in-depth discussions. Trainees should be taught evidence-based approaches supporting the value of bedside rounds for patients. Positive feedback should be provided in front of patients and the team to build confidence and encounters should be kept brief and efficient. A sufficient space for resident autonomy should be ensured through deliberate positioning, delegation of responsibilities, and huddling before and after encounters. Bedside rounds should be educationally worthwhile.";2020;;;"High value";"bedside rounding";"Link to the recommendation on the website of the initiative" 5788;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The effects of non-pharmaceutical measures for pandemic influenza in community settings are unclear";"Non-pharmaceutical measures, such as personal protective equipment are used to limit the transmission of respiratory viruses, such as COVID-19 and influenza, in non-healthcare settings as well as in healthcare settings. In this systematic review, the authors searched for studies of the effects of non-pharmaceutical measures for reducing influenza transmission in community settings. They did not restrict their searches by language of publication and did the search in August 2018. They included studies on hand hygiene (7 randomized trials), face masks (7 randomized trials) or both (6 randomized trials), and surface/object cleaning (2 randomized trials and one observational study). The studies included in this review provided no evidence of a significant effect of hand hygiene measures on laboratory-confirmed influenza transmission, or that surgical-type face masks are effective in reducing transmission of laboratory-confirmed influenza. laboratory, if used by infected people or people from the community in general. Nor did they provide evidence that cleaning surfaces or objects affects flu rates. No studies of respiratory label interventions were identified, making it unclear whether it reduces the risk of influenza transmission.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6044;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Crowe, BMJ";English;"It is not recommended to routinely transfuse fresh frozen plasma or platelets for prophylaxis prior to paracentesis in patients with cirrhosis.";"Observational studies demonstrate no association between INR or platelet counts and bleeding risk in either diagnostic or therapeutic paracentesis, including large-volume paracentesis. Moreover, prophylactic transfusion of fresh frozen plasma or platelets does not significantly reduce bleeding risk. Do not routinely use platelet count or INR when preparing for paracentesis. Reserve transfusion of fresh frozen plasma or platelets before the paracentesis for patients with disseminated intravascular coagulation, hyperfibrinolysis, or other indications for transfusion unrelated to procedural prophylaxis. Abandoning routine correction of coagulopathy does not lead to worse outcomes, can avoid potentially significant transfusion-related adverse events, and can save resources.";2020;;;"Low value";paracentesis;"Link to the recommendation on the website of the iniciative" 6045;33;"Choosing Wisely � : Things we do for no reason";"Orlov, BMJ";English;"It is not recomended to do routine overnight vital sign checks for low-risk patients";"Research supports the notion that frequent and consistent vital sign checks can minimize mortality and morbidity in the hospital.These interventions aim to help identify and treat patients with early clinical deterioration to prevent poor outcomes. A randomized pilot study concluded that low-risk hospitalized patients assigned to less monitoring overnight reported a trend toward better sleep during hospitalization without any adverse events. Most important, evidence indicates that sleep disruptions in the hospital worsen health and impede healing; further supporting nurses? instincts and practices. Use clinical judgment or an existing risk stratification system, to identify patients who may benefit from more or less monitoring and in that case monitor vital signs every 4 hours. Forgo overnight vital sign checks for low-risk patients. .";2020;;;"Low value";"Vital sign checks";"Link to the recommendation on the website of the initiative" 6046;35;"Evidencias COVID-19";"Evidence aid";Spanish;"It is not recommended the PCR test alone for the detection of SARS-CoV-2.";" A variety of diagnostic tests are being used to identify patients infected with SARS-CoV-2, the virus that causes COVID-19. In this rapid review the included studies showed that alternative diagnostic tests such as antibody tests may be used to supplement RT-PCR testing and that serological tests are not as reliable as RT-PCR tests.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6047;35;"Evidencias COVID-19";"Evidence aid ";Spanish;"Antifibrinolytics, NSAIDs, mefnamic acid,combined oral contraception are recommended for the treatment of heavy menstrual bleeding during the pandemic ";"It included 4 Cochrane Reviews, with 11 comparisons, that had used data from 44 randomised trials (3196 women). NSAIDs and Antifibrinolytics may be more effective in reducing heavy menstrual bleeding than placebo. Antifibrinolytics may be more effective in reducing heavy menstrual bleeding than short?cycle progestogen. Combined hormonal contraceptives appear to be more effective for heavy menstrual bleeding than placebo or no treatment. Mefenamic acid may be similar to naproxen, and NSAIDs may be similar to combined hormonal contraceptives for heavy menstrual bleeding.";2020;;;"High value";"Menstrual bleeding ";"Link to the recommendation on the website of the initiative" 5792;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"To reduce the psychological impact of quarantine by COVID-19, voluntary quarantine and for the shortest possible period, to provide information and justification for the quarantine and an adequate supply of resources are recommended";"During the COVID-19 pandemic, some people are staying in a dedicated quarantine facility. In this systematic review, the authors evaluated research on the psychological impact of quarantine and how to alleviate it. They limited their search to articles published in English and Italian in peer-reviewed journals. The review was published in February 2020 but it is unclear when the search was done. They identified 24 relevant studies. Despite the broad and lasting psychological impact of quarantine, voluntary quarantine is associated with less distress and fewer long-term complications, and when deemed necessary, individuals should receive information to help them understand the situation and the quarantine period should be as short as possible. Adequate supplies (general and medical) should also be available in these cases. It is uncertain whether other public health measures (such as social distancing, cancellation of mass gatherings, and school closures) are more favourable than quarantine.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6048;35;"Evidencias COVID-19";"Evidence aid";Spanish;"There is uncertainty about the effectivity of interventions on the development of mental illness in people living in lower middle income countries affected by humanitarian crises";"People living in low- and middle-income countries (LMICs) affected by humanitarian crises are exposed to physical and psychological pressures that make them more susceptible to mental health disorders. A review of randomized trials of psychological and social interventions has been conducted with a total of 2398 participants. The authors concluded in a paucity of eligible prevention studies and the risk of bias and substantial heterogeneity in the studies make the results uncertain.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative" 6049;35;"Evidencias COVID-19";"Evidence aid";Spanish;"Social distancing and school closings are recommended as cost-effective measures for a pandemic";"Non-pharmaceutical interventions are important control measures to minimize the transmission of respiratory viruses. Three systematic reviews discuss cost-effective non-pharmaceutical measures. P�rez Velasco's review indicates that non-pharmaceutical interventions, including social distancing and school closings, are profitable for pandemics. Lee's review indicates that physical interventions to prevent transmission of respiratory viruses appear to be cost-effective during an epidemic or pandemic and the Saunders-Hastings review indicates that social distancing and school closure are likely to be cost-effective in all settings. environments.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative" 6050;35;"Evidencias COVID-19";"Evidence aid";Spanish;"It is not recommended the use of chest computed tomography to differentiate COVID-19 from other causes of lung infection.";"Evidence on the accuracy of different diagnostic tests for COVID-19 is important for people choosing which tests to use. This includes the use of thoracic imaging. They included 30 cross?sectional studies (8491 participants) and 4 case?control studies (848 participants). Chest CT-scans perform well in identifying COVID-19 in people suspected of having the disease but have limited capability in differentiating COVID-19 from other causes of lung infection. The accuracies of chest X ? ray and ultrasound of the lungs for diagnosing COVID ? 19 are uncertain.";2020;;;"Low value";"CT-scans ";"Link to the recommendation on the website of the initiative" 6051;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"There is uncertainty about the efficacy of non-pharmacological hygiene interventions as prevention of the transmission of respiratory infections.";"Several systematic reviews carried out before 2020 on the effectiveness of non-pharmacological hygiene measures in preventing the transmission of respiratory infections are summarized. Hand hygiene has a modest effect as a physical intervention to interrupt the spread of respiratory viruses and no evidence was found of a major effect on the transmission rates of influenza. On the other hand, lapses in infection control measures within healthcare facilities were an important factor in the transmission of MERS.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative" 5284;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"It is recommended to use hydrogen peroxide 1% cream for people with localised non-bullous impetigo who are not systemically unwell or at high risk of complications ";"In the case hydrogen peroxide 1% isn't enough, it is recommended to use a short course of a topical antibiotic.";2020;;;"High value";"Skin infections";"https://www.nice.org.uk/guidance/ng153/chapter/Recommendations#initial-treatment" 6052;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"There is uncertainty about the effects of environmental measures to prevent transmission of infectious diseases.";"Several systematic reviews conducted before 2020 on environmental measures in preventing the transmission of respiratory infections are summarized. Most reviews concluded that ward closures, border controls, and screening at ports of entry are effective at controlling outbreaks of infectious disease, yet it is uncertain due to the lack of controlled studies. On the other hand, no evidence has been found of a major effect of surface or object cleaning in the transmission of influenza.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative" 6053;35;"Evidencias COVID-19";"Evidence Aid";Spanish;"It is recommended an early diagnosis and isolation of patients as an effective measure to reduce the transmission of infectious diseases.";"Most systematic reviews showed that early identification and isolation of patients in hospital wards or at home can be effective in reducing the spread of respiratory viruses and may prevent transmssion in healthcare facilities and in the community. Isolating exposed individuals in addition of ill ones is also an effective intervention. However people were ambivalent about adopting isolation in some contexts. A rapid review showed that the main influencers of adherence to quarantine were a person?s knowledge about the disease and quarantine procedure, social norms, perceived benefits of quarantine and perceived risk of the disease, and practical issues.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative" 6054;35;"Evidencias COVID-19";"Evidence Aid";English;"There is uncertainty regarding the efficiency of high flow nasal cannula as respiratory support for critically ill patients ";"The Corley systematic review found insufficient evidence to determine the effects of high-flow nasal cannula compared with other forms of respiratory support for adult patients in intensive care units. Agarwal et al. reported that high-flow nasal cannula may reduce the need for invasive ventilation and escalation of therapy when compared with conventional oxygen therapy in patients with acute hypoxemic respiratory failure. However, the relevance of the findings to COVID-19 patients is uncertain because none of the patients in the included studies had COVID-19. Agarwal et al. also reported that the evidence on droplet dispersion and aerosol generation and dispersion was of very low certainty.";2020;;;Uncertain;Treament;"Link to the recommendation on the website of the initiative" 6055;35;"Evidencias COVID-19";"Evidence Aid";English;"It is not recommended the use of disposable, cotton or paper masks for protecting healthcare workers from respiratory infection";"In this review authors searched for randomized trials comparing N95 respirators and surgical masks for preventing epidemic influenza in healthcare settings.Medical masks and N95 respirators reduce the risk of respiratory infection when worn by healthcare workers, but universal use of N95 respirators throughout a work shift is likely to be less acceptable because of greater discomfort Disposable, cotton or paper masks are not recommended for protecting healthcare workers from respiratory infection";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6056;35;"Evidencias COVID-19";"Evidence AID";Spanish;"There is uncertainty regarding nutrient supplementation as a way to prevent, treat and manage COVID-19.";"Nutrient supplementation has been suggested as a way to prevent, treat and manage COVID-19. Although the evidence suggested that supplementation with some nutrients may be effective in improving the health status of patients with viral infections, the impact on the health status of patients with COVID-19 was uncertain.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6057;35;"Evidencias COVID-19";"Evidence AID";English;"it is recommended telemedicine, including mHealth tools and telemonitoring, applied in various healthcare settings and health specialities";"Telemedicine, including mHealth tools and telemonitoring, has been successfully applied in various healthcare settings and specialities, and appears satisfactory to both patients and providers. However, the cost-effectiveness of telemedicine interventions is uncertain, partly because of a lack of available data. It seems that telephone interventions appear to reduce depression, anxiety, fatigue and emotional distress in adult cancer patients, however found positive outcomes from telemedicine in low-resource settings, including general health services such as maternal, child and sexual health services by community health workers, and the use of mHealth by frontline healthcare workers resulting in improved data collection";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6058;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de ginecologia y obstetricia";Spanish;"It is not recommended termination of pregnancy should not be recommended after inadvertent vaccination for COVID-19 to a pregnant woman, as the available data show no direct or indirect harmful effects on the fetus,";"Pregnant women are at higher risk of severe COVID-19, ICU admission, need for mechanical ventilation, and death than the general population, although the absolute risk remains low. In addition, they may have an increased risk of adverse effects related to gestation, such as preterm delivery. The coexistence of other risk factors that could be taken into account in the vaccination decision, such as: obesity, smoking, diabetes, hypertension, immunosuppression. The risk associated with exposure in the workplace should also be considered, although the first preventive measure should always be the adaptation of the workplace. Regarding the risks of vaccination, there is limited experience of use in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy. In addition, it seems unlikely that the vaccine components pose a risk to the pregnant woman or the fetus. Pending further data and based on the precautionary principle, widespread vaccination of pregnant women should not be proposed at this early stage of the vaccination strategy. The vaccine can be administered only to a pregnant patient who, due to concomitant conditions, has a very high individual risk of complications due to COVID-19, after a voluntary and informed decision by the pregnant woman based on her own individual benefit-risk balance. ";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5292;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Peginterferon beta?1a is recommended, within its marketing authorisation, as an option for treating relapsing?remitting multiple sclerosis in adults.";"Peginterferon beta?1a is an established drug for relapsing?remitting multiple sclerosis. There is clinical trial evidence showing that the drug slows disease progression and reduces the frequency of relapses when compared with placebo. There is also an indirect comparison suggesting that there are no differences in effectiveness when comparing peginterferon beta?1a with its main comparators, that is, other beta interferons and glatiramer acetate. However, it involves less frequent injections than other beta interferons, so improves choice for people with relapsing?remitting multiple sclerosis.";2020;;;"High value";"Multiple sclerosis";"

Enlace a la recomendaci�n en la p�gina web de la iniciativaLink to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 5548;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"El Consorcio Sanitario de Terrassa";Spanish;"It is not recommended routine determination of NT-ProBNP in patients with COVID-19 disease without clinical suspicion of acute heart failure or in a diagnostic study of dyspnea.";"NT-ProBNP is a marker of myocardial stress that tends to increase frequently in patients with severe respiratory diseases, usually in the absence of high filling pressures or clinical heart failure. This marker can be associated with an unfavorable evolution of the clinical situation, although there are other clinical variables that can guide this situation.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5804;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended to provide information on the electrolyte levels of patients with COVID-19 in assessing the severity of the disease, defining the prognosis, and guiding treatment";"In this pooled analysis, the authors searched for articles reporting data on serum electrolytes in patients with COVID-19. They did not restrict their searches by language of publication and searched for articles published between December 2019 and 23 March 2020. They included 5 studies (1415 participants), which were all from China. At the time of the review, the included studies found that severe COVID-19 infection was associated with lower serum concentrations of sodium, potassium and calcium.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5549;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"El Consorcio Sanitario de Terrassa";Spanish;"Ir is not recommended routinely determination of ultrasensitive Troponin T (hs-CTN) in patients with COVID-19 disease, without clinical suspicion of myocardial infarction and without compatible symptoms or compatible ECG abnormalities.";"The increase in hs-CTN levels is multifactorial and not due to atherothrombotic coronary occlusion. This increase may be due to myocarditis, endothelial dysfunction-microvascular ischemia, stress cardiomyopathy, tachymocardiopathy, myocardial infarction type I, myocardial infarction type 2 (hypoxia, hypotension, tachycardia). Hs-CTN is a marker of myocardial damage. However, although it can be associated with an unfavorable evolution of the clinical situation, there are other clinical variables that can guide this situation.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5805;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is evidence that quarantine measures had negative impacts on mental health during SARS and MERS";"During the COVID-19 pandemic, some people are in quarantine to reduce the risk of transmission of the virus. In this rapid review, the authors searched for studies of the psychosocial effects of quarantine and isolation related to the SARS and MERS outbreaks. The restricted their searches to articles published in English and German and did the search on 30 March 2020. They included 13 studies. At the time of the review, the included studies found that quarantine measures were consistently related to negative psychosocial outcomes, such as anxiety, stress, isolation, depressive symptoms, and stigmatization. They also found that important factors contributing to the adverse effects of quarantine included duration and loss of income, and that health workers were more likely to experience negative psychosocial impacts, particularly stigmatization.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6574;1;"NICE ";NICE;English;"It is recommended maximizing the safety of cancer patients and making the best use of resources during the COVID-19 pandemic.";"Patients having systemic anticancer treatments are immunocompromised and may have atypical presentations of COVID?19. If patients have fever (with or without respiratory symptoms), suspect neutropenic sepsis. Do not routinely delay starting systemic anticancer treatment (SACT), or pause SACT that is already underway, because of the risk of contracting COVID-19.";2020;;;"High value";Treatment;https://www.nice.org.uk/guidance/ng161 5551;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is recommended to monitor markers of clinical progression, such as rapidly progressive respiratory failure and sepsis, especially on days 5 to 10 after onset of symptoms for people with COVID-19.";"This recommendation is not developed with an evidence based framework, but formed through a consensus process.";2020;;;"High value";"Management of COVID-19 patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6063;1;"NICE ";NICE;English;"It is not recommended to offer loop diuretics to treat acute kidney injury in patients with confirmed or suspected COVID-19.";"The purpose of this guideline is to help healthcare professionals prevent, detect and manage acute kidney injury in adults in hospital with known or suspected COVID-19. This is important to improve outcomes and reduce the need for renal replacement therapy.";2020;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5552;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is not recommended to administer hydroxychloroquine for people with COVID-19, only in the context of randomised trials with appropriate ethical approval.";"The Taskforce is continually monitoring research on antimalarial and other disease-modifying treatments. As of 29 April 2020 we identified three randomised trials of hydroxychloroquine versus standard care (total 242 participants). As evidence accumulates regarding the use of hydroxychloroquine in the treatment of COVID-19, the Taskforce will continue to review and update this recommendation, including in special populations (e.g. children, pregnant women, people with immunosuppression or chronic disease).";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6064;1;"NICE ";NICE;Spanish;"It is not reccomended offering oral corticosteroid treatment to Covid-19 patients with suspected pneumonia unless they have other conditions for which these are indicated.";"The purpose of this NICE guideline is to ensure the best treatment for adults with suspected or confirmed pneumonia in the community during the COVID-19 pandemic and best use of NHS resources. This guideline focuses on what you need to stop or start doing during the pandemic.";2020;;;"Low value";treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5041;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patiromer is recommended as an option for treating hyperkalaemia in adults. ";"only if used: - in emergency care for acute life-threatening hyperkalaemia alongside standard care or - for people with persistent hyperkalaemia and stages 3b to 5 chronic kidney disease or heart failure, if they: - have a confirmed serum potassium level of at least 6.0 mmol/litre and - are not taking, or are taking a reduced dosage of, a renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and - are not on dialysis. Stop patiromer if RAAS inhibitors are no longer suitable. This recommendation is not intended to affect treatment with patiromer that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Patiromer is a treatment for people with high blood potassium levels (hyperkalaemia). It can be used for adults with chronic kidney disease or heart failure, either: in emergency care alongside standard care for acute life-threatening hyperkalaemia or for persistent hyperkalaemia if they are able to have RAAS inhibitors. Treating acute life-threatening hyperkalaemia in emergency care is established clinical practice. Other potassium-lowering treatments are rarely used in this setting because they are poorly tolerated. Patiromer could be a useful addition to emergency care. Clinical trials show that patiromer lowers serum potassium. But there is no clinical evidence that it extends life or improves quality of life. Patiromer may allow people to stay on RAAS inhibitors (drugs used to treat heart failure and kidney disease) for longer or at a higher dose. This may extend life and improve quality of life. Considering the benefit from more people being able to stay on RAAS inhibitors, the cost-effectiveness estimates for patiromer suggest that it is a reasonable use of NHS resources. Therefore, it is recommended for treating confirmed persistent hyperkalaemia when started in hospital and alongside standard care for treating acute life-threatening hyperkalaemia in emergency care.";2020;;;"High value";hyperkalaemia;"Link to the recommendation on the website of the initiative" 5553;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is not recommended to administer lopinavir/ritonavir for people with COVID-19, only in the context of randomised trials with appropriate ethical approval.";"The Taskforce is continually monitoring research on antiviral and other disease-modifying treatments. As of 29 April 2020 we identified two randomised trials of lopinavir/ritonavir versus standard care (total 227 participants). As evidence accumulates regarding the use of lopinavir/ritonavir in the treatment of COVID-19, the Taskforce will continue to review and update this recommendation, including in special populations (e.g. children, pregnant women, people with immunosuppression or chronic disease).";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5809;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"It is not recommended the use of lopinavir/ritonavir (LPVr) as part of the treatment for patients hospitalized with COVID-19 as it has no effect on the clinical progression or mortality associated with the disease.";"LPVr treatment does not reduce the need for mechanical ventilation (MV) compared to not using it. The use of rLPV does not change the length of stay in patients hospitalized with IDOC-19. Quality of evidence: high (low risk of bias, accurate results based on sufficient number of events) The effect of LPVr treatment on patients requiring mechanical ventilation (low sample size) has not been sufficiently evaluated. The impact of treatment on patients with milder forms of the disease not requiring hospitalization is not known. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6065;1;"NICE ";"NICE guideline";English;"It is not recommended to start the renal donation until the donor and recipient have negative swab test results for SARS-CoV-2.";"This guideline covers children, young people and adults who need or who have had a kidney transplant, and people who are donating a kidney (live donors). It also advises transplant and referring centres on how to run their services while keeping them safe for patients, donors and staff during the COVID-19 pandemic. Kidney transplants improve life expectancy and quality of life, and cost less than dialysis in the long term, so providing effective and safe services will benefit patients and make the best use of resources.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5554;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is not recommended to administer remdesivir for people with COVID-19, only in the context of randomised trials with appropriate ethical approval.";"The Taskforce is continually monitoring research on antiviral and other disease-modifying treatments. As of 30 April 2020 we identified a single randomised trial of remdesivir versus placebo (total 237 participants). On 29 April, our evidence surveillance identified a media release describing the results of an interim analysis of the Adaptive COVID-19 Treatment Trial (ACTT). We will incorporate the results of this trial into the guidelines as soon as sufficient information becomes available. As evidence accumulates regarding the use of remdesivir in the treatment of COVID-19, the Taskforce will continue to review and update this recommendation, including in special populations (e.g. children, pregnant women, people with immunosuppression or chronic disease).";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5810;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"The use of colchicine may be of clinical benefit in non-critical COVID-19 inpatients";"In the context of COVID-19, reduction of D-dimer has been observed after treatment with colchicine, but not other inflammatory markers. The use of colchicine in short periods is generally safe, except for the incidence of diarrhoea which appears to be related to the use of a loading dose or higher than 1 mg/day. The results come from a small randomized clinical trial (RCT) ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5555;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is recommended to administer disease-modifying treatments only in the context of randomised trials with appropriate ethical approval for people with COVID-19.";"The Taskforce is continually monitoring research on disease-modifying treatments. As evidence accumulates regarding the use of these treatments, the Taskforce will review and update this recommendation, including in special populations (e.g. children, pregnant women, people with immunosuppression or chronic disease).";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5811;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"Standard surgical masks are sufficiently effective (not inferior) compared to N95 masks only in non-aerosol generating care situations; those involved in procedures that generate aerosols should use N95 masks as part of their personal protective equipment. ";"N95 masks should be used by all personnel circulating in high-risk areas such as intensive care units (ICUs), operating rooms, and procedure rooms on patients with suspected or confirmed VIDOC-19. Surgical masks should be used in other hospital and outpatient settings where patients with suspected or diagnosed VIDOC-19 are present: a) Care personnel in close contact (less than one meter), in addition to their personal protective equipment. b) Staff who do not have direct contact with the patient (e.g. cleaning staff, administrative staff, caretakers, etc.). ";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5556;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is recommended to use single rooms or negative pressure rooms wherever possible and ensure contact, droplet and airborne precautions are in place for patients with COVID-19 receiving respiratory support or requiring intubation.";"For patients with COVID-19 for whom respiratory support (HFNO/NIV) is being considered, decisions should balance likelihood of patient benefit against the risk of infection for healthcare workers. For patients with COVID-19 receiving respiratory support (HFNO/NIV) or requiring intubation, use single rooms or negative pressure rooms wherever possible and ensure contact, droplet and airborne precautions are in place.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5812;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"Particular strategies should be adopted and adherence to practices in all care subgroups monitored to maximize desirable practices to prevent SARS-CoV-2 transmission and cross-contamination in health care workers";"The level of education in health personnel is associated with the careful removal of personal protective equipment (PPE) and the greater professional experience is related to frequent hand washing. Being in the second line of care is associated with less quarantine of family members and less participation in training on infection prevention. Higher workload is associated with lower frequency of hand washing and greater fear of the epidemic. ";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5557;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"High-flow humidified oxygen should be considered when unable to maintain SaO2 ? 92% with standard oxygen delivery despite conventional oxygen delivery at FiO2 > 6L/min or an FiO2 0.4.";"High-flow nasal oxygen (HFNO) therapy is a form of respiratory support where oxygen is delivered, often in conjunction with compressed air and humidification. It delivers high flow oxygen via large diameter nasal cannula that is humidified and heated. Flow rates can be given up to 60L/min in adults and 25L/min in children with an oxygen/air blender supplying oxygen at 21-100%. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5813;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"The current evidence does not support the need to suspend the use of ACE inhibitors or ARA-II in the face of the diagnosis of COVID-19. ";"Previous use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARA-II) in patients who are diagnosed with COVID-19 and require hospitalization may be associated with a reduction, rather than an increase, in the risk of in-hospital mortality and critical outcomes* of the disease.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5558;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is recommended in negative pressure rooms, to use high-flow nasal oxygen (HFNO) therapy for patients with hypoxaemia associated with COVID-19, ensuring it is used with caution and strict attention is paid to staff safety.";"Use the lowest flow necessary to maintain oxygen saturation ? 92%.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5814;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"Previous use of angiotensin converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB-II) in patients who are diagnosed with COVID-19 and require hospitalization may be associated with a reduced risk of in-hospital mortality and critical illness outcomes.";"Quality of evidence: moderate (from observational studies with moderate risk of bias and statistically accurate and consistent results) The available information comes from patients previously treated with ACEi or ARB-II, the effect of de novo treatment with these drugs as adjuvant therapy on COVID-19 is not known. The effect of de novo treatment with ACEi or ARB-II on mortality and other critical outcomes in patients with COVID-19 is unknown.";2020;;;Uncertain;"Management of the patient";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5303;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tinnitus: assessment and management";"Do not offer acoustic reflex testing or uncomfortable loudness levels/loudness discomfort levels testing as part of an investigation of tinnitus. Do not offer otoacoustic emissions tests as part of an investigation of tinnitus unless the tinnitus is accompanied by other symptoms and signs. Do not offer psychoacoustic tests, for example pitch and loudness matching, to assess tinnitus. Do not offer imaging to people with symmetrical non-pulsatile tinnitus with no associated neurological, audiological, otological or head and neck signs and symptoms. Do not offer amplification devices to people with tinnitus but no hearing loss. Do not offer betahistine to treat tinnitus.";2020;;;"Low value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5559;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"It is recommended in single rooms or shared ward spaces with cohorting of confimed COVID-19 patients only, to consider using high-flow nasal oxygen (HFNO) therapy for patients with hypoxaemia associated with COVID-19, ensuring it is used with caution and strict attention is paid to staff safety.";"Use the lowest flow necessary to maintain oxygen saturation ? 92%.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5815;35;"Evidencias COVID-19";"Epistemonikos - COVID-19 L�OVE Working Group";Spanish;"The results of research carried out to date do not allow us to affirm that there is a benefit in the use of azithromycin or other macrolides in the treatment of patients with COVID-19. ";"Based on: Direct evidence of VERY LOW CERTAINTY and indirect evidence of LOW CERTAINTY Experimental studies, ideally randomized and according to international quality standards, with a sufficient number of patients, are required to determine the effects of the use of this type of antibiotic on COVID 19.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5560;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use high-flow nasal oxygen (HFNO) therapy in shared wards or emergency department cubicles for patients with hypoxaemia associated with COVID-19.";"For further information please visit the web in the link below";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5816;35;"Evidencias COVID-19";"Epistemonikos - COVID-19 L�OVE Working Group";Spanish;"It has been raised the possibility of vitamin C being effective for the prevention or treatment of COVID-19 disease ";"Based on: No direct scientific evidence. Indirect evidence of other respiratory infections. It is important to note that the absence of evidence does not mean that a measure cannot be effective. It just means that we still don't know for sure if it is effective or not. However, in the case of vitamin C, if we extrapolate the high-certainty evidence about its lack of efficacy in other infections, the conclusion is that it probably plays no role in COVID-19.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6073;35;"Evidencias COVID-19";"Evidence aid";Spanish;"It is not recommended routine laboratory tests for the diagnostic of COVID-19 infection. ";"In this Cochrane rapid review, the authors searched for studies of the diagnostic accuracy of routine laboratory testing as a triage test for COVID-19. At the time of this review, the included studies showed that none of the 67 different laboratory tests reviewed could be used to accurately rule in or rule out COVID-19 on their own, due to low sensitivity and specificity. At the time of this review, the included studies showed that only three tests had a summary sensitivity and specificity above 50% (interleukin-6, increase in C-reactive protein and lymphocyte count decrease), which is below the threshold of 80% sensitivity required to prioritize patients for treatment.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 5562;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using non-invasive ventilation therapy in negative pressure rooms for patients with hypoxaemia associated with COVID-19, ensuring it is used with caution and strict attention is paid to staff safety";"Non-invasive ventilation (NIV), also known as non-invasive positive pressure ventilation (NIPPV) or bilevel positive pressure support (BiPAP), is a form of respiratory support. Bilevel positive pressure is delivered throughout the respiratory cycle by a firm-fitting nasal-face mask. The patient breathes spontaneously and triggers the device to cycle. A higher level of pressure is provided during the inspiratory phase to enhance ventilation, while a lower level of continuous positive pressure is delivered during the expiratory phase (also known as positive end-expiratory pressure or PEEP). Supplemental oxygen can also be delivered through the device.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5818;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"Decontamination using ultraviolet germicidal irradiation (UVGI), hydrogen peroxide vaporization (HPV) and exposure to humid heat, seem safe alternatives for the reuse of N95 masks or with filter respirator if there is risk of shortages";"-Decontamination using UVGI, HPV and exposure to humid heat can destroy viruses without altering the structural and functional characteristics of N95 or filter respirator (FFR) masks, as long as the specifications reported for each method are followed. -Continuous reuse can progressively affect the structural stability or fit of the masks, allowing leaks. Since repeated decontamination reduces filtration capacity (<95%), it is recommended to reuse up to three times * after decontamination.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5563;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using non-invasive ventilation therapy in single rooms or shared ward spaces with cohorting of confimed COVID19 patients only, for patients with hypoxaemia associated with COVID-19, ensuring it is used with caution and strict attention is paid to staff safety";"Non-invasive ventilation (NIV), also known as non-invasive positive pressure ventilation (NIPPV) or bilevel positive pressure support (BiPAP), is a form of respiratory support. Bilevel positive pressure is delivered throughout the respiratory cycle by a firm-fitting nasal-face mask. The patient breathes spontaneously and triggers the device to cycle. A higher level of pressure is provided during the inspiratory phase to enhance ventilation, while a lower level of continuous positive pressure is delivered during the expiratory phase (also known as positive end-expiratory pressure or PEEP). Supplemental oxygen can also be delivered through the device.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5819;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"Decontaminated masks should not be used for exposure to procedures that generate aerosols or other body fluids because there is no clear information on the effect of these decontamination methods on the filtering ability for the SARS-CoV-2 virus.";"Decontamination with liquid solutions based on chlorine, alcohol, or soaps is not recommended, as it has been shown to degrade static charge and alter the insulation and filtration properties of respiratory masks. The information analyzed is restricted to the evaluation of contamination in masks or materials similar to those used for their manufacture. There are no studies evaluating the spread of SARS-CoV-2 or other coronaviruses in health professionals who wear masks subjected to different decontamination methods.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6075;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults.";"The USPSTF found that the evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. More research is needed. Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person?s independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age.";2020;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5564;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use non-invasive ventilation therapy in shared wards or emergency department cubicles for patients with hypoxaemia associated with COVID-19";"Non-invasive ventilation (NIV), also known as non-invasive positive pressure ventilation (NIPPV) or bilevel positive pressure support (BiPAP), is a form of respiratory support. Bilevel positive pressure is delivered throughout the respiratory cycle by a firm-fitting nasal-face mask. The patient breathes spontaneously and triggers the device to cycle. A higher level of pressure is provided during the inspiratory phase to enhance ventilation, while a lower level of continuous positive pressure is delivered during the expiratory phase (also known as positive end-expiratory pressure or PEEP). Supplemental oxygen can also be delivered through the device.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5565;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use non-invasive ventilation therapy during inter-hospital patient transfer/retrieval, for patients with hypoxaemia associated with COVID-19";"Non-invasive ventilation (NIV), also known as non-invasive positive pressure ventilation (NIPPV) or bilevel positive pressure support (BiPAP), is a form of respiratory support. Bilevel positive pressure is delivered throughout the respiratory cycle by a firm-fitting nasal-face mask. The patient breathes spontaneously and triggers the device to cycle. A higher level of pressure is provided during the inspiratory phase to enhance ventilation, while a lower level of continuous positive pressure is delivered during the expiratory phase (also known as positive end-expiratory pressure or PEEP). Supplemental oxygen can also be delivered through the device.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5821;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"It is recommended the use of corticosteroids as part of the treatment in patients with severe SARS-CoV-2 pneumonia who require respiratory support (mechanical ventilation or oxygen therapy).";"In patients with severe forms of COVID-19: In patients requiring mechanical ventilation (MV), the use of corticosteroids would prevent death in approximately 1 out of every 8 treated cases. In patients treated with oxygen therapy but without MV, the use of corticosteroids would prevent death in approximately 1 in 25 treated cases. Limiting the use of low-dose corticosteroids for a period of 7-10 days does not appear to increase the rates of associated serious adverse events. In cases in which the use of corticosteroids is indicated, it is necessary to weigh the risk-benefit balance considering the potential contraindications. In patients with mild or moderate forms of COVID-19: Low-quality evidence suggests that low- or moderate-dose corticosteroids might reduce the progression to severe pneumonia and subsequent acute respiratory distress syndrome (ARDS). The effect of corticosteroid treatment on mortality is uncertain. Therefore, it is recommended that its use for this purpose be done only in the experimental context. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5566;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider early endotracheal intubation and invasive mechanical ventilation in patients with COVID-19 who are deteriorating.";"Please visit the link for more information";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5822;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"It is recommended to implement social distancing measures in addition to the isolation of COVID-19 cases";"The significant rate of spread of SARS-CoV-2 before and after the symptomatic period raises the need to, in addition to isolating those infected, it is also necessary to implement social distancing measures.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6590;1;"NICE ";NICE;English;"It is not recommended to routinely delay starting systemic anticancer treatment (SACT), or pause SACT that is already underway, because of the risk of contracting COVID-19.";"El prop�sito de esta gu�a es maximizar la seguridad de los pacientes con c�ncer y hacer el mejor uso de los recursos durante la pandemia de COVID-19, mientras se protege al personal de infecciones. Tambi�n permitir� que los servicios ajusten la capacidad de tratamiento del c�ncer a las necesidades del paciente si los servicios se vuelven limitados debido a la pandemia de COVID-19. Tenga en cuenta que los pacientes que reciben tratamientos anticancerosos sist�micos est�n inmunocomprometidos y pueden tener presentaciones at�picas de COVID?19. Adem�s, los s�ntomas de COVID-19, sepsis neutrop�nica y neumonitis pueden ser dif�ciles de diferenciar en la presentaci�n inicial. Es importante discutir los riesgos y beneficios del tratamiento anticanceroso sist�mico con personas con c�ncer y sus familiares y cuidadores, teniendo en cuenta las variantes dominantes actuales de COVID-19 y la prevalencia de COVID-19";2020;;;"Low value";"COVID-19, anticancer treatment";"Link to the recommendation on the website of the initiative/ " 6079;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years.";"Hepatitis C virus (HCV) is the most common chronic blood-borne pathogen in the US and a leading cause of complications from chronic liver disease. HCV is associated with more deaths than the top 60 other reportable infectious diseases combined, including HIV. Cases of acute HCV infection have increased approximately 3.8-fold over the last decade because of increasing injection drug use and improved surveillance.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5568;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain that enalapril, losartan and other drugs that act on the renin angiotensin aldosterone system increase or decrease the risk in patients exposed to COVID-19 or in those infected.";"There are no human studies that present conclusive results. The only study identified in humans showed no effect (neither in favor nor against). This constitutes preliminary evidence, so it is currently not possible to establish clearly whether these drugs increase or decrease the risk, or have no effect, in patients at risk of contracting COVID-19 or in those infected. Furthermore, the evidence alone is never enough to make decisions. The balance between benefits and risks, the associated burden, and the costs involved in a decision must always be taken into account.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6080;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"It is not recommended a screening for bacterial vaginosis in pregnant women without an increased risk of preterm delivery.";"It is not recommended a screening for bacterial vaginosis in pregnant women without an increased risk of preterm delivery. In pregnant women who are at increased risk of preterm birth, the USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of bacterial vaginosis screening.";2020;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5313;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Care for adults, children and young people across all phases of bipolar disorder by improving the experience of care Use this guideline in conjunction with the NICE clinical guideline on service user experience in adult mental health to improve the experience of care for adults with bipolar disorder using mental health services, and for adults, children and young people. ";"Follow the recommendations in general principles of care in the NICE clinical guideline on psychosis and schizophrenia in children and young people to improve the experience of care for children and young people with bipolar disorder.";2020;;;"High value";" Bipolar disorder";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5569;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"Currently, there is uncertain evidence on the effectiveness of chloroquine or hydroxychloroquine in COVID-19";"China grouped the authors of 15 ongoing clinical studies. It was announced that they had concluded that chloroquine has potent activity against COVID-19 but to date none of these studies have reported their results. On the other hand, a non-randomized study was developed in France that has been critically analyzed by several experts worldwide and was found to have enormous methodological limitations. After a systematic review of all the existing literature, no other study with available results was found. This review provides very low certainty evidence (preliminary evidence).";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6081;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF concludes that there is uncertainty to assess the balance of benefits and harms of primary care--based behavioral counseling interventions to prevent illicit drug use.";"In 2017, an estimated 7.9% of persons aged 12 to 17 years reported illicit drug use in the past month, and an estimated 50% of adolescents in the US had used an illicit drug by the time they graduated from high school. Young adults aged 18 to 25 years have a higher rate of current illicit drug use, with an estimated 23.2% currently using illicit drugs. Illicit drug use is associated with many negative health, social, and economic consequences and is a significant contributor to 3 of the leading causes of death among young persons (aged 10-24 years): unintentional injuries including motor vehicle crashes, suicide, and homicide. Behavioral counseling interventions to prevent illicit drug use include nonmedical use of prescription drugs, in children, adolescents, and young adults.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5570;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain whether the use of antimalarial drugs has an effect in the treatment of COVID-19 pneumonia.";"It is not possible to establish clearly whether the use of antimalarial drugs in the treatment of COVID-19 pneumonia has any effect on outcomes such as mortality or the requirement for mechanical ventilation. It is not possible to establish clearly whether adding antimalarial drugs to standard treatment reduces the risk of developing respiratory failure Adding antimalarials to standard treatment may increase the incidence of serious adverse effects Adding antimalarials may not even have an effect on PCR negativization for SARS CoV-2, but the certainty of the available evidence for these claims is still low.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5826;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"When appropriate protective measures are taken, there does not appear to be an increase in the rate of infection in healthcare professionals in direct contact with Covid - 19 patients in a hospital setting.";"When health professionals who participate in the treatment of patients with Covid-19 take effective preventive measures: complete protective clothing, high levels of infection control in the hospital, detection problems by PCR in the symptomatic personal and confinement of those infected: the transmission chain is interrupted and a higher rate of hospital infections can be avoided.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6082;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that primary care clinicians provide interventions to prevent initiation of tobacco use among children and adolescents.";"Tobacco use is the leading cause of preventable death in the US. An estimated annual 480 000 deaths are attributable to tobacco use in adults, including from secondhand smoke. It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette and that about 5.6 million adolescents alive today will die prematurely from a smoking-related illness. Exposure to nicotine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood; thus, minimizing nicotine exposure from any tobacco product in youth is important. Interventions, including education or brief counseling, should be provided to prevent the initiation of tobacco use in school-age children and adolescents who have not started using tobacco. However, the USPSTF concludes that current evidence is insufficient to assess the balance of benefits and harms of primary care in relation to feasible interventions to quit tobacco use among school-age children and adolescents who are already smokers.";2020;;;"High value";"Lifestyle. ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5571;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain whether there is a benefit in using interferon as a treatment for COVID-19. ";"Interferon has been used for years in multiple infectious or autoimmune diseases, including SARS-CoV or MERS-COV infection, other epidemic coronavirus diseases. Given that there is no direct evidence in COVID-19, it has been proposed to extrapolate the information from the former; however, the evidence on the benefit of interferon in these diseases is of very low certainty, so the level of uncertainty for COVID-19 is even higher. As it is also an intervention with significant adverse effects and costs, it does not appear to be a reasonable alternative at present, unless it is in the context of a clinical trial to test whether this drug is really beneficial in COVID-19.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5827;35;"Evidencias COVID-19";"Epistemonikos - COVID-19 L�OVE Working Group";Spanish;"Ivermectin is not recommended for the treatment of SARS-CoV-2.";"An in vitro studio and a pair of observational studies with multiple slopes, there is a need for ivermectin, another antiparasitic. It would appear that ivermectin in junction is hydroxychloroquine in April. Unfortunately, we are repeating history. Due to the increase in ivermectin sources, the OPS launched a warning to stop using it.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6083;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"It is recommended to screen drug abuse in adults over 18 years of age through questioning, only when adequate diagnosis, care and treatment can be offered.";"An estimated 12% of adults 18 years or older and 8% of adolescents aged 12 to 17 years report unhealthy use of prescription or illegal drugs in the US. The USPSTF recommends screening for drug abuse in adults 18 years of age and older by questioning only when appropriate diagnosis, care, and treatment can be offered. In the adolescent population, the USPSTF concludes that the current evidence is insufficient to evaluate the balance of benefits and harms of screening for the use of harmful drugs. Screening refers to asking questions about unhealthy drug use, not testing biological specimens. ";2020;;;"High value";Diagnostic;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5572;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"The effectiveness of ritonavir / lopinavir for the treatment of Covid-19 is still uncertain";"Ritonavir/lopinavir is a combination antiviral drug widely used to treat HIV infection. It has relatively few adverse effects and is available in practically all countries and is not associated with significant risks. In the context of previous coronavirus pandemics (SARS-CoV and MERS-CoV) it was one of the most widely used therapeutic options. In the current emergency for COVID-19, it became one of the most frequent options, in the absence of a clearly effective medicine. The publication of a scientific article that analyzes the benefits and risks of this therapy for Covid-19 is currently pending.";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6084;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). ";"Approximately 20 million new cases of bacterial or viral sexually transmitted infections (STIs) occur each year in the US, and about one-half of these cases occur in persons aged 15 to 24 years. Rates of chlamydial, gonococcal, and syphilis infection continue to increase in all regions. Sexually transmitted infections are frequently asymptomatic, which may delay diagnosis and treatment and lead persons to unknowingly transmit STIs to others. Serious consequences of STIs include pelvic inflammatory disease, infertility, cancer, and AIDS. Behavioral counseling should be provided to prevent sexually transmitted infections (STIs) in sexually active adolescents and adults at increased risk.";2020;;;"High value";"Lifestyle. ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5573;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"There is no evidence that suggests the use of anti-inflammatory drugs is a harmful factor in the context of a COVID-19 infection ";"There is no scientific evidence from clinical studies that supports the use of anti-inflammatories, in the context of a coronavirus infection, is harmful for patients. The statements made about the possible harmful effects associated with the use of anti-inflammatory drugs in patients with COVID-19 come from opinion articles, without scientific evidence that has been made public, to support them. The suspension of anti-inflammatories does not seem justified in those patients who were already using them as treatment for some pre-existing pathology. That is, stopping them is likely to have risks or deprive the patient of the benefit sought.";2020;;;Uncertain;"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5829;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"The measures of containment (confinement, isolation of infected persons, social distancing, among others) have shown a rapid and sustained impact on the reproduction rate of the SARS-CoV-2 virus and the number of contagions";"Two studies show the impact of public health measures to prevent the spread of the SARS-CoV-2 virus in Wuhan and Hong Kong";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6085;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"There is uncertainty about screening for high blood in children and adolescents";"""Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3%to 4%. The USPSTF commissioned a systematic evidence review to update its 2013 recommendation on screening for high blood pressure in children and adolescents.1,13 The USPSTF reviewed the evidence on the benefits of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. There is inadequate evidence to assess the potential harms of pharmacologic, lifestyle, or lifestyle interventions combined with pharmacotherapy for treatment of high blood pressure in children and adolescents""";2020;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5574;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain that the BCG tuberculosis vaccine is an effective preventive measure for COVID-19.";"There are still no high-quality studies that specifically assess its utility in COVID-19. There are at least 4 ongoing randomized controlled trials evaluating the use of BCG vaccine in a population at high risk of contracting COVID-19, particularly healthcare workers. Preliminary studies provide evidence of very low certainty. The risks of using the vaccine in this setting are low as are the costs. However, the factors against it is that the evidence is uncertain therefore the benefits as well.";2020;;;Uncertain;"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5830;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Preventive or mitigation psychological strategies are recommended in health workers involved in the control of emerging virus outbreaks, since they are at greater risk of presenting psychological distress and acute or post-traumatic stress";"Based on studies of previous outbreaks, individual, organizational and social factors were identified that favored or reduced the risk of psychological impact. Risk factors for psychological impact can be addressed with preventive or mitigation strategies applied in previous outbreaks of emerging viruses.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6086;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;" It is recommended screening for hepatitis B virus (HBV) infection inadolescents and adults at increased risk of infection.";"A systematic evidence review examined evidence from new randomized clinical trials and cohort studies published from 2014 to August 2019. The systematic review concludes with moderate certainty that screening for HBV infection in adolescents and adults at increased risk for infection has moderate net benefit. This recommendation statement applies to asymptomatic, nonpregnant adolescents and adults at increased risk for HBV infection, including those who were vaccinated before being screened for HBV infection. The population with an increased risk are persons born in regions with a prevalence of HBV infection of 2% or greater, persons who inject drugs; men who have sex with men; persons with HIV infection; and sex partners, needle-sharing contacts, and household contacts of persons with chronic HBV infection. ";2020;;;"High value";"HBV infection";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5063;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Advice to reduce the spread of impetigo.";"1.1.1. People with impetigo, and their parents or carers if appropriate, about good hygiene measures to reduce the spread of impetigo to other areas of the body and to other people. 1.1.2. Consider hydrogen peroxide 1% cream for people with localised non-bullous impetigo who are not systemically unwell or at high risk of complications. Although other topical antiseptics are available for treating superficial skin infections, no evidence was found for using them to treat impetigo. 1.1.3. If hydrogen peroxide 1% cream is unsuitable, offer a short course of a topical antibiotic for people with localised non-bullous impetigo who are not systemically unwell or at high risk of complications. 1.1.4. Offer a short course of a topical or oral antibiotic for people with widespread non?bullous impetigo who are not systemically unwell or at high risk of complications. 1.1.5. Bullous impetigo or impetigo in people who are systemically unwell or at high risk of complications. 1.1.6. Do not offer combination treatment with a topical and oral antibiotic to treat impetigo. ";2020;;;"High value";"Non-bullous impetigo, Bullous impetigo, Decolonisation";"https://www.nice.org.uk/guidance/ng153/chapter/Recommendations" 5319;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patiromer is recommended for treating hyperkalaemia in adults only if used in emergency care for acute life-threatening hyperkalaemia alongside standard care or for people with persistent hyperkalaemia and stages 3b to 5 chronic kidney disease or heart failure. ";"Patiromer is a treatment for people with high blood potassium levels (hyperkalaemia). It can be used for adults with chronic kidney disease (stages 3b to 5) or heart failure, either: - in emergency care alongside standard care for acute life-threatening hyperkalaemia or - In patients who have a confirmed serum potassium level of at least 6.0 mmol/litre and are not taking, or are taking a reduced dosage of, a renin-angiotensin-aldosterone system (RAAS) inhibitor because of hyperkalaemia and are not on dialysis. Stop patiromer if RAAS inhibitors are no longer suitable. Clinical trials show that patiromer lowers serum potassium. But there is no clinical evidence that it extends life or improves quality of life. Patiromer may allow people to stay on RAAS inhibitors (drugs used to treat heart failure and kidney disease) for longer or at a higher dose. This may extend life and improve quality of life. This recommendation is not intended to affect treatment with patiromer that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2020;;;"High value";"Heart failure ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5575;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"Currently, it is uncertain that convalescent plasma is an effective treatment for COVID-19.";"There are no studies that specifically assess its usefulness in COVID-19 yet. Studies evaluating its usefulness in other infections, and whose information could be extrapolated to COVID-19, provide very low certainty evidence. There are at least 12 ongoing randomized clinical trials evaluating the use of convalescent plasma in patients with COVID-19, particularly in the most severe patients. The risks of its use are small but the benefits are uncertain, the costs are high and the availability is limited.";2020;;;Uncertain;" Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5831;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"It is not recommended the use of antimalarials in patients hospitalized for COVID-19";"There is no certainty about the relationship between treatment-induced viral clearance and its effect on clinical outcomes. The clinical impact of antimalarial treatment is uncertain. Indeed, an interim analysis in a large RCT, recommending continued randomization to this treatment, showed a statistically different effect from the excess risk identified by a large observational study.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5576;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain that stem cells are effective in the treatment of COVID-19.";"There are no studies that specifically evaluate its usefulness in COVID-19. Studies evaluating its usefulness in other infections, and whose information could be extrapolated to COVID-19, provide very low certainty evidence. The use of stem cells as a Covid-19 treatment has small risks; however, the benefits are uncertain, the costs potentially high, and may possibly lead to associated problems. Therefore, it is highly unlikely that stem cells are scientifically recommended.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5832;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"It is recommended to follow R&D protocols to ensure vaccine safety.";"The safety profile of the most common vaccines is excellent, with clinically insignificant side effects. Pharmacovigilance systems have proven crucial to have an accurate idea of risk. To ensure the safety of SARS-CoV-2 vaccines, R&D methodologies must follow the usual steps.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5065;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Managing leg ulcer infection in adults";"There are many causes of leg ulcers: underlying conditions, such as venous insufficiency and oedema, should be managed to promote healing. Most leg ulcers are not clinically infected but are likely to be colonised with bacteria. Antibiotics do not help to promote healing when a leg ulcer is not clinically infected. Do not take a sample for microbiological testing from a leg ulcer at initial presentation, even if it might be infected. Only offer an antibiotic for adults with a leg ulcer when there are symptoms or signs of infection (for example, redness or swelling spreading beyond the ulcer, localised warmth, increased pain or fever).";2020;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5577;35;"Evidencias COVID-19";"Epistemonikos Foundation";Spanish;"It is uncertain whether Lopinavir / ritonavir is an effective treatment for COVID-19.";"Lopinavir / ritonavir may slightly decrease mortality in low or moderate risk patients (low certainty of evidence) and in high risk patients may decrease mortality (low certainty of evidence) Studies show that it could decrease the risk of developing respiratory failure or acute respiratory distress syndrome, lead to a slight clinical improvement at 14 days, and make no difference in the length of hospitalization (low evidence certainty) Lopinavir / ritonavir may not be associated with a substantial increase in the risk of serious adverse effects (certainty of low evidence) although it may produce non-serious adverse effects (certainty of moderate evidence) It is not possible to establish clearly if the risk of developing syndrome of requiring mechanical respiratory assistance or extracorporeal membrane oxygenation increases, because the certainty of the existing evidence has been evaluated as very low.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5833;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"The use of a complete personal protection equipment in health professionals is recommended to reduce the risk of infection / contamination by highly infectious agents, but it is difficult to use.";"It is possible to state that, with the results of this systematic review based on low quality evidence, full-body PPE protects against microbial contagion, but presents discomfort to dress and undress. Training in the handling of this equipment appears to be effective in adhering to clinical practice guidelines. For greater user satisfaction, a technical evolution of the currently available PPE will be necessary.";2020;;;"High value";Preventiva;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6089;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Fundaci�n Instituto Catal�n de Farmacolog�a";Spanish;"It is not recommended treatment with metamizole (dipyrone) as first choice in patients with fever or severe acute pain.";"No evidence-based clinical practice guidelines (CPGs) recommending the use of metamizole have been found. Treating fever or severe acute pain in children or adults with metamizole as the first choice is not justified. Metamizole is considered an alternative to paracetamol and NSAIDs, which have similar efficacy and a better safety profile. In the treatment of severe acute pain, an adequate use of metamizole must be made in order to minimize the risks: with the minimum effective dose and a short duration (maximum 7 days). The use of metamizole is contraindicated during the third trimester of pregnancy and lactation. Caution must be exercised in its use in immunosuppressed people, people with comorbidities, the elderly, pregnant women and children.";2020;;;"Low value";"Fever and severe acute pain";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5578;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using videolaryngoscopy over direct laryngoscopy, if available and the operator is trained in its use in adults with COVID-19 undergoing endotracheal intubation.";"Visit the link for further information";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5834;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"There is an unclear profile in the risk-benefit balance of the use of glucocorticoids as a treatment for Covid-19";"In all pathologies (COVID-19, SARS and MERS) there was an increase in the average length of hospital stay and nosocomial infections in patients who received glucocorticoids and, more importantly, the use of systemic glucocorticoids was associated with an increase mortality, either in Covid-19 (RR = 2.0 95% CI: 0.69 to 5.75), or in SARS (RR = 1.52 95% CI: 0.89 to 2.60 ), or in MERS (RR = 1.3, 95% CI 1.1 to 1.5). A high-quality RCT will be necessary to clarify this intervention in the referred pathologies.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6090;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"It is recommended an advice that promotes a healthy diet and physical activity, to prevent cardiovascular disease, in patients with risk factors.";"The target group is adults over 18 years of age with an increased risk of cardiovascular disease (hypertension, dyslipidemia, mixed or multiple risk factors, such as metabolic syndrome, or an estimated 10-year CVD risk of ?7.5%). It does not apply to adults with other known modifiable cardiovascular risk factors, such as abnormal blood, glucose levels, obesity and smoking. Few adverse events were reported, and most of these were mild, such as minor musculoskeletal injuries.";2020;;;"High value";"Cardiovascular risk. Diet. Exercise";"Link to the recommendation on the website of the initiative" 5579;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using a higher positive end-expiratory pressure (PEEP > 10 cm H2O) over a lower PEEP strategy for mechanically ventilated adults with COVID-19 and moderate to severe ARDS.";"Visit the link for further information";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5835;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"The use of hydroxychloroquine and / or azithromycin does not reduce the mortality of Covid-19 patients admitted to hospitals, presenting problems of cardiac toxicity.";"The administration of hydroxychloroquine and / or azithromycin does not have any benefit in the hospital mortality of patients with Covid-19. Therapies that included hydroxychloroquine showed the highest rate of cardiac toxicity";2020;;;"Low value";Treatments;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6091;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Pediatr�a";Spanish;"It is not recommended routine switching to lactose-free milk or formula in children under 5 years of age with acute gastroenteritis in outpatient management.";"According to clinical practice guidelines (CPG), the use of lactose-free formulas is not routinely indicated in children with out-of-hospital acute gastroenteritis and the few studies conducted with children with outpatient acute gastroenteritis have not found evidence that the change to a lactose-free formula is associated with a significant change in the number of days of diarrhea. Lactose intolerance caused by acute gastroenteritis is usually mild and self-limited and, on the other hand, one of the adverse effects of this practice is the risk of loss of breastfeeding in a breastfed child. Consequently, for breastfed infants, continued breastfeeding is recommended throughout the natural course of acute gastroenteritis.";2020;;;"Low value";"Acute gastroenteritis";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5580;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using recruitment manoeuvres for mechanically ventilated adults with COVID-19 and hypoxaemia despite optimising ventilation";"Patients receiving respiratory support are at an increased risk of lung injury. Recruitment manoeuvres are used to open up (?recruit?) collapsed alveoli and are a common element of an ?open lung approach? to protect the lungs during mechanical ventilation. The manoeuvres use a sustained increase in airway pressure to re-open collapsed alveoli. Types of manoeuvres include: prolonged high continuous positive airway pressure; progressive incremental increases in positive end-expiratory pressure at a constant driving pressure (incremental PEEP, stepwise or staircase); and high driving pressures.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5581;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use staircase or stepwise (incremental positive end-expiratory pressure) recruitment manoeuvres , if recruitment manoeuvres are used. ";"Patients receiving respiratory support are at an increased risk of lung injury. Recruitment manoeuvres are used to open up (?recruit?) collapsed alveoli and are a common element of an ?open lung approach? to protect the lungs during mechanical ventilation. The manoeuvres use a sustained increase in airway pressure to re-open collapsed alveoli. Types of manoeuvres include: prolonged high continuous positive airway pressure; progressive incremental increases in positive end-expiratory pressure at a constant driving pressure (incremental PEEP, stepwise or staircase); and high driving pressures. ";2020;;;"Low value";"patients management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5326;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"t is recommended to use this guide in conjunction with other NICE guidelines to recognize, assess, and treat mental health problems in women who plan to have a baby, are pregnant or have had a baby, or have been pregnant in the past year.";"Discuss with all women of childbearing potential who have a new, existing or past mental health problem: - the use of contraception and any plans for a pregnancy - how pregnancy and childbirth might affect a mental health problem, including the risk of relapse - how a mental health problem and its treatment might affect the woman, the fetus and baby - how a mental health problem and its treatment might affect parenting. [new 2014] When prescribing psychotropic medication for women of childbearing potential, take account of the latest data on the risks to the fetus and baby. [new 2014] Do not offer valproate for acute or long-term treatment of a mental health problem in women or girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are ineffective or not tolerated and the pregnancy prevention program is in place. See the MHRA safety advice on valproate use by women and girls. [amended 2020]";2020;;;"High value";"Postnatal care";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5582;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider prone positioning for mechanically ventilated adults with COVID-19 and hypoxaemia despite optimising ventilation.";"Positioning the patient in a face-down (prone) position may help to open up (recruit) collapsed alveoli and improve oxygen levels in the blood.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5838;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of masks is recommended to stop the transmission of respiratory viruses from infected people";"COVID-19 is a respiratory infection and face masks are one type of physical barrier to help reduce the transmission of respiratory viruses from infected people. Mask use by symptomatic individuals can reduce transmission and may contribute to the benefits of face mask use in the wider community. Wearing face masks, especially N95 masks and respirators, can prevent coronavirus infection and that eye protection can provide additional benefits. The use of masks with hand sanitizer can reduce the secondary transmission of respiratory infections within homes, especially if it begins within 36 hours of contact with an affected person.";2020;;;"High value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6094;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Hematolog�a y Hemoterapia";Spanish;"It is recommended to assess whether the patient has anemia before scheduling elective surgery with a moderate or high risk of bleeding";"Its prevalence will depend on the group of patients included or the type of surgery (oncological, cardiac, etc.). However, in large retrospective European and American studies it has been estimated that one third of the patients who undergo surgery arrive for surgery with anemia. For observational studies, patients with moderate or severe preoperative anemia are associated with higher hospital mortality and, after thirty days, a longer hospital stay and a greater need for postoperative admission to intensive care than those with normal preoperative hemoglobin concentrations. Therefore, considering patients with anemia as candidates for elective surgery with high or moderate bleeding risk (> 500 mL), this anemia should not be left untreated (preoperative hemoglobin target ?13 g / dL men and women) before to perform the surgery. The exceptions are patients: a) patients with erythropathy or anemia who do not respond to any treatment (thalassemia major, sickle cell disease, aplasia, severe myelodysplasia; b) patients with nutrient deficiencies that cannot be corrected due to an allergy, intolerance or contraindication to preparations; c) patients with resistance to erythropoietin or who cannot receive it due to high thromboembolic risk; d) in boys and girls, the lack of authorization of some preparations due to the absence of studies and e) anemic patients who have to undergo urgent or elective surgery that is not delayed for whom there is not enough time to optimize.";2020;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5583;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider prone positioning for adults with COVID-19 and respiratory symptoms who are receiving any form of supplemental oxygen therapy and have not yet been intubated.";"Positioning the patient in a face-down (prone) position may help to open up (recruit) collapsed alveoli and improve oxygen levels in the blood. When positioning a patient in prone, ensure it is used with caution and close monitoring of the patient. Patients who are deteriorating should be considered for early endotracheal intubation and invasive mechanical ventilation.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5839;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended to reserve access to the operating theatre for emergencies and oncological procedures during the COVID-19 pandemic";"The COVID-19 pandemic is placing a strain on health care, with some services, such as surgery, particularly affected by the risks of transmission. In this rapid review, the authors searched for articles on COVID-19 and surgery in an emergency setting. They restricted their searches to articles published in English between 15 December 2019 and 30 March 2020. They included 12 articles. At the time of this review, the included studies showed that laparoscopic procedures should be deferred due to the possible release of aerosols. ";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6095;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"Helicobacter pylori testing is not recommended in children and adolescents 5 to 18 years of age with functional abdominal pain without warning signs or symptoms.";"The joint guide between the European and North American Society of Pediatric Gastroenterology, Hepatology and Nutrition updated in 2016 recommends not performing the test for the detection of Helicobacter pylori in children and adolescents with functional abdominal pain without warning signs or symptoms. They argue that Helicobacter pylori is unlikely to cause functional abdominal pain, since most children and adolescents with Helicobacter pylori are asymptomatic. Unjustifiably conducting the test means exposing the child or young person to an unnecessary invasive test and, if positive, to unnecessary treatment that can lead to serious consequences such as increased antibiotic resistance. The 2017 Cochrane review corroborates the lack of evidence to make such a recommendation. However, the guidelines establish that the study of Helicobacter pylori in pediatrics is indicated for the clinical suspicion of organic causes: peptic ulcer disease or epigastric abdominal pain with alarm signs that do not meet the criteria for functional abdominal pain.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5584;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Consider using venovenous extracorporeal membrane oxygenation (VV ECMO) if available, or referring the patient to an ECMO centre, in mechanically ventilated adults with COVID-19 and refractory hypoxaemia (despite optimising ventilation, use of rescue therapies and proning). ";"Extracorporeal membrane oxygenation (ECMO) is a form of life support that removes blood from the body via large cannulae, oxygenates and removes carbon dioxide from the blood external to the patient, and then returns the blood to the body. Venovenous (VV) ECMO provides oxygenation support for the lungs only, while venoarterial (VA) ECMO supports the heart and lungs. Due to the resource-intensive nature of ECMO and the need for experienced centres, healthcare workers and infrastructure, ECMO should only be considered in carefully selected patients with COVID-19 and severe ARDS.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5840;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"The use of convalescent plasma or hyperimmune immunoglobulin in patients with Covid-19 does not seem to be effective in the main clinical measures";"These are preliminary data - some studies (22 clinical trials) are still ongoing, they do not support the use of convalescent plasma or hyperimune immunoglobulin in patients with COVID-19.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6096;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Obstetricia y Ginecolog�a";Spanish;"It is not recommended to routinely schedule elective cesarean sections before week 39+0 of gestation.";"Cesarean section is the most common surgery in the world. It is an operation that serves to prevent and reduce the complications of childbirth and can save the life of the mother and / or the newborn. Even so, it carries risks for both of you, both in the short and long term. Being born before week 39 is associated with an increase in neonatal morbidity and scientific evidence supports that this risk decreases significantly after week 39. This is why, by broad consensus among the clinical practice guidelines of different countries and international regulatory bodies, caesarean sections should only be scheduled before week 39 in cases where justifying clinical criteria are met.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 5585;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use a steroid nebulisers, instead use inhaled or oral steroids for the management of people with co-existing asthma or COPD and COVID-19 as you would normally do for viral exacerbation of asthma or COPD";"Visit the link for further information ";2020;;;"Low value";"Treatment co-morbilities";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5841;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"It is suggested that the use of mechanical ventilation (MV) in the prone position (PP) can reduce mortality in the population with acute respiratory failure from causes other than COVID-19, particularly in more severe cases, when it begins in the first 48 hours of admission in the Intensive Care Unit (ICU) and is administered for at least 16 hours a day.";"-In these studies, this modality of MV was associated with better oxygenation (in terms of before-after difference in PaO2 / FiO2) and a lower frequency of arrhythmias. -This measure would simultaneously demand greater nursing care, given the excess risk of pressure ulcers and endotracheal tube obstructions associated with this type of MV. -There are no studies that specifically evaluate the impact of this type of MV in patients with acute respiratory failure associated with COVID-19.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6097;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Obstetricia y Ginecolog�a";Spanish;"Therapeutic absolute bed rest is not recommended routinely in pregnant women with preeclampsia without serious manifestations.";"Preeclampsia can affect 5-10% of pregnancies. Currently the definition of pre-eclampsia is established as arterial hypertension ? 140/90 (de novo after 20 weeks of gestation) and with at least ? 1 of the following criteria: proteinuria and / or maternal target organ damage (liver, renal, neurological or hematological) and / or utero-placental dysfunction. The clinical practice guidelines that have evaluated the prescription of absolute bed rest to preeclamptic women without serious manifestations have found the quality of the evidence to be low or moderate. Also, prolonged bed rest can carry significant risks of thrombosis and other side effects. As an exception, it is pointed out that there could be situations in which different levels of rest, either at home or in the hospital, that could be indicated for preeclamptic pregnant women in justified cases.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5586;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Use prophylactic doses of anticoagulants, preferably LMWH (e.g. enoxaparin 40 mg once daily or dalteparin 5000 IU once daily) in adults with moderate COVID-19 or other indications, unless there is a contraindication, such as risk for major bleeding.";"Where severe acute kidney disease is present, unfractionated heparin or renally adjusted doses of LMWH may be used (e.g. enoxaparin 20 mg once daily or dalteparin 2500 IU once daily).";2020;;;"High value";"Treatment comorbilities";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5587;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"In patients with COVID-19 who are receiving ACE-I/ARB, these medications should be continued unless contraindicated e.g. hypotension.";"Visit the link for further information ";2020;;;"High value";"Treatment co-morbilities";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6099;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Obstetricia y Ginecolog�a";Spanish;"It is not recommended to do any treatment in asymptomatic vulvar synechiae in a prepubertal girl.";"Vulvar synechiae are a very common acquired condition in which there is an adhesion between the labia minora of the vulva that partially or totally closes the introitus, and does not allow a complete view of the entrance to the vagina or, sometimes, to the urethral meatus. The vast majority are asymptomatic and resolve spontaneously, without treatment, during puberty or before reaching it. The literature is of low or very low quality and therefore the recommendations are mainly by consensus. Intervention will only be recommended in those cases that present significant symptoms that justify it as cases of urinary obstruction with repeated urinary infections or when topical treatments fail. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 5332;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"The combination of lopinavir-ritonavir was not effective in patients severely infected with SARS-CoV-2, but it seems possible to expect that, in future studies of larger dimensions and duration, these agents could be beneficial.";"In a clinical trial with a sample of 199 patients hospitalized for severe SARS-CoV-2, showed no statistically significant difference in the main results. The group treated with LR had a numerically lower mortality at 28 days (19.2% vs. 25%), the average delay in intensive care was less (6 vs. 11 days) and the percentage of patients with clinical improvement at 14 days was greater (45.5 vs. 30%). All these results allow us to believe in the possibility that, if the study had continued with the inclusion of more patients, a benefit of lopinavir-ritonavir therapy could be detected in all indicators.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5588;35;"Evidencias COVID-19";"Instituto Nacional de Salud P�blica (INSP)";Spanish;"The scientific evidence is inconclusive to recommend or discourage the use of surgical masks at the population level.";"We followed the Cochrane rapid review methodology The search strategy encompasses one academic database until April 1, 2020. 21 manuscripts were identified that met the inclusion criteria. Of six systematic reviews, four found no reduction in the probability of transmission. Experimental home studies found no differences in the probability of contagion associated with the use of mouth masks. Only one modeling study estimated a 20% reduction in the incidence of acute respiratory disease, assuming that 10 to 50% of the population use the surgical masks correctly. Considerando los potenciales efectos negativos, las recomendaciones gubernamentales deber�an esperar a los resultados de los experimentos naturales en pa�ses que han recomendado la utilizaci�n poblacional de mascarillas. Considering the potential negative effects, official recommendations should await for the results of natural experiments currently occurring in countries that have recommended the use of face masks at the population level.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6100;35;"Evidencias COVID-19";"Evidence aid ";Spanish;"Preventive actions are recommended to reduce the transmission of COVID-19 in healthcare personnel.";"A variety of interventions have been applied to reduce the transmission of COVID-19 in healthcare personnel. The authors of this review included 7 studies, 5 of which were observational studies. All these suggest the following preventive measures in the protection of healthcare personnel: maintaining a safety distance, carrying out patient screening before consultations, use of hygienic measures such as hydro-alcoholic gel, use of appropriate masks and the practice of telemedicine. . ";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5589;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"The impact of a quarantine can be devastating in terms of the mental health of isolated people.";"The situation becomes even more serious for health professionals. The consequences of quarantine on mental health can be very serious, with enormous uncertainty about its long-term impact, since in the history of humanity people without diseases have never been isolated. Future measures to resolve the crisis should take into account this dramatic reality.";2020;;;"Low value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6101;1;"NICE ";NICE;English;"It is recommended as an option for untreated locally advanced or metastatic epidermal growth factor receptor mutation-positive non-small-cell lung cancer in adults.";"Locally advanced or metastatic EGFR mutation-positive NSCLC is usually first treated with afatinib, erlotinib or gefitinib. Evidence from a randomised controlled trial suggests that people who take osimertinib live longer than people who take erlotinib or gefitinib. They also live longer before their disease gets worse. There is some uncertainty about the comparison of osimertinib with afatinib, which may be more effective than erlotinib and gefitinib, because there is no direct evidence comparing them.""";2020;;;"High value";TREATMENT;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5590;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Pretreatment with angiotensin converting enzyme inhibitors and / or angiotensin receptor blockers and / or beta blockers and / or calcium channel antagonists and / or thiazide diuretics does not present a significant risk in Covid-19";"In this population-based study in Italy (Lombardy), 6,272 cases of SARS-CoV-2 infection were compared with 30,759 uninfected patients (controls). There does not appear to be any risk of Covid-19 in patients taking enzyme inhibitors. conversion of angiotensin (ACE), and / or angiotensin receptor blockers, and / or beta-blockers, and / or calcium channel antagonists and / or thiazide diuretics. Therefore, discontinuation of treatment with these medicinal products is not justified, for example, during the treatment of high blood pressure in these patients.";2020;;;"High value";"Treatment comorbilities";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5846;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended the biocidal agents to inactivate coronaviruses on inanimate surfaces";"Infection prevention and control interventions are especially important during the COVID-19 pandemic. In this rapid review, the authors searched for studies about the persistence of human and veterinary coronaviruses on inanimate surfaces and their inactivation with biocidal agents. They restricted their search to the MEDLINE database did the search on 28 January 2020. They included 22 studies. At the time of this review, the included studies showed that coronaviruses can remain infectious on inanimate surfaces for up to 9 days, although temperatures above 30�C can reduce persistence. The included studies also showed that coronaviruses can be inactivated within 1 minute by surface disinfection procedures with ethanol, 0.5% hydrogen peroxide in accelerated form, or 0.1% sodium hypochlorite.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6102;1;"NICE ";NICE;English;"It is recommended avelumab with axitinib for untreated advanced renal cell carcinoma in adults.";"Treatment for untreated advanced renal cell carcinoma includes sunitinib, pazopanib, tivozanib or cabozantinib. Clinical trial evidence shows that, for people with untreated advanced renal cell carcinoma, avelumab plus axitinib increases how long people live without their disease getting worse compared with sunitinib. Early trial results suggest that avelumab plus axitinib also increases how long people with the disease live. But this is uncertain because the final trial results are not available yet. There are no trials comparing avelumab plus axitinib with tivozanib, pazopanib or cabozantinib directly. So, it is uncertain how it compares with these drugs.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5335;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"It is advised to follow the WHO guideline that contains definitions for COVID infections that serve for surveillance plans for SARS-CoV-2 infection and emphasize the importance of a careful epidemiological survey in the evaluation of patients and the ability to evaluate them.";"This document provides guidance to WHO Member States on the implementation of surveillance for COVID-19 disease, through the following infection definitions: Suspicious case: A) a patient with acute respiratory illness (fever and at least cough or difficulty breathing) and no other cause that fully explains the clinical presentation + a history of travel or residence in a country, area, or territory that reported a local transmission of SARS-CoV-2 during the 14 days prior to the onset of symptoms; or B) a patient with an acute respiratory illness who has been in contact with a confirmed or probable case of SARS-CoV-2 during the 14 days prior to the onset of symptoms; C) patient with severe acute respiratory infection (i.e. fever and at least cough or shortness of breath) without any other cause that fully explains the clinical presentation and requires hospitalization. PROBABLE CASE: Clinically suspicious case, but with inconclusive laboratory test for the SARS-CoV-2 virus. CONFIRMED CASE: patient with laboratory confirmation of infection with the SARS-CoV-2 virus, regardless of the clinical signs and / or symptoms that it may have.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5591;35;"Evidencias COVID-19";"Fundaci� Salut i Envelliment-UAB - Centro Cochrane Iberoamericano";Spanish;"There is no evidence on the negative impact of these measures on the physical health, cognitive and emotional state and social and supportive relationships of older people, nor on how to prevent or treat them.";"Older people are a particularly vulnerable group with a poor prognosis in relation to COVID-19, and they are a priority population for confinement and social distancing initiatives to avoid the spread of SARS-CoV-2. There is evidence that provides information with very low certainty that older people with good self-perception of aging could be more resilient in the face of the suffering situation (negative stress) that confinement and the current pandemic entails. Women suffer more loneliness and suffering.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5847;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended clear communication, access to adequate personal protection, adequate rest, and practical and psychological support to lower psychological distress in healthcare workers";"In this rapid review, the authors searched for studies of the psychological impact on healthcare staff working with patients during an outbreak of an emerging virus in any clinical setting. They did not restrict their searches by language of publication and did the search in late March 2020. They included 59 studies, covering studies on SARS (37 studies), MERS (7), Ebola virus disease (3), COVID-19 (8) and influenza A virus subtypes H1N1 (3) and H7N9 (1). At the time of the review, the included studies showed that healthcare workers in contact with affected patients during novel virus outbreaks had greater levels of acute or post-traumatic stress and psychological distress compared with lower risk controls. They also showed that clear communication, access to adequate personal protection, adequate rest, and practical and psychological support were associated with lower psychological distress in healthcare workers during novel virus outbreaks.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6359;29;"Choosing Wisely Australia";"Royal Australian & New Zealand College of Ophthalmologists";English;"Do not recommend corneal cross-linking for all patients with keratoconus.";"It is indicated when there is clear evidence of progression via change in refraction, anterior and posterior topographical data and tomographic data. In younger patients? consideration can be given to cross-linking without evidence of progression if there is a strong index of suspicion that progression will occur without intervention.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5592;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"Based on the available evidence, the benefits and harms of hand cleaning with ash compared with soap or other materials for reducing the spread of viral or bacterial infections are uncertain. ";"Handwashing is important to reduce the spread and transmission of infectious disease. Ash, the residue from stoves and fires, is a material used for cleaning hands in settings where soap is not widely available. We identified 14 studies that assessed ash for hand cleaning. Only one small study directly compared people chosen at random to use ash or soap or other materials (randomised studies produce the best evidence). Our certainty (confidence) in the evidence was limited because we found few studies; those we did find had unreliable methods and different kinds of participants, and none of the studies we found reliably examined whether participants got infections.";2020;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5848;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The effects of azithromycin in the treatment of COVID-19 are unclear";"Azithromycin has been suggested as possible treatment for COVID-19 patients. In this rapid review, the authors searched for in vivo and in vitro studies assessing the safety and effectiveness of azithromycin for treating COVID-19 patients. They restricted their searches to articles published from 2019 onwards, but did not restrict by language of publication and did the search on 16 April 2020. They included two in vitro studies and one in vivo study, which were all published as pre-prints. At the time of this review, the available evidence on the effects of azithromycin for treating COVID-19 patients was very limited and the potential benefits and harms were uncertain. ";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6104;1;"NICE ";NICE;English;"It is recommended naldemedine as an option for treating opioid-induced constipation in adults who have had laxative treatment. ";"The treatment of opioid-induced constipation depends on whether the opioid is the only cause of the constipation (pure opioid-induced constipation) or if there are other contributing factors (mixed aetiology constipation). Treatment may include a peripherally acting mu-opioid receptor antagonist alone. But, commonly a peripherally acting mu-opioid receptor antagonist and a conventional laxative are used together. Naldemedine is an oral peripherally acting mu-opioid receptor antagonist for adults who have had laxative treatment. The clinical evidence shows that naldemedine increases the frequency of bowel movements compared with no treatment and other peripherally acting mu-opioid receptor antagonist. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5593;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is uncertain whether daily interruption of sedation alters clinical outcomes in adults with mechanical ventilation";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). This requires the patient to be sedated, which can cause complications. Daily sedation interruption might be used to try to reduce these. In this Cochrane systematic review, the authors searched for randomized trials comparing DSI with other sedation strategies for critically ill adults receiving MV. Although the review found no strong evidence that daily sedation interruption alters clinical outcomes for critically ill adults receiving mechanical ventilation compared to sedation strategies that do not include DSI, the effects are uncertain because of the variability in the included studies.";2020;;;Uncertain;"Treatment COVID19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5849;35;"Evidencias COVID-19";"Fundaci�n Cardioinfantil - Cochrane Colombia";Spanish;"The use of anticoagulation as part of the treatment of severe COVID-19 could reduce the risk of death in hospitalized patients, especially those who require mechanical ventilation";"The benefit of anticoagulation shows a positive gradient in relation to treatment time. The possible excess risk of major bleeding events associated with anticoagulation is still imprecise due to the low event rate. The effect of anticoagulation on disease progression in patients with milder forms of COVID-19 is not known. The available data also do not allow us to know the effects of different anticoagulants and therapeutic regimens on the clinical outcomes of the disease.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5594;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertain the effect of some drugs to reduce early mortality in critically ill patients with Acute Respiratory Distress Syndrome (ARDS)";"Corticosteroids may reduce all-cause mortality within 3 months and increase the number of ventilator-free days up to day 28. It is uncertain if corticosteroids make any difference to late (later than 3 months) all-cause mortality. Surfactants, N-aceytylcysteine and statins probably make little or no difference to early mortality. Beta-agonists probably slightly increase early mortality. The review did not investigate the effects of nitric oxide, inhaled prostacyclins, partial liquid ventilation, neuromuscular blocking agents, fluid and nutritional interventions or medical oxygen.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5850;35;"Evidencias COVID-19";"Centro Cochrane Argentina";Spanish;"It is recommended PPE design modifications, such as grabbing tabs, as well as placement and removal procedures following CDC instructions, removal of glove and gown in one step, use of double gloves, and disinfection with gloves to reduce contamination and increase compliance with these recommendations";"This is an update of a Cochrane review published in 2016 and previously updated in 2019. It included 24 studies with 2,278 participants, of which 14 were randomized controlled trials (RCTs), one was a quasi-randomized RCT, and nine were of nonrandomized design. The evidence for all results is of very low certainty, based on one or two studies, with indirect evidence from sham studies, and at high risk of bias. Translated with www.DeepL.com/Translator (free version)";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6106;1;"NICE ";NICE;English;"It is not recommended pembrolizumab with axitinib for untreated advanced renal cell carcinoma in adults.";"Current treatment for untreated advanced renal cell carcinoma includes pazopanib, tivozanib or sunitinib. Also, cabozantinib is recommended for patients with intermediate or poor-risk cancer as defined by the International Metastatic Renal Cell Carcinoma Database Consortium. Short-term clinical trial evidence shows that pembrolizumab with axitinib is more effective than sunitinib for people with untreated renal cell carcinoma, but it is uncertain if there is a long-term benefit. This means the cost-effectiveness estimates are uncertain. Pembrolizumab with axitinib is not suitable for use in the Cancer Drugs Fund because it is unlikely to be cost effective at its current price (even if the uncertainty about its effectiveness is reduced).";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6362;29;"Choosing Wisely Australia";"Royal Australian & New Zealand College of Ophthalmologists";English;"Do not recommend using topical antibiotics before or after intravitreal injections.";"Topical antibiotics (either before or after intravitreal injection) have not been found to decrease the risk of endophthalmitis.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5339;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"There are no reliable studies that have evaluated the efficacy and safety of corticosteroids in patients with COVID-19.";"Available data from studies on patients affected by other viral infections are conflicting and in some cases subject to multiple biases, although many highlight that treatment could produce a variety of adverse effects on patients. Despite these data, some scientific societies have defined situations in which corticosteroid treatment can be used to palliate the uncontrolled inflammatory response caused by the virus, although there is no unanimity in their proposals. The absence of studies on patients with COVID-19 does not allow to conclude with any certainty the possible impact of the use of corticosteroids, and it will be necessary to wait for the publication of the results of the multiple clinical trials underway. A search of the Cochrane COVID-19 study registry retrieves six ongoing clinical trials up to April 08, 2020.";2020;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5595;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There is uncertainty about the beneficial effect of Tocilizumab as a potential therapy against COVID-19, since it can also carry unknown damage and, therefore, it should be considered as an experimental therapy with all its precautions.";"- There is currently no well validated effective treatment for COVID-19. - Tocilizumab (TCZ) is authorized in Spain for patients with severe involvement of T-CAR cell-induced cytokine release syndrome (SLC). - There are no clinical trials with results available regarding the use of TCZ in patients with COVID-19. - The study by Xu et al. It presents important limitations in its non-experimental and non-comparative design, so its hypotheses require confirmation. - A retrospective analysis of 66 patients with haematological tumors and severe SLC treated with TCZ suggests a beneficial effect in 70% of those analyzed. However, its limitations are of great significance in the COVID-19 population (among others, different patient profiles, without a control group, heterogeneity of the baseline studies, confusion with the effect of corticosteroids and a post-hoc efficacy variable). - The immunosuppressive effect of TCZ carries a significant risk of infections that could be detrimental in patients with severe COVID-19 pneumonia.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5851;35;"Evidencias COVID-19";"Centro Cochrane Argentina";Spanish;"It is recommended to include all health care personnel in the design of prevention strategies and influencing factors to improve their ability and willingness to follow infection prevention and control guidelines when caring for patients with respiratory infectious diseases.";"Healthcare workers report several factors that influence their ability and willingness to follow infection prevention and control guidelines when caring for patients with respiratory infectious diseases. These include factors linked to the practice guideline itself and how it is communicated, support from health care managers, workplace culture, training, physical space, accessibility and confidence in PPE, and a desire to provide good patient care. The review also highlights the importance of including all staff of the institution, including support staff, when implementing infection prevention and control guidelines. ";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6363;29;"Choosing Wisely Australia";"Australasian Chapter of Addiction Medicine";English;"While managing patients with Substance Use Disorder, exercise caution in the use of treatment approaches that are not supported by current evidence or involve unlicensed therapeutic products.";"Informed consent and treatment decision-making can be complicated in the field of addiction medicine where at times ?desperate? patients and/or their carers are attracted to treatment approaches that may not be supported by available evidence. In considering treatment options, it is our responsibility to present patients and carers with the available evidence regarding safety and effectiveness and to clearly identify where a proposed medication is not licensed for an indication. There are several medications in the field of addiction medicine for which the evidence is still emerging, such as the use of baclofen or topiramate in the treatment of alcohol dependence, amphetamine-based medications in the treatment of methamphetamine dependence, flumazenil for benzodiazepine withdrawal, or nabiximols in treating cannabis dependence. Other products (e.g. long acting naltrexone implants, medical cannabis products) may not be licensed by local regulatory bodies (the Therapeutic Goods Administration in Australia and Medicines Control in NZ). In these circumstances, clinicians should a) Follow RACP guidance regarding off-label prescribing or relevant therapeutic advisory bodies such as the Council of Australian Therapeutic Advisory Groups, the TGA and Medicines Control?s medicine safety updates and procedures for unlicensed medications, b) Provide clear and written information to patients and carers, and c) Consider such treatment approaches as ?second line? options for those not responding to conventional treatment approaches. A second opinion from another Addiction Medicine specialist is often advised. ";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6619;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"The use of N-acetylcysteine is not recommended for the prevention of acute renal failure after intravenous contrast. Hydration prior to the administration of intravenous contrast in patients with a GFR ?30 ml/min/1.73 m2 is not routinely justified.";"The recommendations and proposals only refer to adult patients (?18 years) who are going to undergo a radiological test prior to which the administration of iodinated contrast is required by INTRAVENOUS WAY. In all cases, the following should always be assessed: ? The need to perform a radiological test (mainly CT); ? Analyze whether there are other alternative imaging tests that do not require contrast administration; ? Evaluate the urgency of carrying out said test. Regarding the measures for the prevention of post-contrast acute renal failure in patients who are going to receive intravenous iodinated contrast: The use of N-Acetylcysteine ??for the prevention of post-contrast acute renal failure is NOT justified. The management of patients will be carried out according to the GFR that they present: Patients with glomerular filtration rate (GFR) ?30 ml/min/1.73 m2: In general, hydration is NOT justified for the prevention of post-contrast acute renal failure in patients with GFR ?30 ml/min/1.73 m2. In general, monitoring of renal function after administration of intravenous contrast in patients with GFR ?30ml/min/1.73m2 is not justified either. Patients with glomerular filtration rate (GFR) <30 ml/min/1.73 m2: There is no evidence on the efficacy and safety of hydration as a preventive measure for post-contrast acute renal failure in patients with GFR <30 ml/min. /1.73 m2 that are going to receive intravenous iodinated contrast. The management of these patients will be carried out according to the moment in which the radiological test is performed: Patients who are going to undergo a radiological test scheduled in advance: ? It is recommended to increase the salt intake in the diet (10-20 g of salt daily) and fluid intake (at least 1.5-2 liters of water per day ) during the 4-5 days prior to the radiological test. ? Whenever possible, treatment with metformin, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARA) should be interrupted 2 days before the test is performed. II) and as far as possible the treatment with diuretics will be suspended or reduced. ? Whenever possible, the administration of nephrotoxic chemotherapeutic treatments will be separated from the administration of the contrast medium by at least 7 days. Intravenous hydration is not justified. Patients who are going to undergo an urgent radiological test: The need for hydration will be analyzed on an individual basis according to the specific situation that the patient presents at that time and carefully assessing its benefit-risk in patients with heart failure. In cases where hydration is deemed necessary, intravenous administration is considered justified.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5596;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"The results of clinical trials that have evaluated the efficacy of hydroxychloroquine in the treatment of COVID-19 have shown inconclusive results, which must be interpreted with caution due to the limitations in their design.";"According to the results of an open, non-randomized clinical trial, hydroxychloroquine (at a dose of 600 mg per day) reduces the viral load of the SARS-CoV-2 coronavirus to the nasopharynx in patients with COVID-19 from the third day of treatment, with a more evident effect in patients receiving the treatment in combination with azithromycin (500 mg on the first day and 250 mg on the following four days). This study, however, has a very small sample, and has not yet described the clinical evolution of the patients or the adverse effects of the treatment. A small sample randomized clinical trial showed a similar rate of negativization in patients treated with hydroxychloroquine (400 mg daily for 5 days) or those who received usual care.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6108;1;"NICE ";NICE;English;"Volanesorsen is recommended for the treatment of genetically confirmed familial chylomicremia syndrome in adults who are at high risk of pancreatitis.";"Familial chylomicronaemia syndrome is a rare and potentially life-threatening condition that has a significant effect on the quality of life of people with the condition, and their families and carers. People with the condition have severe abdominal pain, unpredictable and recurrent acute pancreatitis and fatigue, and need to have a restricted low-fat diet. Current treatment options are limited. Clinical trial evidence shows short-term benefits with volanesorsen, including reduced triglyceride levels. It is uncertain whether this is maintained in the longer term, particularly at the licensed dose, which was not used in clinical trials.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 5853;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones, Facultad de Medicina - Universidad de";Spanish;"There is uncertainty about the impact of school closures on the epidemiological behavior of COVID-19 disease and on the physical and mental health of children and adolescents";"? The evidence on the transmissibility of the disease among children and from children to adults is contradictory and varies from low to very low quality. Three studies report transmission rates of SARS-CoV- 2 among children equal to those of adults, while five studies report lower transmissibility among children. ? Evidence indicates a lower rate of infection by SARS-CoV-2 in children in comparison to general population. Besides, children present milder or asymptomatic forms of COVID-19. We found a systematic review and three observational studies with low to moderate quality of evidence, which support this finding. ? Three studies were found reporting a moderately high real or simulated benefit from school closings on the number of COVID-19 cases, reduced pressure on health systems, or reduced mortality. In contrast, three studies reported little or no benefit, and two reported that closing schools generates more collapse of health services and higher mortality. ? Regarding the impact of school closings on the physical and mental health of children and adolescents. Evidence on this topic comes from situational analyzes, from findings in other epidemics, and from early observational studies reporting difficulties in accessing food or mental health services for children with disabilities, mental illness, or low socioeconomic status. ? Indirect evidence suggests that when children do not go to school, they are physically less active, have much more screen time, irregular sleep patterns, and less favorable diets, resulting in weight gain and loss of cardiorespiratory fitness. ? Stressors such as prolonged length of confinement, fear of infection, frustration and boredom, inadequate information, lack of face-to-face contact with peers, friends and teachers, lack of personal space at home and loss Family finances can have even more troublesome and lasting effects on children and teens.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5598;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Non-pharmacological interventions have reduced the number of reproduction (Rt) to 1.43 in the group of countries considered, which corresponds to a reduction of 64% with respect to the value prior to the implementation of the measures.";"In Spain, a model developed by Imperial College London estimates that 15.0% of the population (7.0 million people; ICr95% 1.8 to 19) would be infected as of March 28, 2020. The model estimates that non-pharmacological interventions applied to curb the epidemic would have prevented 16,000 deaths (ICr95% 5,400 to 35,000). Across the 11 European countries evaluated, they would have avoided 59,000 deaths (ICr95% 21,000 to 120,000). Non-pharmacological interventions have had a substantial impact on the reproduction number (Rt) of the countries where enough time has passed to observe their effects on the mortality trend (Italy and Spain). The proximity in time of the application of the different types of non-pharmacological measures makes it statistically impossible to determine which of them has a greater impact. The model derives the percentage of infected people from the data on the number of deaths observed, so that possible differences between countries in the mortality record could have an effect on the number of estimated cases of infection.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6110;1;"NICE ";NICE;English;"It is recommended nivolumab as an option for the treatment of locally advanced or metastatic squamous non-small cell lung cancer after chemotherapy in adults, ";"The treatment pathway for locally advanced or metastatic squamous NSCLC starts with a PD-1 or PD-L1 inhibitor or chemotherapy. Nivolumab would be used after chemotherapy. In line with clinical practice, nivolumab is a treatment option for people who have not had a PD?1 or PD?L1 inhibitor. Evidence of the key clinical trial shows that people who have nivolumab live longer than those who have docetaxel, which is the most appropriate comparator. There is uncertainty about how long people should have nivolumab for, but evidence suggests that there is continued benefitonly if it is stopped after 2 years of uninterrupted treatment or earlier if their disease progresses and they have not had a PD-1 or PDL-1 inhibitor before.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative." 6366;29;"Choosing Wisely Australia";"Royal Australian & New Zealand College of Ophthalmologists";English;"Do not recommend systemic investigation of healthy patients with a first uncomplicated episode of acute anterior uveitis.";"Investigations are not needed for the first episode if there is a negative review of the system. If it is a second episode or the history suggests a possible underlying cause, the appropriate investigations are: FBC, U and E, LFT, ESR, CRP, AS, Syphilis serology, HLA B27 and chest X-ray. Other tests are expensive and the performance is very low.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5599;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"It should be recommended to increase mobility in non-hospitalized patients with mild COVID-19 and risk of VTE.";"In non-hospitalized patients with mild COVID-19, increased mobility should be recommended. Although indiscriminate use of drug therapy for VTE prophylaxis should not be pursued, it is reasonable to conduct a risk assessment of VTE and bleeding. Pharmacological prophylaxis may be indicated after having individually assessed the risk in patients with a high risk of VTE without a high risk of bleeding. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5600;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"If patients have been taking antithrombotic agents due to a prior known thromboembolic disease, they should continue their antithrombotic treatment as recommended, as the risk of severe COVID-19 due to the use of antithrombotic agents is unknown.";"A consensus document establishes the main guidelines regarding thromboembolic disease management in the context of the COVID-19 pandemic";2020;;;"High value";"Treatment comorbilities";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6112;1;"NICE ";NICE;English;"It�s not recommended the use of balloon cryoablation in the treatment of squamous dysplasia of the esophagus.";"Squamous cells in the oesophagus may become dysplastic (squamous dysplasia). In some people, this condition may become malignant. Current management includes lifestyle change, acid-suppressing medicines, endoscopic mucosal resection, endoscopic submucosal dissection, ablative therapies and surgery. Ablative therapies include radiofrequency ablation, photodynamic therapy, argon plasma coagulation, laser ablation, multipolar electrocoagulation and cryotherapy. The evidence is not very high as there have been two case series studies. Radiotherapy ablation has been established as the first line of therapy, as it has been shown to decrease the risk of progression to high-grade dysplasia or adenocarcinoma. ";2020;;;"Low value";Treatment.;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6368;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Ophthalmologists";English;"Do not recommend topical steroids unless infection has been ruled out in any patient with red eye.";"Undiagnosed red eye should never be treated with topical steroids in any patient where infection must be ruled out.";2020;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5601;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"It is advisable to change to a treatment with an oral anticoagulant if there are no contraindications and there are no problems with access or availability for the drug, in patients with mild non-admitted COVID-19 who take vitamin K antagonists and who do not have stable INRs. recent, and that they are unable to carry out INR controls at home.";"A consensus document establishes the main guidelines regarding thromboembolic disease management in the context of the COVID-19 pandemic";2020;;;"High value";"Treatment co-morbilitites";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5602;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Risk stratification should be performed to decide on VTE prophylaxis in patients admitted with moderate or severe COVID-19 without disseminated intravascular coagulation (DIC).";"In patients admitted with COVID-19 without DIC, prophylactic doses of anticoagulants can be administered to prevent VTE. If pharmacological prophylaxis is contraindicated, it is recommended to consider intermittent mechanical compression. In patients admitted with COVID-19 without DIC, there is insufficient data to consider routine use with therapeutic or intermediate doses of parenteral anticoagulation with unfractionated heparin or low molecular weight heparin. Routine screening for VTE (with bilateral lower extremity ultrasound) cannot be recommended at this time in hospitalized patients with COVID-19 and with elevated D-dimer (> 1,500 ng / mL).";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6114;1;"NICE ";NICE;English;"It's not recommended pressurised intraperitoneal aerosol chemotherapy for peritoneal carcinomatosis in clinical practice";"PIPAC is a minimally invasive procedure that is performed by administering chemotherapy in the form of an aerosol into the peritoneal cavity. To do this, a special device is used that generates the aerosol and a microinjection pump or laparoscopic nebulizer connected to a standard double-head high-pressure injector through which the cytostatic drugs will be injected. Peritoneal Carcinomatosis is the tumor dissemination that affects, in a localized or massive way, the serosa of the peritoneum and the neighboring organs that can have two origins: the peritoneum or tumors of the digestive or gynecological tract. There is no curative treatment. NICE did a rapid review of the evidence from 4 systematic reviews, 3 case series and 1 case report. This procedure can cause serious but well-recognised side effects, therefore, should only be used in the context of research.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 5603;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Prophylactic anticoagulation should be administered in patients with moderate or severe COVID-19 and with DIC, but without obvious bleeding.";"-In patients with moderate or severe COVID-19 and with suspicion or confirmation of DIC, but without evident bleeding, there are insufficient data to consider the routine use of parenteral anticoagulation treatment with therapeutic or intermediate doses with unfractionated heparin or heparin. low molecular weight. -In patients with moderate or severe COVID-19 and on chronic anticoagulation treatment with suspected or confirmed DIC without obvious bleeding, it would be reasonable to consider the indication for anticoagulation, weighing the risk of bleeding when making clinical decisions about dose adjustment or interruption. Most authors of this manuscript recommended reducing the intensity of anticoagulation in this clinical circumstance, unless the risk of thrombosis is excessively high. -In patients with moderate or severe COVID-19 and with an indication of double antiplatelet therapy (eg, percutaneous coronary intervention in the last 3 months or recent myocardial infarction) and with suspicion or confirmation of DIC without evident bleeding, in In the absence of evidence, decisions about antiplatelet therapy must be made on an individual basis. In general, it is reasonable to continue double antiplatelet therapy if the platelet count is> 50,000, reduce it to single antiplatelet therapy if the platelet count is between 25,000 and 50,000; and suspend it if the count is <25,000. However, these guidelines could be changed in one direction or another depending on the individualized relative risk of thromboembolic complications versus bleeding. -In patients who were admitted for COVID-19 and are now being discharged, it would be reasonable to perform VTE screening routinely to consider pharmacological prophylaxis for 45 days from discharge. Pharmacological prophylaxis should be considered when there is an increased risk of thrombotic events, without an increased risk of bleeding. -Mobility and physical activity should be recommended.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5604;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Upon presentation of ST segment elevation myocardial infarction (STEMI) and COVID-19, clinicians should weigh the risks and severity of STEMI against the potential severity of COVID-19 infection for the patient, as well as the COVID-19 infection risk for the individual clinician and for the health system as a whole.";"Decisions about the primary performance of a percutaneous coronary intervention or fibrinolytic therapy should be informed from this assessment for patients with COVID-19 and acute coronary syndrome (ACS).";2020;;;"High value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5860;35;"Evidencias COVID-19";" Cochrane - Revisi�n sistem�tica";Spanish;"It is recommended the use of antifibrinolytics and combined hormonal oral contraceptives as treatments commonly available during pandemics for heavy menstrual bleeding";"There is moderate?certainty evidence that antifibrinolytics and combined hormonal oral contraceptives reduce heavy menstrual bleeding when compared with placebo. There is low?certainty evidence that non?steroidal anti?inflammatory drugs (NSAIDs) reduce heavy menstrual bleeding when compared with placebo. There is low?certainty evidence that antifibrinolytics are more effective in reducing heavy menstrual bleeding when compared with NSAIDs, short?cycle progestogen, or long?cycle progestogen. No conclusions can be made with regards to quality of life, women's satisfaction with treatment, or serious adverse events. Within the context of a pandemic, when direct contact with healthcare providers is not possible, women with heavy menstrual bleeding could be offered antifibrinolytics (tranexamic acid), NSAIDs, and combined hormonal oral contraceptives. They should be prescribed following the exclusion of contraindications. All treatments are commonly associated with side effects. Within the pandemic context, when the treatment for heavy menstrual bleeding is chosen without face?to?face contact, without a physical exam, blood tests, or ultrasound, it is important to emphasize that the women should have a complete assessment when health services are available.";2020;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5349;19;"Choosing Wisely Canada";"Choosing Wisely Canada";English;"Don?t go out for non-essential reasons. Keep a safe physical distance from others (2 m or 6 ft.) and follow guidance from your national and local public health authority.";"Physical distancing, along with handwashing, are the most effective ways to reduce the spread of COVID-19. Avoid crowds, unnecessary travel, and social gatherings. Individuals should only go out for groceries, to the pharmacy, or other essential trips. Decreasing the spread of COVID-19 can help alleviate the pressure on the health care system.";2020;;;"Low value";Prevenci�n;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5605;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of enteral and parenteral nutrition and their combination on sepsis and hospital mortality.";"Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit (ICU). This may interrupt their feeding routines and reduce appetite or increase nausea and vomiting, leading to malnutrition. In this Cochrane systematic review, the authors searched for randomized trials and quasi-randomized trials comparing enteral nutrition (EN), parenteral nutrition (PN) and the combination in adult ICU patients. There is low certainty evidence that enteral nutrition may reduce sepsis, based on studies among people with a range of different conditions. The effects of the feeding route on many outcomes including hospital mortality, mortality within 90 days or the number of ventilator-free days and adverse events such as pneumonia is uncertain.";2020;;;Uncertain;"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5861;35;"Evidencias COVID-19";"Unidad de Investigaci�n de Medicina Basada en Evidencias ? Hospital Infantil de M�xico Federico G�me";Spanish;" It is recommended to carry out physical interventions to interrupt or reduce the spread of respiratory viruses";"To reduce the transmission of respiratory diseases by viruses, the following effective interventions should be implemented, preferably in combination: - Frequent hand washing, with or without antiseptics attached. - Barrier measures such as gloves, gowns and masks with filtration devices. - Diagnosis of suspicion with isolation of probable cases. In addition, efforts should be focused on implementing all three interventions to reduce transmission from young children, who are generally the most fertile source of respiratory viruses. More large, pragmatic clinical trials are required, with better methodological quality and evaluating the most effective strategies (combined interventions) in the community and in healthcare settings, and with other respiratory viruses. It is important for clinicians to consider the risks, costs and benefits when making decisions for better practice and patient care.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6117;1;"NICE ";NICE;Spanish;"It is recommended to offer testing for Lynch syndrome to people who are diagnosed with endometrial cancer.";"Lynch syndrome is an inherited condition that increases the risk of certain types of cancer, including endometrial and colorectal cancer. If diagnosed, treatment and surveillance can be offered to reduce the risk of having another Lynch syndrome-associated cancer (in particular colorectal cancer) or identify it earlier. The external assessment group did a systematic review to identify evidence on the clinical effectiveness and diagnostic accuracy of immunohistochemistry and microsatellite instability based testing strategies for detecting Lynch syndrome in people with endometrial cancer and their relatives, with a focus on the benefits and harms of colorectal and endometrial cancer surveillance. ";2020;;;"High value";"Genetic testing";"Link to the recommendation on the website of the initiative" 5350;19;"Choosing Wisely Canada";"Choosing Wisely Canada";English;"Don?t go in person to a hospital, clinic, or health care provider for routine care (preventative visits, routine blood work) or non-essential care without calling ahead.";"Avoiding these locations lowers personal risk of infection. Clinics, hospitals and facilities are determining what care will continue and what can be delayed or rescheduled. Some routine tests or procedures may not be necessary if an individual has no symptoms or risk factors, while others should not delay. Individuals should speak with their health care provider. Health care professionals are also offering care virtually. ";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5606;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is uncertain that Extracorporeal Membrane Oxygenation (ECMO) is effective in reducing mortality in patients with Acute Respiratory Failure.";"Some patients with COVID-19 will become critically ill and need help with their breathing. Extracorporeal membrane oxygenation (ECMO) is a form of life support that targets the heart and lungs and which might be used for them. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials testing the use of ECMO for acute respiratory failure. It is uncertain whether ECMO is, or is not, more effective than conventional lung support in reducing mortality among patients with acute respiratory failure.";2020;;;Uncertain;"Treatment COVID-19, ICU, critically ill patient, acute respiratory failure";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5862;35;"Evidencias COVID-19";"Unidad de Evidencia y Deliberaci�n para la Toma de Decisiones, Facultad de Medicina - Universidad de";Spanish;"Combined interventions have been shown to be effective and have a high impact in reducing the transmissibility of the disease, the collapse of health care services, and mortality.";"? Mass confinement was studied in 6 of 39 studies, reporting contradictory results on the impact of its implementation. One of these studies reports deleterious effects on the economy and another on the mental health of citizens. ? The closure of schools and colleges was evaluated in 8 of 39 studies, which reported a low impact of the measure in reducing the transmissibility of the infection, the collapse of health care services, and mortality. ? Regarding measures of physical distancing, one of the simulation studies showed that the spread of the disease decreases when the time spent in a crowded place is reduced to 2 hours or less. ? Restriction of domestic travel has a moderate impact when it is introduced in the early stages of the epidemic, and is not effective when the epidemic has spread geographically. ? Self-isolation of symptomatic people is more effective the earlier it is done after the onset of symptoms, ideally in the first 24 hours. ? When the number of new cases has been controlled, it is necessary to maintain some measures of physical distancing, control of public transport, work at home measures, detection and isolation of cases; and contact tracing, to avoid new outbreaks. ? Contact tracing and case isolation is highly effective in controlling a new COVID-19 outbreak within 3 months of the first episode. ? For the dismantling of non-pharmacological interventions, when the number of new cases demonstrates control of the disease, evidence suggests that measures such as border closures, airport case detection procedures, and school closures and nurseries, could be those to be dismantled at first.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5095;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence on the safety of selective internal radiation therapy (SIRT) for unresectable colorectal metastases in the liver shows there can be serious complications, but these are well recognised and infrequent.";"Patient selection should be done by a specialist hepatobiliary cancer multidisciplinary team that can offer the full range of treatment options for this condition.";2020;;;"High value";"Colorectal cancer ";"https://www.nice.org.uk/guidance/ipg672" 5351;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t go to the emergency department for assessment of mild COVID-19 symptoms. Use virtual tools or screening centres if available.";"Individuals with mild symptoms of COVID-19 should not go to the emergency department for COVID-19 testing. Online self-assessment tools and dedicated screening centres can help people determine how to seek further care if necessary. Avoiding unnecessary calls and trips to the emergency department will help protect vulnerable patients in the emergency department, as well as health professionals caring for them. ";2020;;;"Low value";Prevenci�n;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6119;1;"NICE ";NICE;English;"Galcanezumab is recommended as an option for preventing migraine in adults";"Galcanezumab is 'indicated for the prophylaxis of migraine in adults who have at least 4 migraine days per month'. Treatment options for preventing episodic or chronic migraine include beta-blockers, antidepressants and anticonvulsant drugs. If episodic migraine does not respond to at least 3 oral preventive drug treatments, best supportive care (treatment for the migraine symptoms) is offered. If chronic migraine does not respond to at least 3 oral preventive drug treatments, botulinum toxin type A or best supportive care is offered. For migraine that has not responded to at least 3 preventive treatments, clinical trial evidence shows that galcanezumab works better than best supportive care in both episodic and chronic migraine. It is plausible that galcanezumab may work better than botulinum toxin type A. For episodic and chronic migraine, the most likely cost-effectiveness estimates are within what NICE normally considers an acceptable use of NHS resources. So galcanezumab is recommended for episodic and chronic migraine.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5352;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t self-prescribe or request unproven therapies to prevent or treat COVID-19.";"There are currently no vaccines, medications, or natural health products that are known to treat or protect against COVID-19. Using non-evidence- based treatments may expose patients to harm and lead to resource shortages. Additionally, antibiotics do not work against viral infections like COVID-19. ";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5608;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of high flow nasal cannulas compared to other forms of respiratory support for adult ICU patients.";"Viral infections such as COVID-19 can progress to acute respiratory failure, with patients needing help with their breathing in an intensive care unit (ICU). This might include the use of high-flow nasal cannulae (HFNC), which supply high flows of blended humidified air and oxygen. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials of the effects of high-flow nasal cannulae use in adult ICU patients compared to other non-invasive forms of respiratory support. There is insufficient evidence to determine the effects of high-flow nasal cannulae compared with other forms of respiratory support for adult ICU patients.";2020;;;Uncertain;"Treatment COVID-19, ICU, respiratory support";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5353;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t offer non-essential services to patients in person, if virtual tools such as telephone or online visits are available. Delay non-essential care and laboratory testing when possible.";"Virtual care can often meet patients? needs in a safer way. Further, delaying non-essential care or laboratory testing may free capacity for sicker patients. However, it is imperative to maintain continuity of care for patients with chronic medical conditions.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5865;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;"There is uncertainty about the psychological interventions to foster resilience in healthcare students";"For healthcare students, there is very?low certainty evidence for the effect of resilience training on resilience, anxiety, and stress or stress perception at post?intervention. The heterogeneous interventions, the paucity of short?, medium? or long?term data, and the geographical distribution restricted to high?income countries limit the generalisability of results. Conclusions should therefore be drawn cautiously. Since the findings suggest positive effects of resilience training for healthcare students with very?low certainty evidence, high?quality replications and improved study designs (e.g. a consensus on the definition of resilience, the assessment of individual stressor exposure, more attention controls, and longer follow?up periods) are clearly needed.";2020;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6121;1;"NICE ";NICE;English;"It is recommended Isatuximab, plus pomalidomide and dexamethasone as an option for treating relapsed and refractory multiple myeloma in adults.";"After 3 lines of treatment, people usually have pomalidomide plus dexamethasone, or daratumumab alone.Clinical trial evidence suggests that Isatuximab plus pomalidomide and dexamethasone delays the disease progressing and increases how long people live compared with pomalidomide plus dexamethasone. But, the trial is not finished so the benefit in the longer term is uncertain.";2020;;;"High value";treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5354;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t send frail residents of a nursing home to the hospital, unless their urgent comfort and medical needs cannot be met on site.";"Transfers can lead to risk for elder patients of contracting COVID-19. Furthermore, frail patients risk hospital-acquired infections, medication side effects, lack of sleep, and rapid loss of muscle strength while bedridden. Harms often outweigh benefits. If a transfer is unavoidable, give clear instructions to the hospital of the patient?s advance directives for care.";2020;;;"Low value";"Management ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5866;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;"Psychological interventions may have positive effects to foster resilience in healthcare professionals";"For healthcare professionals, there is very?low certainty evidence that, compared to control, resilience training may result in higher levels of resilience, lower levels of depression, stress or stress perception, and higher levels of certain resilience factors at post?intervention. The paucity of medium? or long?term data, heterogeneous interventions and restricted geographical distribution limit the generalisability of our results. Conclusions should therefore be drawn cautiously. The findings suggest positive effects of resilience training for healthcare professionals, but the evidence is very uncertain. There is a clear need for high?quality replications and improved study designs.";2020;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6122;1;"NICE ";NICE;English;"It is recommended Carfilzomib as an option for treating multiple myeloma in adults";"Evidence-based recommendations. Carfilzomib is a possible treatment for multiple myeloma in adults who have had only 1 previous therapy. ";2020;;;"High value";treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5355;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t give red blood cells (RBC) based solely on an arbitrary hemoglobin level. Give one-unit of RBC at a time and reassess the need for more.";"Many any Choosing Wisely recommendations indicate that RBC transfusions are overused. In non-bleeding patients, more appropriate approaches include single unit transfusions when the hemoglobin is less than 70-80 g/L (7-8 g/dL) Conserving the blood supply during the COVID-19 pandemic is critical.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5611;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"High levels of PEEP were not found to reduce hospital mortality in patients with ARDS";"Some patients with COVID-19 will develop acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). High levels of positive end-expiratory pressure (PEEP) might be used to prevent lung damage during MV. In this Cochrane systematic review, the authors searched for randomized trials to assess the effects of high versus low levels of PEEP in patients with ARDS or ALI. High levels of PEEP were not found to reduce hospital mortality compared to low levels in patients with ARDS or ALI.";2020;;;"Low value";"Treatment COVID-19, ICU, respiratory support, mechanical ventilation, lung injury";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5867;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Dexamethasone administration may be useful in severe patients with Covid-19, who need oxygen supplementation or mechanical ventilation";"The results of this preliminary study indicate that the administration of dexamethasone decreased mortality at 28 days in patients hospitalized with Covid-19 and who needed non-invasive oxygenation or assisted ventilation. These results suggest that therapies to be used in patients with Covid-19 should be based on their initial risk. For example, remdesivir is more effective in critically ill patients, but it is unlikely that non-ventilated patients and outpatients will be treated with these drugs. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6123;1;"NICE ";NICE;English;"It is recommended carfilzomib with dexamethasone as an option for treating multiple myeloma that have had one previous therapy in adults.";"Carfilzomib can be effective at late stages of the disease and does not appear to be associated with neuropathic adverse reactions to the same extent as standard treatment. It also offers a longer remission time. The company presented data from 2 clinical trials: carfilzomib plus dexamethasone, compared with bortezomib plus dexamethasone and carfilzomib plus lenalidomide and dexamethasone, compared with lenalidomide plus dexamethasone. The committee concluded the trial evidence showed a progression-free survival benefit for carfilzomib combinations over the comparators in the overall population.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5356;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t intubate frail elderly patients in the absence of a discussion with family members regarding the patient?s advance directives whenever possible.";"In the COVID-19 pandemic, these decisions must be made urgently, hopefully based on prior discussions. Frail elderly patients who are sick enough to require intubation for any reason, including COVID-19, have very poor survival outcomes and poor quality of life. Early conversations with patients and families help to prevent rushed decisions or ones that do not reflect patient wishes.";2020;;;"Low value";"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5868;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"The use of dexamethasone compared to usual treatment reduces mortality in patients hospitalized with COVID-19 and in need of mechanical ventilation or oxygen therapy.";"The randomized clinical trial RECOVERY (Randomised Evaluation of COVid-19 theERapY) studies a series of possible therapeutic alternatives for patients hospitalized with COVID-19, including dexamethasone. The study has so far recruited more than 11,500 patients from over 175 NHS hospitals in the UK. Overall, dexamethasone was found to reduce the 28-day mortality rate by 17% with a greater benefit among those patients who required mechanical ventilation. Dexamethasone reduced mortality by up to one-third in patients on mechanical ventilation and by up to one-fifth in patients receiving oxygen therapy only. No statistically significant differences were observed in those patients who did not require any supportive respiratory therapy. No out-of-hospital patients were studied. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6124;1;"NICE ";NICE;English;"It is recommended isatuximab plus pomalidomide and dexametasone Isatuximab for use as an option for treating relapsed and refractory multiple myeloma in patients who have had 3 previous lines of treatment including lenalidomide and a proteasome inhibitor, and whose disease has progressed on their last treatment, in adults.";"NICE guidance recommends both pomalidomide plus dexamethasone and panobinostat plus bortezomib and dexamethasone after 3 previous lines of treatment for relapsed and refractory multiple myeloma. Panobinostat plus bortezomib was not considered in the comparison due to its toxic effects and lack of efficacy. A clinical trial demonstrated that the use of isatuximab together with pomalidomide and dexamethasone extended the progression-free survival compared to the use of pomalidomide and dexamethasone from 7.8 to 13.3 months. It was concluded that isatuximab plus pomalidomide and dexamethasone was likely to prolong progression-free and overall survival compared with pomalidomide plus dexamethasone after 3 previous lines of treatment, but noted that the median follow-up was short, the subgroup small and immature data.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5357;19;"Choosing Wisely Canada";"Choosing wisely Canada";English;"Don?t prescribe unproven therapies for COVID-19 patients other than in an approved clinical trial.";"There is no formal consensus between clinician groups regarding treatment of COVID-19 and evidence is evolving. Treating patients outside of clinical trials will limit our collective ability to scientifically assess treatment efficacy and put patients at risk of harm from drugs. Monitored compassionate use approaches may be acceptable in some jurisdictions.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5613;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"Honey probably relieves cough symptoms in children more than other treatments like diphenhydramine and placebo";"Most people with COVID-19 will develop a persistent cough. Honey probably relieves cough symptoms, in children from 1 to 16 years, more than no treatment, diphenhydramine, and placebo, but may make little or no difference compared to dextromethorphan. Honey should not be given to children under 1 year of age.";2020;;;"High value";"Treatment COVID-19, children, persistent cough";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5869;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"BCG vaccine does not appear to protect against COVID-19";"There is no evidence that the BCG vaccine protects against Covid-19, so the WHO does not recommend changes to already approved vaccination plans.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6125;1;"NICE ";NICE;English;"Pembrolizumab is recommended as a therapeutic option for untreated or unresectable recurrent head and neck squamous cell carcinoma expressing PD-L1 with a combined positive score of 1 or more if given as monotherapy and if it is stopped after two years of uninterrupted therapy or earlier if the disease progresses in adults.";"Treatment of metastatic or unresectable recurrent head and neck squamous cell carcinoma depends on where it starts. If it starts in the oral cavity (mouth), it is usually first treated with cetuximab combination therapy (cetuximab with platinum and 5?fluorouracil [5-FU] chemotherapy). If it starts outside the oral cavity it is treated with chemotherapy (platinum and 5-FU) alone. Clinical trial evidence from people who have head and neck squamous cell carcinoma that expresses a biomarker called PD-L1 (with a combined positive score of 1 or more) shows that, if their cancer started in the oral cavity, pembrolizumab monotherapy works at least as well as cetuximab combination therapy and has lower overall costs. If their cancer started outside the oral cavity, pembrolizumab monotherapy works better than chemotherapy alone. It has higher overall costs but the cost-effectiveness estimates are within what NICE normally considers an acceptable use of NHS resources. Pembrolizumab monotherapy is therefore recommended for both types of head and neck squamous cell carcinoma.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5870;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Quarantine measures reduce the incidence of new cases and mortality from IDOC-19";"The implementation of quarantine measures is important to reduce the incidence of cases and mortality during the VOC-19 pandemic. To ensure greater effectiveness, it is recommended that it be combined with other public health measures.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6126;1;"NICE ";NICE;English;"It is recommended darolutamide with androgen deprivation therapy as an option for treating hormone-relapsed prostate cancer at high risk of developing metastatic disease in adults.";"When prostate cancer no longer responds to hormone treatment (androgen deprivation therapy), but has not spread beyond the prostate, the only option was to continue androgen deprivation therapy. Darolutamide added to androgen deprivation therapy would be another option at this stage. Clinical trial evidence shows that people taking darolutamide with androgen deprivation therapy have longer metastasis-free survival and overall survival compared with androgen deprivation therapy alone. However, it is unclear by how much in the long term.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5871;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Social distance measures, mask use, and eye protection appear to be effective in transmitting SARS-CoV-2";"Interventions to reduce viral transmission (physical distance of 1 meter or more, use of masks and/or eye protection) appear to be reasonably effective. The quality of the studies in this review was generally modest.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6127;1;"NICE ";NICE;English;"It is recommended as an option for treating secondary progressive multiple sclerosis with evidence of active disease (that is, relapses or imaging features of inflammatory activity) in adults. ";"In some people who have secondary progressive multiple sclerosis, a progressive one develops later in the course of the disease, often with overlapping relapses and without defined periods of remission. Between 30 and 50% of patients who are in the relapsing-remitting form of multiple sclerosis develop the secondary progressive form. The recommendation to administer siponimod in this type of multiple sclerosis comes from a clinical trial. Interferon beta-1b is the only disease-modifying treatment available for people with active secondary progressive multiple sclerosis. However, few people have it. Most of the people do not receive any treatment that modifies the disease. Therefore, effective treatment options are very limited. Results from clinical trials show that siponimod reduces the number of relapses and slows the progression of disability compared to placebo. It is not known how effective siponimod is compared to interferon beta-1b because there is no evidence comparing them.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5360;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"It is uncertain if masks under normal exhalation conditions (with or without spontaneous cough) could limit the transmission of SARS-CoV-2, additional studies are required in different settings to evaluate the potential benefit of its use.";"Recently it has been shown that exhalation, coughing and sneezing can have a turbulent multi-phase behavior, leading to an emission of particles of multiple sizes. The persistence of SARS-CoV-2 particles has also been shown both in the personal belongings of people with COVID-19, and in the environments in which they have remained. This justifies the need to evaluate the use of masks to see if they can reduce the transmission of SARS-CoV-2. A clinical trial that, among others, included 11 patients with seasonal coronaviruses other than SARS-CoV-2, did not detect viral particles in the drop samples or aerosols in the exhaled air samples when these people wore surgical masks. An experimental study in four participants who were asked to actively cough on Petri dishes showed that the use of cotton or surgical masks did not prevent the dispersion of SARS-Cov-19 particles. These studies show inconsistent results, which could be explained by its methodology (spontaneous exhalation versus active cough) or by the limited number of participants in each of them. ";2020;;;Uncertain;"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5872;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Video calls do not appear to have any effect on reducing social isolation and loneliness, or improving the quality of life for the elderly";"There is no good quality evidence to justify the use of video calls to improve the social isolation, loneliness and quality of life of older people.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6128;1;"NICE ";NICE;English;"It is recommended as an option for preventing migraine only if: they have 4 or more migraine days a month and at least 3 preventive drug treatments have failed, in adults.";"Migraine is a type of headache that can occur with symptoms such as nausea, vomiting, or sensitivity to light and sound. In many people, a throbbing pain is felt only on one side of the head. The evidence for administering galcanezumab in migraine (with the conditions set forth) comes from a clinical trial. Treatment options for preventing episodic or chronic migraine include beta-blockers, antidepressants and anticonvulsant drugs. If episodic migraine does not respond to at least 3 oral preventive drug treatments, best supportive care (treatment for the migraine symptoms) is offered. If chronic migraine does not respond to at least 3 oral preventive drug treatments, botulinum toxin type A or best supportive care is offered. For migraine that has not responded to at least 3 preventive treatments, clinical trial evidence shows that galcanezumab works better than best supportive care in both episodic and chronic migraine. It is plausible that galcanezumab may work better than botulinum toxin type A.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5361;35;"Evidencias COVID-19";"Cochrane Navarra - Secci�n de Innovaci�n y Organizaci�n del SNS-O";Spanish;"There is no certainty to discontinue ACEI or ARA-II treatments due to fear of COVID-19 infection";"- The scientific literature that supports the use of ACEI or ARA-II in hypertensive patients to obtain an alleged benefit against COVID-19 infection is scarce and of low quality evidence. - The hypotheses of potential benefit are based on experience with a previous virus (SARS-CoV), have been tested primarily in animal or in-vitro models and include both ACEI and ARA-II. - There is a potential risk of severe hypotension in patients hospitalized with respiratory failure and receiving treatment with ARS drugs. In order to give more clarity to the situation, the Spanish Agency for Medicines and Health Products (AEMPS) has issued a safety note in which it is recalled that ?patients under treatment with drugs from these groups must continue treatment, without that a modification of the same is currently justified ? - Adequately designed studies are needed to help determine if there really is an influence of the use of RAS drugs on the relevant clinical variables related to the patient with COVID-19. ";2020;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5873;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Es preciso que se sigan medidas preventivas para disminuir la carga viral en el hogar y as� reducir la incidencia y gravedad de la infecci�n COVID-19 que se transmite en este entorno.";"-Although there is little evidence on the impact of preventive measures at home, especially in the case of COVID-19, a clinical trial showed efficacy of using a web-based platform promoting hand washing to prevent seasonal flu. -Isolation of the patient in the infected home as much as possible (e.g., avoiding sharing areas of the home), habit modification (e.g., improving room ventilation or cleaning common surfaces), and frequent hand washing are some of the actions that can reduce viral load in the home. ";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6129;1;"NICE ";NICE;English;"It is recommended Venetoclax plus obinutuzumab as an option for untreated chronic lymphocytic leukaemia (CLL) in adults.";"People with untreated CLL are offered different treatments depending on whether they are likely to tolerate chemo-immunotherapy, and whether they have certain genetic abnormalities (such as a 17p deletion or TP53 mutation). In people with a 17p deletion or TP53 mutation, CLL does not usually respond well to standard chemo-immunotherapy, and ibrutinib is usually used. In people without a 17p deletion or TP53 mutation, FCR or BR are the most common chemo-immunotherapies used. If FCR or BR is unsuitable, obinutuzumab plus chlorambucil is used instead. Venetoclax plus obinutuzumab has not been directly compared with ibrutinib in people with a 17p deletion or TP53 mutation, and the results of an indirect comparison are uncertain. Clinical trial evidence shows that, in people without a 17p deletion or TP53 mutation and for whom FCR or BR is unsuitable, CLL treated with venetoclax plus obinutuzumab takes longer to progress than CLL treated with obinutuzumab plus chlorambucil. The cost-effectiveness estimates suggest that venetoclax plus obinutuzumab is more effective and less costly than obinutuzumab plus chlorambucil. Therefore, venetoclax plus obinutuzumab is recommended for routine use in the NHS for these people. Other recomendations: - Venetoclax plus obinutuzumab is recommended for use within the Cancer Drugs Fund as an option for untreated CLL in adults, only if: there is no 17p deletion or TP53 mutation, and FCR or BR is suitable, and the conditions in the managed access agreement for venetoclax plus obinutuzumab are followed. These recommendations are not intended to affect treatment with venetoclax plus obinutuzumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5618;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The effects of using omega-3 fatty acids or antioxidants in patients with ARDS are uncertain.";"Some patients with COVID-19 will develop acute respiratory distress syndrome (ARDS), and may need mechanical ventilation (MV) to help with their breathing. ARDS is an overwhelming systemic inflammatory process associated with significant morbidity and mortality. Immunonutrition, given as part of a feeding formula or as a nutritional supplement, might be used as part of its treatment. However; it is uncertain whether using omega-3 fatty acids or antioxidants as part of nutritional intake in patients with ARDS reduces the length of ICU stay or time on MV, improves oxygenation or increases adverse outcomes. There was no mortality benefit associated with use of omega?3 fatty acids or antioxidants in adults with ARDS.";2020;;;Uncertain;"Treatment COVID-19, ICU, mechanical ventilation, ARDA, inmunonutrition";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5874;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"There are no good quality data to validate the administration of convalescent plasma (post-SARS-CoV-2 infection) or hyperimmune immunoglobulin in patients with COVID-19";"The data available so far, although not conclusive, do not allow to measure with certainty the benefit and risk of therapies with convalescent plasma or hyperimmune immunoglobulin in patients with Covid-19. We will have to wait for the results of the 22 clinical trials still in progress.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5619;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The integration of traditional Chinese medicine with western medicine is recommended to replace western medicine alone.";"Like COVID-19, severe acute respiratory syndrome (SARS) is an acute respiratory disease caused by a coronavirus. Therapy which integrated traditional Chinese medicine (TCM) with western medicine (WM) was used to treat patients with these earlier coronaviruses and might be considered as a treatment for COVID-19. In this systematic review, the authors searched for randomized and non-randomized trials that compared the treatment effects of integrative TCM/WM with WM alone in the treatment of severe acute respiratory syndrome (SARS). The integration of traditional Chinese medicine with western medicine significantly improved some patient outcomes compared to western medicine alone, including resolution of lung infiltrate, CD4+, average daily use of corticosteroids and time to abatement of fever. There were no significant differences for mortality rate or cure rate.";2020;;;"High value";"Treatment COVID-19, SRAS, traditional Chinese medicine ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5875;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"Vitamin D is not recommended for use in the treatment or prevention of COVID-19";"The link between vitamin D and Covid-19 arises through the possibility that a population deficiency of vitamin D, to a greater or lesser extent, may be associated with a higher rate of SARS-CoV-2 infection or, alternatively, a worse diagnosis in those already infected. It is known that groups with higher infection rates may have higher levels of vitamin D deficiency, for example, the elderly and those with chronic illnesses, so this line of reasoning seems logical. But children, who are also at risk for vitamin D deficiency, are not considered to be at high risk for Covid-19. Currently, there are no studies evaluating, for example, the results of introducing vitamin D supplements into the diet of patients with Covid-19, nor are there any clinical trials comparing vitamin D and non-vitamin D therapeutic regimens.";2020;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6131;1;"NICE ";NICE;English;"Liraglutide is recommended as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults.";"Liraglutide is recommended as an option for managing overweight and obesity alongside a reduced-calorie diet and increased physical activity in adults, only if they have a body mass index (BMI) of at least 35 kg/m2 (or at least 32.5 kg/m2 for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population) and they have non-diabetic hyperglycaemia (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre) and they have a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia, because this group of people was at high risk of experiencing the adverse consequences of obesity. The clinical evidence shows that people lose more weight with liraglutide plus lifestyle measures than with lifestyle measures alone. Liraglutide has also been shown to delay the development of type 2 diabetes and cardiovascular disease. People from some minority ethnic groups are at an equivalent risk of the consequences of obesity at a lower BMI than the white population. NICE's guideline on BMI recommends using lower BMI thresholds for people from south Asian, Chinese, black African and African-Caribbean populations when identifying the risk of developing type 2 diabetes and providing interventions to prevent it. ";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5620;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of many pharmacological and non-pharmacological interventions to prevent delirium in patents in ICU. ";"Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit (ICU). One potential complication of this is the development of delirium, which has been associated with longer stays in ICU or hospital, greater risk of early death and long-term cognitive impairment. Various interventions have been tested to try to prevent delirium in patients in ICU. The effects of many pharmacological and non-pharmacological interventions used to try to prevent delirium in adults patents in ICU are uncertain. Dexmedetomidine may reduce the risk of developing delirium and shorten ICU stay for patients receiving non-invasive mechanical ventilation. Haloperidol did not significantly lower the rate of ICU delirium.";2020;;;Uncertain;"Prevention COVID-19, ICU. Delirium, mechanical ventilation";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5876;35;"Evidencias COVID-19";"Cochrane Portugal - Institute for Evidenced Based Health";Spanish;"There is uncertainty about the effect of remdesivir in patients with COVID-19, but there appears to be a benefit. ";"The results of this study ( J.H. Beigel et al. Remdesivir for the treatment of Covid?19 ? Preliminary report. NEJM published on May 22. 2020 DOI: 10.1056/NEJMoa2007764) seem to suggest the benefit of remdesivir on Covid-19, but they are preliminary data, difficult to generalize: for example, benefits were found mostly in more severe (but not ventilated) patients and in milder patients over time. The recovery period was the same: 5 days. These overall data seem to suggest that the timing of starting recovery therapy and the initial severity of Covid-19 may influence the results.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6132;1;"NICE ";NICE;English;"Atezolizumab plus bevacizumab is recommended as an option for treating advanced or unresectable hepatocellular carcinoma in adults who have not had previous systemic treatment.";"Standard care for advanced or unresectable hepatocellular carcinoma is either sorafenib or lenvatinib for people who have not had previous systemic treatment. Atezolizumab plus bevacizumab is a potential new treatment option. Clinical trial evidence shows that people with Child-Pugh grade A liver impairment and an ECOG performance status of 0 or 1 who have atezolizumab plus bevacizumab live longer and have longer before their disease progresses than people who have sorafenib. Results of an indirect comparison suggest that atezolizumab plus bevacizumab is more effective than lenvatinib. But this is uncertain because there is no direct evidence comparing them.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5621;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of many non-pharmacological interventions during an influenza pandemic";"A variety of interventions are likely to be used to limit the impact of the COVID-19 pandemic. Evidence on interventions that were used to reduce pandemic influenza transmission and infection may help in developing strategies for the management of COVID-19. The effects of many non-pharmacological interventions (including border control measures) are uncertain during an influenza pandemic, due to a lack of high quality evidence. There is insufficient evidence to determine the effects of extracorporeal membrane oxygenation for influenza-associated respiratory failure during an influenza pandemic. Corticosteroid therapy showed no benefit when used to treat acute lung injury and significantly increased nosocomial infection and mortality during an influenza pandemic.";2020;;;Uncertain;"Prevention COVID-19, influenza, public health";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5877;35;"Evidencias COVID-19";"Cochrane - Revisi�n r�pida";Spanish;"There is uncertainty whether plasma convalescence and hyperimmune immunoglobulin benefit people admitted to the hospital for covid-19";"There are 98 ongoing studies, 50 of which are RCTs, evaluating plasma and hyperimmune immunoglobulin. This is the first update of the review, and it will continue to be updated on a regular basis. These updates may show different results than those described here.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6133;1;"NICE ";NICE;English;"Upadacitinib, with methotrexate, is recommended as an option for treating active rheumatoid arthritis in adults whose disease has responded inadequately to intensive therapy with a combination of conventional disease-modifying antirheumatic drugs.";"The clinical trials show that for moderate to severe active rheumatoid arthritis that has not responded adequately to conventional DMARDs, upadacitinib with methotrexate is more effective than adalimumab with methotrexate or placebo with methotrexate. Based on the health-related benefits and costs compared with conventional and biological DMARDs, upadacitinib alone, or with methotrexate, is recommended only for severe active rheumatoid arthritis.";2020;;;"High value";"treatment, upadacitinib, rheumatoid arthritis, methotrexate, adults";"Link to the recommendation on the website of the iniciative/Link a la recomendaci�n en la p�gina web de la iniciativa" 5366;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is recommended to use a multifaceted approach (e.g. the use of masks during high risk exposure and the practice of evidence-based hand hygiene techniques) to prevent the transmission of respiratory infection in the community.";"(Grade A) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5622;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The use of a facemask in conjunction with hand hygiene is recommended to reduce infection during an influenza pandemic.";"A variety of interventions are likely to be used to limit the impact of the COVID-19 pandemic. Evidence on interventions that were used to reduce pandemic influenza transmission and infection may help in developing strategies for the management of COVID-19. Wearing a facemask in conjunction with hand hygiene reduces infection compared to hand hygiene alone during an influenza pandemic. School closure reduced contacts with infected people during an influenza pandemic.";2020;;;"High value";"Prevention COVID-19, influenza, public health ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5878;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Do not request non-urgent blood tests on different blood draws if they can be grouped together.";"A consortium of academic medical centers in the United States and Canada is proposing a set of recommendations for health professionals to prevent harm during the VOC-19 pandemic. The risks and benefits to both patients and health care workers of each test and treatment need to be carefully weighed.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6134;1;"NICE ";NICE;English;"It is recommended caplacizumab with plasma exchange and immunosuppression as an option for treating an acute episode of acquired thrombotic thrombocytopenic purpura in adults, and in young people aged 12 years and over who weigh at least 40 kg.";"Standard care for an acute episode of acquired thrombotic trombocytopenic purpura includes plasma exchange and immunosuppressant medicines.Adding caplacizumab likely reduces the long-term complications of acquired thrombotic trombocytopenic purpura and risk of death around the time of an acute episode, but it is unclear by how much. This is because the trial results do not address whether adding caplacizumab improves either length or quality of life in the long term after people stop taking the drug. Also, there are limited reported data on the long-term complications of acquired thrombotic trombocytopenic purpura after an acute episode.";2020;;;"High value";Treatment;"Link to the recommendation on the website of the iniciative/Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5367;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is not recommended the wearing of masks or respirators by uninfected persons in the general community.";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5623;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The effects of liberal fluid therapy for adults with septic shock are uncertain.";"Sepsis and septic shock are life-threatening complications of infection. Fluid therapy, either conservative or liberal, is used during its initial treatment. This may have relevance for the treatment of some critically ill patients with COVID-19. Liberal fluid therapy carried a greater risk of death in children with sepsis and septic shock, and there was insufficient evidence to conclude that it had any beneficial effects on other outcomes, compared to conservative fluid therapy. The effects of liberal versus conservative fluid therapy for adults with sepsis or septic shock are uncertain.";2020;;;Uncertain;"Treatment COVID-19, fluid therapy, sepsis, septic shock";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5879;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Do not use bronchodilators unless there is active obstructive airway disease and, if necessary, use metered-dose inhalers instead of nebulizers.";"A consortium of academic medical centers in the United States and Canada is proposing a set of recommendations for health professionals to prevent harm during the VOC-19 pandemic. The risks and benefits to both patients and health care workers of each test and treatment need to be carefully weighed.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5112;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for decontamination of all surgical instruments that come into contact with high-risk tissues during an interventional procedure.";"Surgical instruments that come into contact with high-risk tissues must not be moved from one set to another and must remain within their individual sets. Maintaining set integrity reduces the risks associated with instrument migration (including infection) and makes it easier to trace instruments back to the patients they were used on. Supplementary instruments that come into contact with high-risk tissues must remain within the individual set to which they have been introduced. Supplementary instruments are those that are not part of a specific instrument set. If supplementary instruments are used with different sets, this would compromise set traceability and increases the risks associated with instrument migration. The evidence on cost effectiveness does not support using sets of single-use instruments to reduce the risk of Creutzfeldt?Jakob disease (CJD) transmission.";2020;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5368;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is recommended to wear a mask by persons at high risk of exposure (e.g. persons living in a household with an infected individual). ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5624;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is uncertain whether early use of the Lopinave/Litonawe regimen is an effective treatment for COVID-19.";"Like COVID-19, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS) are acute respiratory diseases caused by a coronavirus. Antiviral therapy with Lopinave/Litonawe (LPV/r) was used to treat patients with these earlier coronaviruses and might be considered as a treatment for COVID-19. In this rapid systematic review, the authors searched Chinese and English literature databases for research of any design that compared LPV/r versus either placebo or standard care for patients with SARS or MERS, published between January 2003 and 24 January 2020. There was found that although early use of LPV/r regimen reduced the mortality of SARS and MERS, and reduced steroids dosing in the included studies, it is uncertain if it will be an effective treatment for patients with COVID-19. ";2020;;;Uncertain;"Treatment COVID-19, lopinave, SARS, antiviral";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5880;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Do not use the postero-anterior and lateral chest radiograph as the initial imaging test. Instead, use a portable chest x-ray.";"A consortium of academic medical centers in the United States and Canada is proposing a set of recommendations for health professionals to prevent harm during the VOC-19 pandemic. The risks and benefits to both patients and health care workers of each test and treatment need to be carefully weighed.";2020;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6136;35;"Evidencias COVID-19";"Evidence Aid";English;"It is recommended the use of telemedicine in patients with urogynecologic conditions.";"The COVID-19 pandemic is placing a great strain on healthcare systems and increasing use is being made of telehealth. This is a rapid review. The studies address the use of telemedicine for the treatment of outpatients with urogynecological conditions during the COVID-19 pandemic. At the time of this review, the included studies showed that virtual visits are effective for established Female Pelvic Medicine and Reconstructive Surgery patients who do not require a physical examination or for follow-up visits of those who live in rural regions. Virtual discussions of alternative therapies and counseling were suggested as replacements to preoperative visits while these patients wait for surgery delayed by the COVID-19 pandemic and its associated measures. The included studies showed that patients can safely extend the time between pessary cleanings to 6 (and in some cases to 24 months) with minimal risk of adverse events. Patients who are able to remove and reinsert their pessary should be encouraged to self-clean the pessary. Empiric vaginal estrogen may help minimize adverse events for patients who do not already take vaginal estrogen. The included studies showed that telemedicine is effective and lower costs for patients with urinary tract infections but may lead to increased prescriptions.";2020;;;"High value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5369;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is recommended to change immediately masks when they become damp. ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5625;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is recommended that the removal of mechanical ventilation in critically ill adults and children protocols take into account the complexity of clinical practice, the social and cultural environment in which they will be implemented.";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). Various methods are used to help wean patients off MV. Weaning protocols need to take account of the social and cultural environment in which they will be implemented. Weaning protocols need to accommodate the complexities of clinical practice found in the ICU environment. Comprehensive inter-professional input will help to ensure broad-based understanding and a sense of ownership of weaning protocols. Training of all relevant ICU staff will help with implementation of weaning protocols. Protocols should be designed with the patient profile and requirements of the target ICU in mind. An under-resourced ICU will impact adversely on protocol implementation. ";2020;;;"High value";"Prevention COVID-19, ICU, mechanical ventilation, weaning protocol";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5881;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Unless necessary, avoid face-to-face assessments and encourage virtual communication.";"A consortium of academic medical centers in the United States and Canada is proposing a set of recommendations for health professionals to prevent harm during the VOC-19 pandemic. The risks and benefits to both patients and health care workers of each test and treatment need to be carefully weighed.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5370;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is recommended to discard immediately and never reuse single-use masks.";" (Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5626;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Medidas de prevenci�n y control de la infecci�n";English;"The use of mechanical ventilation with a lower tidal volume is recommended in adult ICU patients.";"Some patients with COVID-19 will develop acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). However, complications such as ventilator-induced lung injury may arise with MV. Lung protective ventilation strategies involving gentler forms of MV are widely used to prevent this. Using mechanical ventilation with a lower tidal volume reduces 28-day mortality for adult ICU patients. The effects of different lung-protective ventilation strategies on mortality over the long-term is uncertain. ";2020;;;"High value";"Prevention COVID-19, ICU, mechanical ventilation, ARDS, mortality";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5882;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"Do not delay conversations about health care goals for inpatients who are unlikely to benefit from life support treatments.";"A consortium of academic medical centers in the United States and Canada is proposing a set of recommendations for health professionals to prevent harm during the VOC-19 pandemic. The risks and benefits to both patients and health care workers of each test and treatment need to be carefully weighed.";2020;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5371;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"If a mask is worn, it should be placed to cover the mouth and nose and tied securely to minimize any gaps. ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5627;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Medidas de prevenci�n y control de la infecci�n";English;"Ribavirin and interferon are recommended for the treatment of MERS";"Like COVID-19, Middle East respiratory syndrome (MERS) is an acute respiratory disease caused by a coronavirus. Some of the drugs given to patients with MERS are being considered for the treatment of patients with COVID-19. The combination of ribavirin and interferon might be effective for the treatment of MERS, if given promptly and with monitoring of adverse events. Corticosteroids did not show benefits on survival of patients with MERS. Interferon did not show benefits on mortality rate or duration of survival for patients with MERS.";2020;;;"High value";"Treatment COVID-19, MERS, ribavirin, interferon, adverse event";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5883;35;"Evidencias COVID-19";"Epistemonikos - COVID-19 L�OVE Working Group";Spanish;"There is uncertainty about the benefits of Remdesivir as a treatment for COVID-19";"The evidence available to decide what role to assign to remdesivir in the treatment of COVID-19 is of very low certainty. This means that it is not possible to establish whether it is effective, and if it is, the benefit-cost ratio cannot be determined. There are at least 19 ongoing randomized controlled trials evaluating the use of remdesivir in patients with VOC-19, especially in patients who require ventilatory support or are more severe. We estimate that the range of recommendations that we should expect with the currently available data is from recommending against its use (pending further evidence) to recommending weakly in favor of it in selected patients (e.g., severe patients). The latter could occur in contexts where financial resources are not a constraint.";2020;;;Uncertain;Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6139;35;"Evidencias COVID-19";"Evidence Aid";English;"Squama Manitis (pangolin scale) is not recommended for use in medical care in COVID-19 patients due to lack of evidence.";"Squama Manitis (pangolin scale) is used in traditional Chinese medicine but its effectiveness for the treatment of COVID-19 patients is not known. In this rapid review, the authors searched for studies of the therapeutic use of Squama Manitis for any health condition. They restricted their searches to articles published before 1 May 2020. They included 4 randomized trials, 1 case control study, 3 case series and 7 case reports. There were no included studies of the use of Squama Manitis for COVID-19 patients. The authors concluded that there was no reliable evidence for the clinical value of Squama Manitis. They suggested that it would be rational to prohibit its use in health care.";2020;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5372;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"The mask should not be touched while wearing or when removing ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5628;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"Non-invasive mechanical ventilation is recommended in high-risk lung infections, especially in pandemics.";"Some patients with COVID-19 will become seriously ill and develop breathing problems. Noninvasive ventilation (NIV) might be used to help with this. Use in the management of acute respiratory failure in pulmonary infections, especially in pandemics, can avert or reverse respiratory failure and decrease the need for endotracheal intubation in selected groups of contagious patients. Reasonable and adequate precautionary steps should be followed to protect healthcare workers, other patients and family members from an infectious spread when NIV is used. The use of NIV as first-line therapy is not recommended in severe respiratory failure with acute respiratory distress syndrome or in pneumonia.";2020;;;"High value";"Prevention COVID-19, ICU, mechanical ventilation, respiratory infection";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5884;35;"Evidencias COVID-19";"Instituto Nacional de Salud P�blica (INSP)";Spanish;"It is recommended to identify strategies to mitigate the transmission of acute respiratory diseases in public transportation";"Mathematical models suggest that transmission by acute respiratory diseases may be even greater over long distances, in environments with large congregations, such as wagons and subway stations, as well as in corporate areas, where a significant density of people are crowded together. Therefore, it is important to consider not only how often people use public transportation, but also the type of transportation and the areas where transportation starts and ends.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5373;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"If inadvertently touching the mask, hands must be immediately cleaned with soap and water, or alcohol-based hand rub. ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5629;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Medidas de prevenci�n y control de la infecci�n";English;"Noninvasive positive pressure ventilation reduces complications by helping to wean patients off mechanical ventilation";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but this can cause complications. Non-invasive positive-pressure ventilation (NPPV) (such as via a mask connected to a positive pressure ventilator) is used to try to reduce these complications by helping to wean patients off MV. There was a Cochrane systematic review, where the authors searched for randomized and quasi-randomized trials comparing early extubation with immediate application of NPPV versus invasive positive-pressure ventilation (IPPV) weaning in adults with respiratory failure. They identified 15 randomized and one quasi-randomized trial (total: 994 participants). Two thirds of the included patients had respiratory failure due to chronic obstructive pulmonary disease (COPD). NPPV appears to decrease mortality, weaning failure, pneumonia, length of stay in ICU and hospital, total duration of ventilation and tracheostomy and re-intubation rates, compared to invasive positive-pressure ventilation. However, these findings are mainly from trials in patients with COPD.";2020;;;"High value";"Prevention COVID-19, ICU, mechanical ventilation, NPPV";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5374;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"Cloth (e.g. cotton or gauze) masks are not recommended under any circumstances, to prevent the transmission of respiratory infection in low-risk community settings. ";"(Grade B) This evidence summary is based on a structured search of the literature and selected evidence-based health care databases. The evidence in this summary comes from: ? A systematic review (part of a series of four systematic reviews) of 10 RCTs.1 ? A systematic review of 17 studies (8 RCTS ? five in community settings and three hospital-based studies, and nine observational studies ? seven conducted among healthcare workers and two community-based studies).2 ? A systematic review of 16 studies, eight measuring the effectiveness of face mask use (one cluster RCT, three case-control, two cohort, and two cross-sectional), and the remaining measuring the effectiveness of hand hygiene practices only.3 ? A WHO interim guideline.4 ";2020;;;"Low value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5630;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effects of oral Ribavirin for treating non-influenza respiratory viral infections.";"COVID-19 is a viral infection of the respiratory tract. Oral ribavirin has been suggested for the treatment of other non-influenza respiratory viral infections. In this systematic review, the authors searched for research into the clinical outcomes of patients treated with oral ribavirin for symptomatic non-influenza respiratory viral infections. They identified 12 retrospective and 3 prospective studies. There were no randomized or controlled prospective studies. Oral ribavirin may improve outcomes for some adults with non-influenza respiratory viral infections (such as those who are immune-compromised) but its use should be based on a patient-specific risk and benefit assessment. The effects of oral ribavirin for children with non-influenza respiratory viral infections is uncertain.";2020;;;Uncertain;"Treatment COVID-19, ribavirin, influenza, respiratory infection";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5886;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"It is recommended to follow the prevention strategies: physical distancing, mask use, and eye protection as they decrease the risk of SARS-CoV-2 infection";"The findings of this review provide the best available evidence regarding three interventions aimed at decreasing the risk of SARS-CoV-2 infection: Physical spacing: One meter distance is associated with a significant reduction in infection. A distance of two meters may be more effective. Facemasks: The use of masks offers protection to people against coronavirus (both in healthcare settings and in the general public). Eye protection: may offer additional benefit in preventing infection. None of these interventions offer complete protection against SARS-CoV-2 infection.";2020;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5375;35;"Evidencias COVID-19";"JBI COVID-19 Special Collection";English;"It is advisable not to reuse surgical masks and respirators in the treatment of respiratory infections.";"A surgical/medical mask should only be worn once (single use only) and discarded immediately after use. A surgical/medical mask may be worn for up to six hours of continuous wear and should be replaced when damp. Respirator (N95 or equivalent) lifespan should be extended rather than intermittently reused because it involves less touching of the respirator and therefore, less risk of contact transmission. Extended use of a respirator may be implemented when: - Multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards. - The healthcare worker undertakes a series of close patient contacts (e.g. worn continuously on a shift, or for a few hours, especially in a situation where multiple patients are infected with the same respiratory pathogen). - For pathogens in which contact transmission (e.g. fomites) is not a concern (e.g. during the care of a patient with TB, SARS, or 2009 H1N1 flu). Respirators should not be reused: - After aerosol generating procedures, where higher FFR contamination levels are likely to occur. - Where patients are under contact precautions, such as those co-infected with common healthcare pathogens with the ability for prolonged environmental survival (e.g., Vancomycin-resistant enterococci, Clostridium difficile, norovirus, and COVID19). - If it becomes contaminated or damaged or difficult to breathe through. If a respirator is reused, it should be decontaminated with UVGI; however, ethylene oxide (EtO) or VHP may be considered in the absence of UVGI. ";2020;;;"Low value";"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5631;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is uncertain that over-the-counter medicines used to treat cough are effective";"Most people with COVID-19 will develop a persistent cough. Non-prescription, over-the-counter (OTC) medicines are often used to treat cough in children and adults. In the Cochrane systematic review, the authors searched for randomised trials of OTC cough preparations in children and adults with acute cough. They identified 10 placebo-controlled randomised trials in children (1036 participants) and 19 placebo-controlled randomised trials in adults (3799 participants). There is insufficient evidence for or against the effectiveness of OTC medicines for acute cough in children or adults.";2020;;;Uncertain;"Treatment COVID-19, cough, over-the-counter medicines";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5887;35;"Evidencias COVID-19";"Centro Cochrane Iberoamericano";Spanish;"It is not recommended the prolonged use and reuse of surgical masks and respirators (with or without reprocessing) ";"Prolonged use and reuse of surgical masks and respirators (with or without reprocessing) should only be considered in situations of critical shortages of protective equipment. When extended use or reuse is practiced, health care organizations should ensure that policies and systems are in place to ensure that these practices are carried out as safely as possible.";2020;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4608;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Advice on diet and lifestyle is recommended to prevent and relieve heartburn in pregnancy. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification.";"(Recommended) Remarks ? Lifestyle advice to prevent and relieve symptoms of heartburn includes avoidance of large, fatty meals and alcohol, cessation of smoking, and raising the head of the bed to sleep. ? The GDG agreed that antacids, such as magnesium carbonate and aluminium hydroxide preparations, are probably unlikely to cause harm in recommended dosages. ? There is no evidence that preparations containing more than one antacid are better than simpler preparations. ? Antacids may impair absorption of other drugs, and therefore should not be taken within two hours of iron and folic acid supplements.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4609;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman?s preferences and available options.";"(Recommended) Remarks ? The review found no evidence on the effect of non-pharmacological therapies, such as muscle stretching, relaxation, heat therapy, dorsiflexion of the foot and massage. ? The evidence on magnesium and calcium is generally of low certainty. However, the GDG agreed that they are unlikely to be harmful in the dose schedules evaluated in included studies. ? Further research into the etiology and prevalence of leg cramps in pregnancy, and the role (if any) of magnesium and calcium in symptom relief, is needed.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4610;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, support belts and acupuncture, based on a woman?s preferences and available options.";"(Recommended) Remarks ? Exercise to prevent low back and pelvic pain in pregnancy can take place on land or in water. While exercise may also be helpful to relieve low back pain, it could exacerbate pelvic pain associated with symphysis pubis dysfunction and is not recommended for this condition. ? Regular exercise is a key component of lifestyle interventions, which are recommended for pregnant women as part of ANC to prevent excessive weight gain in pregnancy. ? Pregnant women with low back and/or pelvic pain should be informed that symptoms usually improve in the months after birth. ? Women should be informed that it is unclear whether there are side-effects to alternative treatment options due to a paucity of data. ? Standardized reporting of outcomes is needed for future research on treatment for low back and/or pelvic pain in pregnancy.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4611;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Wheat bran or other fibre supplements can be used to relieve constipation in pregnancy if the condition fails to respond to dietary modification, based on a woman?s preferences and available options.";"(Recommended) Remarks ? Dietary advice to reduce constipation during pregnancy should include promoting adequate intake of water and dietary fibre (found in vegetables, nuts, fruit and whole grains). ? For women with troublesome constipation that is not relieved by dietary modification or fibre supplementation, stakeholders may wish to consider intermittent use of poorly absorbed laxatives.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4612;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Non-pharmacological options, such as compression stockings, leg elevation and water immersion, can be used for the management of varicose veins and oedema in pregnancy based on a woman?s preferences and available options.";"(Recommended) Remarks ? Women should be informed that symptoms associated with varicose veins may worsen as pregnancy progresses but that most women will experience some improvement within a few months of giving birth. ? Rest, leg elevation and water immersion are low-cost interventions that are unlikely to be harmful.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5124;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to seek specialist advice when prescribing antibiotics for a suspected diabetic foot infection in children and young people under 18 years.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4613;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"It is recommended that each pregnant woman carries her own case notes during pregnancy to improve continuity, quality of care and her pregnancy experience.";"(Recommended) Remarks ? The GDG noted that women-held case notes are widely used and are often the only medical records available in various LMIC settings. ? The GDG agreed that the benefits of women-held case notes outweigh the disadvantages. However, careful consideration should be given as to what personal information it is necessary to include in the case notes, to avoid stigma and discrimination in certain settings. In addition, health-system planners should ensure that admission to hospitals or other health-care facilities do not depend on women presenting their case notes. ? Health-system planners should consider which form the women-held case notes should take (electronic or paper-based), whether whole sets of case notes will be held by women or only specific parts of them, and how copies will be kept by health-care facilities. ? For paper-based systems, health-system planners also need to ensure that case notes are durable and transportable. Health systems that give women access to their case notes through electronic systems need to ensure that all pregnant women have access to the appropriate technology and that attention is paid to data security. ? Health-system planners should ensure that the contents of the case notes are accessible to all pregnant women through the use of appropriate, local languages and appropriate reading levels.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5125;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Enzyme-linked immunosorbent assay (ELISA) tests for therapeutic monitoring of tumour necrosis factor (TNF)-alpha inhibitors (drug serum levels and antidrug antibodies) show promise but there is currently insufficient evidence to recommend their routine adoption in rheumatoid arthritis. ";"The ELISA tests covered by this guidance are Promonitor, IDKmonitor, LISA-TRACKER, RIDASCREEN, MabTrack, and tests used by Sanquin Diagnostic Services. Laboratories currently using ELISA tests for therapeutic monitoring of TNF-alpha inhibitors in rheumatoid arthritis should do so as part of research and further data collection (see section 5.22). Further research is recommended on the clinical effectiveness of using ELISA tests for therapeutic monitoring of TNF?alpha inhibitors in rheumatoid arthritis (see sections 5.23, and 6.1 and 6.2). TNF-alpha inhibitors can be an effective treatment option for severe rheumatoid arthritis that does not respond to conventional therapy. Therapeutic monitoring of TNF?alpha inhibitors could help to optimise their use, improving management of the condition and outcomes that are important for people with rheumatoid arthritis. These include how long their disease is in remission, the rate of flares and relapse, and health-related quality of life. The clinical-effectiveness evidence for ELISA tests for therapeutic monitoring of TNF?alpha inhibitors in rheumatoid arthritis is not robust, although there are some positive trends. The key INGEBIO study is of poor quality and is not generalisable to NHS practice.";2019;;;"Low value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4614;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Midwife-led continuity-of-care models, in which a known midwife or small group of known midwives supports a woman throughout the antenatal, intrapartum and postnatal continuum, are recommended for pregnant women in settings with well functioning midwifery programmes. ";"(Context-specific recommendation) Remarks ? MLCC models are models of care in which a known and trusted midwife (caseload midwifery), or small group of known midwives (team midwifery), supports a woman throughout the antenatal, intrapartum and postnatal period, to facilitate a healthy pregnancy and childbirth, and healthy parenting practices. ? MLCC models are complex interventions and it is unclear whether the pathway of influence producing these positive effects is the continuity of care, the midwifery philosophy of care or both. The midwifery philosophy inherent in MLCC models may or may not be enacted in standard midwife practice in other models of care. ? Policy-makers in settings without well functioning midwife programmes should consider implementing this model only after successfully scaling up of the number and quality of practising midwives. In addition, stakeholders may wish to consider ways of providing continuous care through other care providers, because women value continuity of care. ? The panel noted that with this model of care it is important to monitor resource use, and provider burnout and workload, to determine whether caseload or team care models are more sustainable in individual settings. ? MLCC requires that well trained midwives are available in sufficient numbers for each woman to see one or only a small group of midwives throughout pregnancy and during childbirth. This model may therefore require a shift in resources to ensure that the health system has access to a sufficient number of midwives with reasonable caseloads. ? The introduction of MLCC may lead to a shift in the roles and responsibilities of midwives as well as other health-care professionals who have previously been responsible for antenatal and postnatal care. Where this is the case, implementation is likely to be more effective if all relevant stakeholders are consulted and human resources departments are involved. In some settings, government-level consultation with professional organizations could also aid implementation processes. ? The need for additional one-off or continuing training and education should be assessed, and should be provided where necessary.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4870;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Dyer O. BMJ 2019;364:l515";English;"It is not recommended that procedures to stabilize spinal fractures in patients with osteoporosis be the first choice for treatment. ";"Percutaneous vertebroplasty provides no demonstrable clinically significant benefit over placebo. While patients who had these surgeries may have had a short term reduction in pain, we found that there was no significant benefit over the long term in improving pain, back related disability, and quality of life when compared with those who did not have the procedures.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative " 5126;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence on the safety and efficacy of midcarpal hemiarthroplasty for wrist arthritis is inadequate in quantity and quality. ";"This procedure should only be used in the context of research. Further research could be in the form of case series. It should report patient selection, type and severity of arthritis, patient-reported outcome measures and the need for revision in the longer term (at least 5 years)";2019;;;"Low value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4615;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Group antenatal care provided by qualified health-care professionals may be offered as an alternative to individual antenatal care for pregnant women in the context of rigorous research, depending on a woman?s preferences and provided that the infrastructure and resources for delivery of group antenatal care are available.";"(Context-specific recommendation ? research) Remarks ? With the group ANC model, the first visit for all pregnant women is an individual visit. Then at subsequent visits, the usual individual pregnancy health assessment, held in a private examination area, is integrated into a group ANC session, with facilitated educational activities and peer support. ? Health-care facilities need to be seeing sufficient numbers of pregnant women, as allocation to groups is ideally performed according to gestational age. ? Health-care providers need to have appropriate facilities to deal with group sessions, including access to large, well ventilated rooms or sheltered spaces with adequate seating. A private space should be available for examinations, and opportunities should be given for private conversations. ? Group ANC may take longer than individual ANC, and this may pose practical problems for some women in terms of work and childcare. Health-care providers should be able to offer a variety of time slots for group sessions (morning, afternoon, evening) and should consider making individual care available as well. ? The GDG noted that group ANC may have acceptability and feasibility issues in settings where perceived differences keep people apart, e.g. women from different castes in India may not wish to be in a group together. ? Group ANC studies are under way in Nepal, Uganda and five other low-income countries, and the GDG was informed by a GDG member that some of these studies are due to report soon. Core outcomes of studies of group ANC should include maternal and perinatal health outcomes, coverage, and women's and providers' experiences.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4871;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";" Mahase E. BMJ";English;"A panel of international experts has recommended against routine testing of everyone aged 50-79 for bowel (colorectal) cancer. ";"The advice comes as part of a BMJ Rapid Recommendation, which looked at current guidelines and evidence. It concluded that screening should be recommended for men and women with a risk of 3% or more in the next 15 years, as this is the point at which the balance of benefits and harms tilts in favour of screening.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative " 5127;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";Spanish;"It is recommended to give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5639;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There is a slight beneficial effect of telephone interventions provided by health professionals for the education and psychosocial support of informal caregivers of adult patients with diagnosed diseases.";"Although the review indicated that there may be a mild beneficial effect of telephone support interventions on some outcomes (eg, anxiety and predisposition to provide care at the end of the intervention), in most outcomes, interventions that only using the phone may have little or no effect on caregiver outcomes compared to usual care. The results of the review were based primarily on studies with high overall risk of bias and a small number of participants. More high-quality trials are needed, with a larger sample size.";2019;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4616;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"The implementation of community mobilization through facilitated participatory learning and action (PLA) cycles with women?s groups is recommended to improve maternal and newborn health, particularly in rural settings with low access to health services.";"Participatory women?s groups represent an opportunity for women to discuss their needs during pregnancy, including barriers to reaching care, and to increase support to pregnant women. (Context-specific recommendation) Remarks ? Part of this recommendation was integrated from WHO recommendations on community mobilization through facilitated participatory learning and action cycles with women?s groups for maternal and newborn health (2014). ? The pathways of influence of this multifaceted, context-specific intervention on maternal and newborn outcomes are difficult to assess. Women meeting to identify their needs and seek solutions plays an important role; mechanisms related to additional activities that are organized based on the solutions identified at the meetings may also play a role.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4617;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Packages of interventions that include household and community mobilization and antenatal home visits are recommended to improve antenatal care utilization and perinatal health outcomes, particularly in rural settings with low access to health services.";"(Context-specific recommendation) Remarks ? The GDG agreed that the extent to which these packages improve communication and support for pregnant women is not clear. ? As a stand-alone intervention, the evidence does not support the use of antenatal home visits by lay health workers during pregnancy to improve ANC utilization health outcomes. While the quality and effectiveness of communication during home visits, and the extent to which they increase support for women, is not clear, antenatal home visits may be helpful in ensuring continuity of care across the antenatal, intrapartum and postnatal periods and in promoting other healthy behaviour. ? Stakeholders need to be clear that antenatal home visits by lay health workers do not replace ANC visits. ? Stakeholders should implement health system strengthening interventions alongside these community based interventions. ? Health-care providers need initial and ongoing training in communication with women and their partners. For women?s groups and community mobilization, providers also need training on group facilitation, in the convening of public meetings and in other methods of communication. ? Information for women and community members should be provided in languages and formats accessible to them and programme planners need to ensure that health-care providers/facilitators have reliable supplies of appropriate information materials. ? Programme planners should be aware of the potential for additional costs associated with home visits and community mobilization initiatives, including the potential need for extra staff and travel expenses. ? When considering the use of antenatal home visits, women?s groups, partner involvement or community mobilization, programme planners need to ensure that these can be implemented in a way that respects and facilitates women?s needs for privacy as well as their choices and their autonomy in decision-making. By offering pregnant women a range of opportunities for contact, communication and support, their individual preferences and circumstances should also be addressed. ? Further research is needed on the acceptability and feasibility of mixed-gender communication, the optimal methods for community mobilization, the best model for integration with health systems, continuity elements of home visits, and the mechanisms of effect of these interventions.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4873;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mahase E. BMJ";Spanish;"The WHO has urged governments around the world to implement a tool to reduce the spread of antimicrobial resistance. ";"The AWaRe tool classifies antibiotics into three groups: Access, Watch, and Reserve. It indicates which antibiotics to use for common or serious infections, which ones should be used sparingly or preserved, and which should be used only as a last resort. The campaign could increase the proportion of global antibiotic consumption in the Access group by at least 60%, while reducing the use of antibiotics in the Watch and Reserve groups. This would lower the risk of resistance because Access antibiotics are narrow spectrum, targeting a specific micro-organism rather than several. ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative " 5129;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Letermovir is recommended, within its marketing authorisation, as an option for preventing cytomegalovirus (CMV) reactivation and disease after an allogeneic haematopoietic stem cell transplant (HSCT) in adults who are seropositive for CMV";"Current management of CMV after an allogeneic HSCT (a stem cell transplant from a donor) involves regular blood tests to monitor CMV levels (with or without aciclovir). If CMV levels rise, treatment with ganciclovir, valganciclovir or foscarnet (pre-emptive therapy) is started to prevent disease but this can cause severe side effects. Letermovir is an option for reducing CMV and is safer than pre-emptive therapy. Clinical trial evidence shows that letermovir is effective in reducing CMV infection and also reduces the need for pre-emptive therapy. The most plausible cost-effectiveness estimates for letermovir are within the range that NICE usually considers acceptable. Therefore, it is recommended.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4618;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Task shifting the promotion of health-related behaviours for maternal and newborn health to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended.";"(Recommended) ? The GDG noted that, while task shifting has an important role to play in allowing flexibility in health-care delivery in low-resource settings, policy-makers need to work towards midwife-led care for all women. ? Lay health workers need to be recognized and integrated into the system, and not be working alone, i.e. task shifting needs to occur within a team approach. ? The mandate of all health workers involved in task shifting programmes needs to be clear. ? In a separate guideline on HIV testing services (98), WHO recommends that lay providers who are trained and supervised can independently conduct safe and effective HIV testing using rapid tests. ? The GDG noted that it may be feasible to task shift antenatal ultrasound to midwives with the appropriate training, staffing, mentoring and referral systems in place. ? Further research is needed on the mechanism of effect of MLCC and whether continuity of care can be task shifted.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5130;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Letermovir is recommended, within its marketing authorisation, as an option for preventing cytomegalovirus (CMV) reactivation and disease after an allogeneic haematopoietic stem cell transplant (HSCT) in adults who are seropositive for CMV";"Current management of CMV after an allogeneic HSCT (a stem cell transplant from a donor) involves regular blood tests to monitor CMV levels (with or without aciclovir). If CMV levels rise, treatment with ganciclovir, valganciclovir or foscarnet (pre-emptive therapy) is started to prevent disease but this can cause severe side effects. Letermovir is an option for reducing CMV and is safer than pre-emptive therapy. Clinical trial evidence shows that letermovir is effective in reducing CMV infection and also reduces the need for pre-emptive therapy. The most plausible cost-effectiveness estimates for letermovir are within the range that NICE usually considers acceptable. Therefore, it is recommended.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4619;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives and doctors is recommended.";"(Recommended) ? The GDG noted that, while task shifting has an important role to play in allowing flexibility in health-care delivery in low-resource settings, policy-makers need to work towards midwife-led care for all women. ? Lay health workers need to be recognized and integrated into the system, and not be working alone, i.e. task shifting needs to occur within a team approach. ? The mandate of all health workers involved in task shifting programmes needs to be clear. ? In a separate guideline on HIV testing services (98), WHO recommends that lay providers who are trained and supervised can independently conduct safe and effective HIV testing using rapid tests. ? The GDG noted that it may be feasible to task shift antenatal ultrasound to midwives with the appropriate training, staffing, mentoring and referral systems in place. ? Further research is needed on the mechanism of effect of MLCC and whether continuity of care can be task shifted.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4620;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Policy-makers should consider educational, regulatory, financial, and personal and professional support interventions to recruit and retain qualified health workers in rural and remote areas.";"(Context-specific recommendation) Strong recommendations (abridged) on recruitment and staff retention from the above guideline include the following. ?? Use targeted admission policies to enrol students with a rural background in education programmes for various health disciplines and/or establish a health-care professional school outside of major cities. ?? Revise undergraduate and postgraduate curricula to include rural health topics and clinical rotations in rural areas so as to enhance the competencies of health-care professionals working in rural areas. ?? Improve living conditions for health workers and their families and invest in infrastructure and services (sanitation, electricity, telecommunications, schools, etc.). ?? Provide a good and safe working environment, including appropriate equipment and supplies, supportive supervision and mentoring. ?? Identify and implement appropriate outreach activities to facilitate cooperation between health workers from better-served areas and those in underserved areas, and, where feasible, use tele-health to provide additional support. ?? Develop and support career development programmes and provide senior posts in rural areas so that health workers can move up the career path as a result of experience, education and training, without necessarily leaving rural areas. ?? Support the development of professional networks, rural health-care professional associations, rural health journals, etc., to improve the morale and status of rural providers and reduce feelings of professional isolation. ?? Adopt public recognition measures such as rural health days, awards and titles at local, national and international levels to lift the profile of working in rural areas.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4621;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women?s experience of care.";"(Recommended) Remarks ? The GDG stresses that the four-visit focused ANC (FANC) model does not offer women adequate contact with health-care practitioners and is no longer recommended. With the FANC model, the first ANC visit occurs before 12 weeks of pregnancy, the second around 26 weeks, the third around 32 weeks, and the fourth between 36 and 38 weeks of gestation. Thereafter, women are advised to return to ANC at 41 weeks of gestation or sooner if they experience danger signs. Each ANC visit involves specific goals aimed at improving triage and timely referral of high-risk women and includes educational components. However, up-to-date evidence shows that the FANC model, which was developed in the 1990s, is probably associated with more perinatal deaths than models that comprise at least eight ANC visits. Furthermore, evidence suggests that more ANC visits, irrespective of the resource setting, is probably associated with greater maternal satisfaction than less ANC visits. ? The GDG prefers the word ?contact? to ?visit?, as it implies an active connection between a pregnant woman and a health-care provider that is not implicit with the word ?visit?. In terms of the operationalization of this recommendation, ?contact? can be adapted to local contexts through community outreach programmes and lay health worker involvement. ? The decision regarding the number of contacts with a health system was also influenced by the following: ?? evidence supporting improving safety during pregnancy through increased frequency of maternal and fetal assessment to detect problems; ?? evidence supporting improving health system communication and support around pregnancy for women and families; ?? evidence from HIC studies indicating no important differences in maternal and perinatal health outcomes between ANC models that included at least eight contacts and ANC models that included more (11?15) contacts (203); ?? evidence indicating that more contact between pregnant women and knowledgeable, supportive and respectful health-care practitioners is more likely to lead to a positive pregnancy experience.";2019;;;"High value";"Health systems interventions to improve the utilization and quality of ANC ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4877;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"O?Dowd A. BMJ";English;"Flu vacination for NHS staff should become a contractual duty.";"England?s chief medical officer has suggested to MPs that employers should consider making it a contractual duty for NHS staff to have the annual flu vaccination to protect vulnerable patients from catching the disease. ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative " 5134;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended when intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4879;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mahase E. BMJ";English;"Public Health England urges to vaccinate all children due to the increase in measles cases. ";"Public Health England said that recent measles cases had mainly occurred in under-vaccinated communities and were linked with travel to countries with current large outbreaks. Consequently, it urged all parents to get their children vaccinated against measles, mumps, and rubella (MMR), especially if they did not have it when scheduled. ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative " 4880;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2019;364:l157";English;"It is recommended transdermal hormone replacement therapy to menopausic women who have a higher risk of serious venous thromboembolism";"Women who take hormone replacement therapy (HRT) as tablets have a higher risk of serious venous thromboembolism (VTE) than those not taking oral HRT. Patches, gels, and creams did not increase a woman?s chance of VTE.";2019;;;"High value";-;"<a href=""https://www.bmj.com/content/364/bmj.l157"" target=""_blank"">Link to the recommendation on the website of the initiative</a>" 5136;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to review the need for continued antibiotics regularly. Base antibiotic course length on the severity of the infection and a clinical assessment of response to treatment.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4881;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ.";Spanish;"Panel recommends that GPs should lead process of defining diseases to cut overdiagnosis. ";"The group has proposed a new process to set diagnostic thresholds and boundaries for conditions based on guidance proposed by the Guidelines International Network, which includes examining the potential harms as well as the benefits of changing a disease definition. The aim of this project is to reduce overdiagnosis. ";2019;;;"High value";-;"Link to the recommendation on the website of the " 5137;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recomended when hen prescribing antibiotics for a diabetic foot infection, give advice about: possible adverse effects of the antibiotic(s), seeking medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 1 to 2 days. ";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4883;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ";English;"It's not recommended to delay antibiotics in over 65s with UTI due to the risk of sepsis. ";"Prompt treatment should be offered to older pacients , especially men and patients living in areas of greater socioeconomic deprivation; however, more research is needed ""to establish whether treatment should be started with a broad or narrow spectrum antibiotic and to identify those in whom treatment is delayed is safe"".";2019;;;"High value";-;"Link to the recommendation on the website of the initiative " 5139;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended when microbiological results are available: review the choice of antibiotic and change the antibiotic according to results, using a narrow-spectrum antibiotic, if appropriate.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5652;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"It is encouraged to use the implementation of user-directed communication programs using mobile devices";"They include barriers to use that have equity implications. Program planners must take these factors into account when designing and executing programs. Authors of future trials should also actively consider these factors and report their efforts in trial publications.";2019;;;"High value";"Management ";"Link to the recommendation on the website of the initiative" 5141;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to reassess people with a suspected diabetic foot infection if symptoms worsen rapidly or significantly at any time, do not start to improve within 1 to 2 days, or the person becomes systemically very unwell or has severe pain out of proportion to the infection.";"Take account of: - other possible diagnoses, such as pressure sores, gout or non-infected ulcers, - any symptoms or signs suggesting a more serious illness or condition, such as limb ischaemia, osteomyelitis, necrotising fasciitis or sepsis, - previous antibiotic use.";2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5142;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to do not offer antibiotics to prevent diabetic foot infections and give advice about seeking medical help if symptoms of a diabetic foot infection develop.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4887;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to be aware that an acute cough is usually self-limiting and gets better within 3 to 4 weeks without antibiotics, is most commonly caused by a viral upper respiratory tract infection, such as a cold or flu and can also be caused by acute bronchitis, a lower respiratory tract infection, which is usually a viral infection but can be bacterial.";"Refer people with an acute cough to hospital, or seek specialist advice on further investigation and management, if they have any symptoms or signs suggesting a more serious illness or condition (for example, sepsis, a pulmonary embolism or lung cancer).";2019;;;"High value";Infections;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5144;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on platelet-rich plasma injections for knee osteoarthritis raises no major safety concerns. However, the evidence on efficacy is limited in quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";"Clinicians wishing to give platelet-rich plasma injections for knee osteoarthritis should: Inform the clinical governance leads in their NHS trusts. Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear information to support shared decision making. In addition, the use of NICE's information for the public is recommended. Audit and review clinical outcomes of all patients having platelet-rich plasma injections for knee osteoarthritis, including details of the methods used to prepare and administer the platelet-rich plasma injections. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion). Further research should be in the form of randomised controlled trials with medium- to long-term follow?up, including validated measures of knee function and patient-reported outcomes.";2019;;;"Low value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4889;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Benralizumab, as an add-on therapy, is recommended as an option for treating severe eosinophilic asthma that is inadequately controlled in adults despite maintenance therapy with high-dose inhaled corticosteroids and long-acting beta-agonists.";"only if: the person has agreed to and followed the optimised standard treatment plan and the blood eosinophil count has been recorded as 300 cells per microlitre or more and the person has had 4 or more exacerbations needing systemic corticosteroids in the previous 12 months, or has had continuous oral corticosteroids of at least the equivalent of prednisolone 5 mg per day over the previous 6 months (that is, the person is eligible for mepolizumab) or the blood eosinophil count has been recorded as 400 cells per microlitre or more with 3 or more exacerbations needing systemic corticosteroids in the past 12 months (that is, the person is eligible for reslizumab).";2019;;;"High value";Asthma;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5405;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";English;"Due to the very low?certainty evidence available, it is not clear whether bathing with chlorhexidine reduces hospital?acquired infections, mortality, or length of stay in the ICU, or whether the use of chlorhexidine results in more skin reactions. ";"This review assesses whether using chlorhexidine (instead of soap and water) to bathe patients in an intensive care unit (ICU), or a high?dependency or critical care unit reduces the number of hospital?acquired infections. The evidence available from the studies we analysed was very low quality, meaning that we cannot be certain whether bathing with chlorhexidine reduces the likelihood of critically?ill patients developing an infection, or dying. We are also uncertain whether bathing critically ill patients with chlorhexidine shortens the length of time people spend in hospital, or lowers their risk of developing skin reactions.";2019;;;Uncertain;"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative" 4895;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to start antibiotic treatment as soon as possible after establishing a diagnosis of hospital-acquired pneumonia, and certainly within 4 hours.";"Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. Send a sample (for example, sputum sample, nasopharyngeal swab or tracheal aspirate) for microbiological testing.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4898;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nivolumab with ipilimumab is recommended for use within the Cancer Drugs Fund as an option for adults with untreated advanced renal cell carcinoma that is intermediate- or poor-risk as defined in the International Metastatic Renal Cell Carcinoma Database Consortium criteria. It is recommended only if the conditions in the managed access agreement for nivolumab with ipilimumab are followed.";"This recommendation is not intended to affect treatment of nivolumab with ipilimumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Why the committee made these recommendations Current treatment for untreated advanced renal cell carcinoma is usually pazopanib, sunitinib, tivozanib or cabozantinib. For people with untreated advanced renal cell carcinoma that is at intermediate or high risk of getting worse, the results of a clinical trial (CheckMate 214) show that nivolumab with ipilimumab is more effective than sunitinib in the short term, but its long-term effects are uncertain. Nivolumab with ipilimumab has the potential to be cost effective, but more evidence is needed to address the clinical uncertainties. Longer-term follow-up of patients in CheckMate 214 would help to address the uncertainties about how long people live, and how long they live without their disease getting worse. Therefore, nivolumab with ipilimumab is recommended for use in the Cancer Drugs Fund for people who have untreated advanced renal cell carcinoma, while the manufacturer of nivolumab and ipilimumab collects further data.";2019;;;"High value";"Renal Cancer";"Link to the recommendation on the website of the initiative " 4905;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nivolumab is recommended for use within the Cancer Drugs Fund as an option for the adjuvant treatment of completely resected melanoma in adults with lymph node involvement or metastatic disease. It is recommended only if the conditions in the managed access agreement are followed.";"This recommendation is not intended to affect treatment with nivolumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. There are currently no adjuvant immunotherapies recommended by NICE for routine use in people who have melanoma with lymph node involvement or metastatic disease, who have had complete resection. Clinical evidence from CheckMate 238, an ongoing randomised trial, shows that nivolumab improves recurrence-free survival compared with ipilimumab. There are currently no trials comparing nivolumab with routine surveillance, which is the standard of care in the NHS. An indirect treatment comparison using ipilimumab as a common comparator showed that nivolumab is likely to improve recurrence-free survival compared with routine surveillance. However, there is currently no reliable clinical evidence to show that it improves overall survival. This means that the clinical and cost effectiveness of adjuvant nivolumab is uncertain. ";2019;;;"High value";"Skin Cancer Metastases";"Link to the recommendation on the website of the initiative " 4906;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Encorafenib with binimetinib is recommended, within its marketing authorisation, as an option for treating unresectable or metastatic BRAF V600 mutation-positive melanoma in adults. It is recommended only if the company provides encorafenib and binimetinib according to the commercial arrangements.";"Current treatments for unresectable or metastatic BRAF V600 mutation-positive melanoma include targeted therapy, usually using a combination of a BRAF and MEK inhibitor (dabrafenib with trametinib) or sometimes monotherapy with a BRAF inhibitor (vemurafenib or dabrafenib). Clinical trial evidence shows that, compared with vemurafenib, encorafenib with binimetinib extends the time until melanoma progresses and also how long people live. There are no trials directly comparing it against dabrafenib with trametinib. But compared indirectly, encorafenib with binimetinib appears to be as effective as dabrafenib with trametinib. When the commercial arrangements for encorafenib, binimetinib, dabrafenib and trametinib are taken into account, encorafenib with binimetinib is considered to be a cost-effective use of NHS resources. It is therefore recommended.";2019;;;"High value";"Skin Cancer Metastases";"Link to the recommendation on the website of the initiative" 5162;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended Tildrakizumab as an option for treating plaque psoriasis in adults, only if: the disease is severe, as defined by a total (PASI) of 10 or more and a (DLQI) of more than 10 and the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated.";"Consider stopping tildrakizumab between 12 weeks and 28 weeks if there has not been at least a 50% reduction in the PASI score from when treatment started. Stop tildrakizumab at 28 weeks if the psoriasis has not responded adequately. An adequate response is defined as: - a 75% reduction in the PASI score (PASI 75) from when treatment started or - a 50% reduction in the PASI score (PASI 50) and a 5?point reduction in DLQI from when treatment started. If patients and their clinicians consider tildrakizumab to be one of a range of suitable treatments, the least expensive should be chosen (taking into account administration costs, dosage, price per dose and commercial arrangements). When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate. When using the DLQI, healthcare professionals should take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any adjustments they consider appropriate. These recommendations are not intended to affect treatment with tildrakizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2019;;;"High value";" Psoriasis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4907;1;"NICE ";" National Institute for Health and Clinical Excellence (NICE)";English;"Cemiplimab is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced or metastatic cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy is not appropriate. It is recommended only if the conditions in the managed access agreement are followed.";"Treatment with cemiplimab should be continued until disease progression or for up to 24 months (whichever is sooner). These recommendations are not intended to affect treatment with cemiplimab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Living with advanced unresectable cutaneous squamous cell carcinoma is physically and emotionally challenging, and there is a high unmet need for new treatments. Cemiplimab trial data are promising but uncertain.";2019;;;"High value";"Skin Cancer Metastases";"Link to the recommendation on the website of the initiative " 5163;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";Spanish;"Certolizumab pegol is recommended as an option for treating plaque psoriasis in adults, on determined conditions.";"Certolizumab pegol is recommended as an option for treating plaque psoriasis in adults, only if: - the disease is severe, as defined by a total Psoriasis Area and Severity Index (PASI) of 10 or more and a Dermatology Life Quality Index (DLQI) of more than 10 and - the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated and - the lowest maintenance dosage of certolizumab pegol is used (200 mg every 2 weeks) after the loading dosage and - the company provides the drug according to the commercial arrangement. Stop certolizumab pegol at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as: - a 75% reduction in the PASI score (PASI 75) from when treatment started or - a 50% reduction in the PASI score (PASI 50) and a 5?point reduction in DLQI from when treatment started.";2019;;;"High value";Psoriasis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5419;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"Dexmedetomidine may shorten the duration of delirium in critically ill adults";"In this Cochrane systematic review and network meta-analysis, the authors searched for randomized and quasi-randomized trials of pharmacological interventions for treating delirium in critically ill adults. They did not restrict their search by type or language of publication and did the search in March 2019. They included 14 studies (1844 participants). They also identified 10 ongoing trials and 6 studies awaiting classification.";2019;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative" 5164;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"Risankizumab is recommended as an option for treating plaque psoriasis in adults, only if: the disease is severe, as defined by a total PASI of 10 or more and a DLQI of more than 10 and the disease has not responded to other systemic treatments, including ciclosporin, methotrexate and phototherapy, or these options are contraindicated or not tolerated.";"Stop risankizumab treatment at 16 weeks if the psoriasis has not responded adequately. An adequate response is defined as: - a 75% reduction in the PASI score (PASI 75) from when treatment started or - a 50% reduction in the PASI score (PASI 50) and a 5?point reduction in DLQI from when treatment started. If patients and their clinicians consider risankizumab to be one of a range of suitable treatments, including guselkumab, secukinumab and ixekizumab, the least expensive should be chosen (taking into account administration costs, dosage, price per dose and commercial arrangements). When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate. When using the DLQI, healthcare professionals should take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any adjustments they consider appropriate. These recommendations are not intended to affect treatment with risankizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2019;;;"High value";Psoriasis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5420;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is not recommended Rivastigmine for the treatment of delirium as it was associated with harm (longer ICU stay)";"In this Cochrane systematic review and network meta-analysis, the authors searched for randomized and quasi-randomized trials of pharmacological interventions for treating delirium in critically ill adults. They did not restrict their search by type or language of publication and did the search in March 2019. They included 14 studies (1844 participants). They also identified 10 ongoing trials and 6 studies awaiting classification";2019;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative" 5165;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended, to ensure that cellulitis and erysipelas are treated appropriately, exclude other causes of skin redness such as: an inflammatory reaction to an immunisation or an insect bite or a non-infectious cause such as chronic venous insufficiency.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5166;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to consider taking a swab for microbiological testing from people with cellulitis or erysipelas to guide treatment, but only if the skin is broken and: there is a penetrating injury or there has been exposure to water-borne organisms or the infection was acquired outside the UK.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5167;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended, before treating cellulitis or erysipelas, consider drawing around the extent of the infection with a single-use surgical marker pen to monitor progress. Be aware that redness may be less visible on darker skin tones.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4912;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It's recommended to refer urgently adults with new-onset blackouts (transient loss of consciousness), accompanied by features that are strongly suggestive of epileptic seizures, for neurological assessment in line with the recommendation for people with suspected epilepsy in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s.";"Do not routinely refer adults with blackouts if there are clear features of vasovagal syncope, even if associated with brief jerking of the limbs. See recommendation 1.1.4.3 on uncomplicated faint in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s.";2019;;;"High value";"Brain cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5168;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to offer an antibiotic for people with cellulitis or erysipelas. ";"When choosing an antibiotic (see the recommendations on choice of antibiotic), take account of: - the severity of symptoms - the site of infection (for example, near the eyes or nose) - the risk of uncommon pathogens (for example, from a penetrating injury, after exposure to water-borne organisms, or an infection acquired outside the UK) - previous microbiological results from a swab - the person's meticillin-resistant Staphylococcus aureus (MRSA) status if known.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6704;36;"Choosing Wisely UK";"Royal Pharmaceutical Society";English;"It is recommended that the use of any antibiotic in hospital centers be reviewed within 72 hours of its initiation.";"This guideline deals with awareness of the correct use of antimicrobial medicines (including antibiotics) and the dangers associated with their excessive or incorrect use. It also includes infection prevention and control measures that can prevent people from needing antimicrobials or from spreading the infection to others. Its goal is to change people's behavior to reduce antimicrobial resistance and the spread of resistant microbes.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5169;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6705;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended to offer a three-month trail of supervised pelvic floor muscle training as a first line treatment to pregnant women and women experiencing stress or mixed urinary incontinence. ";"Approximately one third of women experience urinary incontinence and up to one tenth fecal incontinence after childbirth. Pelvic floor muscle training (PFMT) is often recommended during pregnancy and after delivery for both prevention and treatment of incontinence. The evidence supporting the recommendation of supervised training of the pelvic floor muscles is extensive and includes several clinical guidelines.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5170;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended, if intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5171;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to manage any underlying condition that may predispose to cellulitis or erysipelas, for example: diabetes, venous insufficiency, eczema, oedema, which may be an adverse effect of medicines such as calcium channel blockers.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6707;36;"Choosing Wisely UK";"Royal Pharmaceutical Society";English;"It is recommended that all people of the general population be advised on and signposted to alternative options by their pharmacist such as self-care, lifestyle changes and non-pharmacological interventions where appropriate.";"Data on social prescribing broadly support its potential to reduce the demand for primary and secondary care. reduce the demand for primary and secondary care. However However, the quality of the data is poor and without a more thorough evaluation it would be premature. conclude that a proof of concept for demand reduction has been established. Similarly, the evidence that social prescribing saves health services costs over and above operational costs is encouraging.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5172;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended, when prescribing antibiotics for cellulitis or erysipelas, give advice about: possible adverse effects of antibiotics, the skin taking some time to return to normal after the course of antibiotics has finished seeking medical help if symptoms worsen rapidly or significantly at any time, or do not start to improve within 2 to 3 days.";.;2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4917;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Abemaciclib with an aromatase inhibitor is recommended, within its marketing authorisation, as an option for treating locally advanced or metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer as first endocrine-based therapy in adults. Abemaciclib is recommended only if the company provides it according to the commercial arrangement.";"Palbociclib or ribociclib, taken with an aromatase inhibitor, are usually the first treatments for locally advanced or metastatic, hormone receptor-positive, HER2-negative breast cancer. They are cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors, as is abemaciclib. Clinical trial evidence shows that abemaciclib with an aromatase inhibitor increases how long people live without their disease getting worse, compared with an aromatase inhibitor alone. It is not known whether abemaciclib increases the length of time people live, because the final trial results are not available yet. Abemaciclib, palbociclib and ribociclib have different side effects, but they all appear to work as well as each other. Taking into account the commercial arrangements for all the CDK 4/6 inhibitors, abemaciclib is a cost-effective use of NHS resources and it can be recommended.";2019;;;"High value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5173;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to reassess people with cellulitis or erysipelas if symptoms worsen rapidly or significantly at any time, do not start to improve within 2 to 3 days, or the person: becomes systemically very unwell or has severe pain out of proportion to the infection or has redness or swelling spreading beyond the initial presentation.";"has redness or swelling spreading beyond the initial presentation (taking into account that some initial spreading may occur, and that redness may be less visible on darker skin tones)";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6709;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended that a supervised pelvic floor muscle training (PFMT) program be offered, along with lifestyle modifications and vaginal estrogen, if appropriate, for a minimum of 16 weeks (continue if effective) to women 18 years and older with symptomatic prolapse, before considering surgery.";"Pelvic organ prolapse occurs when one or more of the pelvic organs, such as the uterus or vagina, slip out of position and sag, and may be accompanied by functional urination problems. Treatment options for pelvic organ prolapse should include lifestyle modification, such as weight loss, pelvic floor muscle training for at least 16 weeks as the first option for women with symptomatic stage 1 pelvic organ prolapse or stage 2, and the application of topical estrogens in case of pelvic organ prolapse and signs of vaginal atrophy. These options should be considered prior to surgery. The evidence for this recommendation includes clinical practice guidelines as well as other publications.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 4918;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pertuzumab, with intravenous trastuzumab and chemotherapy, is recommended for the adjuvant treatment of human epidermal growth factor receptor 2 (HER2)-positive early stage breast cancer in adults, only if they have lymph node-positive disease and the company provides. ";"This guidance is not intended to affect adjuvant treatment with pertuzumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. There is uncertainty about the size of the clinical benefit for pertuzumab in the adjuvant treatment of HER2?positive early stage breast cancer at high risk of recurrence. Clinical trial evidence measuring invasive disease-free survival suggests that 1.7% fewer people with this type of cancer have invasive disease at 4 years with adjuvant pertuzumab. Evidence from people with lymph node-positive disease (that is, disease that has spread to lymph nodes in the armpit) suggests more benefit in this population, with 3.2% fewer people having invasive disease at 4 years. However, it is not known whether this means that adjuvant pertuzumab increases the overall length of time people live.";2019;;;"High value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5174;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommende, when reassessing people with cellulitis or erysipelas, take account of: other possible diagnoses, any underlying condition that may predispose to cellulitis or erysipelas, any symptoms or signs suggesting a more serious illness or condition, any results from microbiological testing any previous antibiotic use.";"- other possible diagnoses, such as an inflammatory reaction to an immunisation or an insect bite, gout, superficial thrombophlebitis, eczema, allergic dermatitis or deep vein thrombosis - any underlying condition that may predispose to cellulitis or erysipelas, such as oedema, diabetes, venous insufficiency or eczema - any symptoms or signs suggesting a more serious illness or condition, such as lymphangitis, orbital cellulitis, osteomyelitis, septic arthritis, necrotising fasciitis or sepsis - any results from microbiological testing - any previous antibiotic use, which may have led to resistant bacteria.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5686;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is uncertainty about the possible benefits of remotely provided psychological therapies for the treatment of recurrent and chronic pain in children and adolescents.";"There are currently few trials investigating psychological therapies at a distance, especially on the Internet. Interpretations of analyzes are made with caution. A beneficial effect of therapies was found to reduce headache severity after treatment. Regarding the remaining results, there were no beneficial effects after treatment or at follow-up, or evidence to determine an effect was lacking. In general, the participant's satisfaction with the treatment was positive. Therefore, the quality of the available evidence was considered very low, which means that there is little certainty about the estimates. Additional studies are needed to increase confidence in this potentially encouraging field.";2019;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 4919;1;"NICE ";;Spanish;"Palbociclib with fulvestrant is recommended for use within the Cancer Drugs Fund as an option for treating hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer in people who have had previous endocrine therapy.";"Only if: - Exemestane plus everolimus is the most appropriate alternative to a cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitor and - The conditions in the managed access agreement for palbociclib with fulvestrant are followed. This recommendation is not intended to affect treatment with palbociclib with fulvestrant that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2019;;;"High value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4920;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Neratinib is recommended as an option for the extended adjuvant treatment of hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)?positive early stage breast cancer in adults who completed adjuvant trastuzumab-based therapy less than 1 year ago.";"Only if: - trastuzumab is the only HER2?directed adjuvant treatment they have had, and - if they had neoadjuvant chemotherapy-based regimens, they still had residual invasive disease in the breast or axilla following the neoadjuvant treatment, and - the company provides neratinib according to the commercial arrangement. This recommendation is not intended to affect treatment with neratinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2019;;;"High value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5432;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"Reliable information on the use of corticosteroids to reduce mortality in adults with acute respiratory distress syndrome is not available.";"Corticosteroids can reduce all-cause mortality within three months by 86 per 1,000 patients (with up to 161 fewer or 19 more deaths). However, the 95% confidence interval (CI) includes the possibility of increasing and decreasing deaths (relative risk [RR] 0.77; 95% CI 0.57 to 1.05; six studies, 574 participants ; evidence of low certainty).";2019;;;Uncertain;"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mortality";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4922;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence recommend adopting Endocuff Vision in the NHS because it improves the adenoma detection rate during colonoscopy, particularly for people having a colonoscopy as part of bowel cancer screening.";"Endocuff Vision should be considered as an option for people having a colonoscopy as part of bowel cancer screening following a positive stool test. There is limited evidence for the benefits of Endocuff Vision in a non-screening population. Cost modelling shows that for people having a colonoscopy as part of bowel cancer screening, using Endocuff Vision is cost saving. Savings are related to the adenoma detection rate; for a colonoscopist with a baseline adenoma detection rate of 51%, using Endocuff Vision saves �53 per patient over 10 years compared with standard colonoscopy.";2019;;;"High value";"Colorectal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5178;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend letermovir, within its marketing authorisation, as an option for preventing cytomegalovirus (CMV) reactivation and disease after an allogeneic haematopoietic stem cell transplant (HSCT) in adults who are seropositive for CMV. It is recommended only if the company provides it according to the commercial arrangement.";"Current management of CMV after an allogeneic HSCT (a stem cell transplant from a donor) involves regular blood tests to monitor CMV levels (with or without aciclovir). If CMV levels rise, treatment with ganciclovir, valganciclovir or foscarnet (pre-emptive therapy) is started to prevent disease but this can cause severe side effects. Letermovir is an option for reducing CMV and is safer than pre-emptive therapy. Clinical trial evidence shows that letermovir is effective in reducing CMV infection and also reduces the need for pre-emptive therapy. The most plausible cost-effectiveness estimates for letermovir are within the range that NICE usually considers acceptable. Therefore, it is recommended. ";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4667;19;"Choosing Wisely Canada";"Canadian Dermatology Association";English;"Don?t routinely prescribe antibiotics for bilateral lower leg redness and swelling.";"Cellulitis is commonly misdiagnosed and may be incorrectly applied as a diagnosis in 1 in 3 cases. There are many causes of ?pseudocellulitis?, including: stasis dermatitis, acute lipodermatosclerosis, lymphedema, eczematous dermatitis, contact dermatitis, gout and tinea pedis. The most common among these is stasis dermatitis which generally affects the bilateral lower legs. In the setting of bilateral lower leg skin changes, causes of ?pseudocellulitis? should be considered.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5179;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend adopting the 3M Tegaderm CHG IV securement dressing for central venous and arterial catheter insertion sites. This technology allows observation, and provides antiseptic coverage, of the catheter insertion site. It reduces catheter?related bloodstream infections and local site infections compared with semipermeable transparent (standard) dressings. ";"The 3M Tegaderm CHG IV securement dressing can be used with existing care bundles. It should be considered for use in critically ill adults who need a central venous or arterial catheter in intensive care or high dependency units. ";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6715;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"It is recommended to carry out an adequate evaluation and preoperative preparation of elective surgery patients. If administered correctly, many do not need to be admitted to hospital the day before the operation.";"The available evidence supporting this recommendation is limited to two consensus publications on enhanced recovery programmes.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5692;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is no evidence as to whether computer and mobile technology interventions promote medication adherence and disease management in people with thalassemia";"Due to the lack of evidence, no comments can be made about the efficacy or effectiveness of intervention strategies with computerized and mobile technology to promote the treatment of the disease and adherence to iron chelation treatment in patients with thalassemia.";2019;;;"Low value";"management of patients";"Link to the recommendation on the website of the initiative" 4669;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Aliskiren is not recommended as an antihypertensive renin inhibitor to prevent cardiovascular events. ";" A trial in diabetic patients showed that aliskiren was associated with an increase in cardiovascular events and renal failure. It is better to choose a thiazide diuretic or an angiotensin converting enzyme (ACE) inhibitor. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4670;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Bezafibrate, ciprofibrate and fenofibrate are nor recommended as cholesterol-lowering drugs in the prevention of cardiovascular events.";"Bezafibrate, ciprofibrate and fenofibrate have numerous adverse effects, including cutaneous, haematological and renal disorders. When a fibrate is justified, gemfibrozil is the only one that has been shown to prevent the cardiovascular complications of hypercholesterolaemia.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4926;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lenalidomide is recommended as an option, within its marketing authorisation, that is for treating transfusion?dependent anaemia caused by low or intermediate?1 risk myelodysplastic syndromes associated with an isolated deletion 5q cytogenetic abnormality when other therapeutic options are insufficient or inadequate. Just if the company provides it according to the commercial arrangement.";"No further information.";2019;;;"High value";"Blood and bone marrow cancers";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5694;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"The use of eHealth interventions in the population with chronic kidney disease is of low quality, with uncertain effects due to methodological limitations and the heterogeneity of the modalities and types of eHealth intervention.";"EHealth interventions can improve the treatment of dietary sodium intake and the treatment of fluids. However, in general these data suggest that the evidence is of low quality. The review has highlighted the need for robust, high-quality research that reports a basic (minimal) data set to allow meaningful evaluation of the literature.";2019;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 4672;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Dronedarone is not recommended as an antiarrhythmic at preventing atrial fibrillation recurrence.";"Dronedarone is less effective than amiodarone, yet has at least as many severe adverse effects, in particular hepatic, pulmonary and cardiac disorders. Amiodarone is a better option. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5440;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of corticosteroids in adult patients with acute respiratory distress syndrome is not recommended to decrease late mortality (after three months).";"There is no reliable information available on the use of corticosteroids in adult patients with acute respiratory distress syndrome on late mortality from all causes (after three months).Due to very low certainty evidence, it is not known whether corticosteroids lead to little or no difference in late mortality from all causes (after three months) (RR 0.99, 95% CI 0.64 at 1.52; one study, 180 participants).";2019;;;Uncertain;"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mortality";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5441;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of steroids is recommended to decrease the number of days that adult patients with acute respiratory distress syndrome require mechanical ventilation (days without ventilation until day 28).";"Four studies reported duration of mechanical ventilation for 368 participants. One study reported a shorter duration of mechanical ventilation in the corticosteroids group (median 5 days (interquartile range (IQR) 3 to 8 days) compared to the control group (median 9.5 days (IQR 6 to 9.5 days): P = 0.002). In the remaining three studies, no found evidence of a difference between groups in duration of mechanical ventilation (MD ?4.30 days, 95% CI ?9.72 to 1.12; I2 = 93%; 277 participants; very low?certainty evidence). It was found that days without ventilation until day 28 can improve with corticosteroids. Four studies reported the number of ventilator?free days up to day 28 for 494 participants . The found that corticosteroids may increase ventilator?free days (MD 4.09 days, 95% CI 1.74 to 6.44; I2 = 36%; low?certainty evidence). ";2019;;;"High value";"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mechanical ventilation ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5442;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"Reliable information on the use of surfactants in adult patients with acute respiratory distress syndrome to decrease mortality is not available.";"It is not known for certain whether surfactants result in little or no difference in early mortality (RR 1.08, 95% CI 0.91 to 1.29; nine studies, 1338 participants) or if they reduce late mortality. from all causes (RR 1.28, 95% CI 1.01 to 1.61; one study, 418 participants).";2019;;;Uncertain;"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mortality";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4675;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;" Ivabradine is not recommended as an inhibitor of the cardiac current in angina or heart failure.";"Ivabradine can cause visual disturbances, cardiovascular disorders (including myocardial infarction), potentially severe bradycardia and other cardiac arrhythmias. It has no advantages over other available options in either angina or heart failure.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4931;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Regorafenib is recommended as an option for treating advanced unresectable hepatocellular carcinoma in adults who have had sorafenib, only if they have Child?Pugh grade A liver impairment and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and the company provides it according to the commercial arrangement.";"This recommendation is not intended to affect treatment with regorafenib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Advanced unresectable hepatocellular carcinoma is mostly treated with sorafenib in the NHS. For people who cannot tolerate sorafenib, or whose disease progresses on sorafenib, the only current option is best supportive care. Regorafenib is a possible treatment option after sorafenib instead of best supportive care. Clinical trial evidence comes from people who have advanced hepatocellular carcinoma that has been treated with sorafenib, and who have an ECOG performance status of 0 or 1 and Child?Pugh grade A liver impairment. This shows that people having regorafenib live longer than people having best supportive care. However, the trial does not include people who cannot tolerate sorafenib, or who have more severe liver disease or a poorer performance status. So it can't be assumed that these people would get the same benefits from regorafenib as the people in the trial.";2019;;;"High value";"Liver cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5443;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of surfactants is not recommended to reduce the duration of mechanical ventilation in adult patients with acute respiratory distress syndrome.";"It is not known whether surfactants reduce the duration of mechanical ventilation (DM ?2.50, 95% CI ?4.95 to ?0.05, one study, 16 participants). Six studies reported the number of ventilator?free days up to day 28 for 856 participants. They found little or no difference between participants given surfactants or a control for this outcome in two studies (MD ?0.39, 95% CI ?2.49 to 1.72; I2 = 0%; 344 participants; very low?certainty evidence).";2019;;;Uncertain;"Trewatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mechanical ventilation";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4932;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Irreversible electroporations is not recommended for human therapy. This procedure should only can be used in the context of research. Evidence on the safety of irreversible electroporation for primary liver cancer shows serious but infrequent and well-recognised complications. Evidence on its efficacy is inadequate in quantity and quality.";"Patient selection should be done by a multidisciplinary team. The procedure should only be done in specialist centres by clinicians with experience and specific training. Further research could be in the form of case series or registry-based research. It should include: details of patient selection; tumour position and size; long-term outcomes including overall survival, progression-free survival and tumour regression; and patient-reported outcomes including quality of life.";2019;;;"Low value";"Liver cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5444;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of statins is not recommended in adult patients with acute respiratory distress syndrome to decrease the duration of mechanical ventilation.";"Statins may result in little or no difference in the duration of mechanical ventilation (MD 2.70, 95% CI ?3.55 to 8.95; one study, 60 participants; evidence of low certainty). Three studies reported the number of ventilator?free days up to day 28 for 1342 participants. The found that statins probably make little or no difference to the number of ventilator?free days up to day 28 (MD 0.40 days, 95% CI ?0.71 to 1.52; I2 = 0%; moderate?certainty evidence";2019;;;Uncertain;"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Mechanical ventilation ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4677;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Nicorandil is not recommended as a vasodilator in preventing effort angina.";"Nicorandil can cause severe mucocutaneous ulceration. A nitrate is a better option to prevent angina attacks.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5445;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of beta-agonists is not recommended in adult patients with acute respiratory distress syndrome.";"Beta-agonists are likely to slightly increase early mortality by 40 per 1,000 patients (with up to 119 more deaths or 25 fewer); however, the 95% CI includes the possibility of an increase as well as a reduction in mortality (RR 1.14, 95% CI 0.91 to 1.42; three studies, 646 participants; evidence of moderate certainty) ). Due to very low certainty evidence, it is not known for certain whether beta-agonists increase days without ventilation (DM ?2.20, 95% CI ?3.68 to ?0.71; three studies, 646 participants) or if there are no differences in adverse events leading to discontinuation of the study drug (one study reported little or no difference between groups and one study reported more events in the beta-agonist group). No study reported late mortality from all causes, duration of mechanical ventilation, or physical condition upon return to work at 12 months.";2019;;;"Low value";"Treatment COVID-19, Respiratory Distress Syndrome, Adult, Drug therapy, Beta-agonists";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4678;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Olmesartan is not recommended as an angiotensin II receptor blocker against the complications of hypertension.";"Olmesartan can cause sprue-like enteropathy leading to chronic diarrhoea (potentially severe) and weight loss, and, possibly, an increased risk of cardiovascular mortality. It is better to choose losartan or valsartan. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4679;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Ranolazine is not recommended as an antianginal for reducing the frequency of angina attacks.";"Ranolazine provokes adverse effects including: gastrointestinal disorders, neuropsychiatric disorders, palpitations, bradycardia, hypotension, QT prolongation and peripheral oedema.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5447;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento con l�quidos y vasopresores)";Spanish;"The use of 0.9% saline or buffer solutions is recommended in the resuscitation of critically ill adults and children for the prevention of intra-hospital mortality";"Intravenous fluid therapy is the most likely intervention provided for critically ill patients. Although 0.9% saline is a widely used crystalloid solution, it causes hyperchloremic acidosis with significant consequences for patients identified in several observational studies. According to a Cochrane review on the safety and efficacy of buffered fluids in adult patients undergoing elective surgery, those who received buffered solutions did not develop hyperchloremic acidosis. In another systematic review of elective surgery and critical care, high chloride fluids were associated with an increased risk of acute kidney failure. The objectives of this Review was to evaluate the effects of buffered solutions versus 0.9% saline for resuscitation in critically ill adults and children. We included randomized controlled trials (RCTs) with a parallel or crossover design, regardless of the language of publication. Critically ill patients (including trauma, burns, or emergency surgery during a critical illness) who required intravenous fluid therapy were included. We included studies of adults and children, and explored the effects of age in a subgroup analysis. The primary outcomes considered were: General mortality and acute kidney injury (ARF) during hospitalization. Secondary outcomes were: Number of participants with organ system dysfunction (respiratory, hemodynamic, central nervous system, and liver) as defined in the included studies during admission. Electrolyte disorders during admission (hyperchloremic acidosis; serum concentrations of sodium, potassium, calcium, and chloride; pH; serum bicarbonate; excess base; strong ion difference) measured as serum levels or defined by the study authors (for example, presence or absence of hyperchloremic acidosis). Blood loss or transfusion requirements during admission. Coagulation disorders (expressed as thrombocytopenia or coagulopathy) during admission. Total volume of intravenous fluids required during resuscitation. Quality of life measured with Short Form (SF) ?36 and the EuroQOL quality of life questionnaire (EQ - 5D) and costs. Twenty-one RCTs (20,213 participants) were included and three ongoing studies were identified. Three RCTs contributed 19,054 participants (94.2%). Four RCTs (402 participants) were performed in children with severe dehydration and dengue shock syndrome. Fourteen trials reported results on mortality and nine on acute kidney injury. Sixteen included trials were conducted in adults, four in the pediatric population, and one trial did not limit minimum age or maximum age as the inclusion criterion. Eight studies with 19 218 participants were rated as of high methodological quality (trials with low overall risk of bias by domain: allocation concealment, participant / evaluator blinding, incomplete outcome data, and selective reporting) and in the remaining trials , some form of bias was introduced or could not be ruled out. We found no effect of buffer solutions on the prevention of in-hospital mortality compared to 0.9% saline solutions in critically ill patients. The certainty of the evidence for this finding was high, indicating that further research would detect little or no difference in mortality. The effects of buffers and 0.9% saline on the prevention of acute kidney injury were similar in this setting. The certainty of the evidence for this finding was low, and further research could change this conclusion. Patients treated with buffers showed lower chloride levels, higher bicarbonate levels, and a higher pH. The certainty of the evidence for these findings was very low. Future research should further examine patient-centered outcomes, such as quality of life. All three ongoing studies may alter the conclusions of the review once published and evaluated ";2019;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4936;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently adults with new-onset blackouts (transient loss of consciousness), accompanied by features that are strongly suggestive of epileptic seizures, for neurological assessment in line with the recommendation for people with suspected epilepsy in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s.";"Do not routinely refer adults with blackouts if there are clear features of vasovagal syncope, even if associated with brief jerking of the limbs. See recommendation 1.1.4.3 on uncomplicated faint in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s. The committee agreed that the NICE guideline on transient loss of consciousness ('blackouts') in over 16s provides comprehensive recommendations on recognition and referral.";2019;;;"High value";"Brain Cancers";"Link to the recommendation on the website of the initiative " 4937;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently children who present with discrete episodes of loss of awareness (mid-activity vacant spells) or of attention and concentration difficulty, in line with the NICE guideline on epilepsies.";"Be aware that medicines commonly used to treat epilepsy in children can adversely affect concentration and memory. The committee noted that concentration and memory problems are common in children who have diagnosed or undiagnosed epilepsy. They agreed that, in a child not diagnosed with epilepsy, episodes of loss of awareness, attention or concentration might be unrecognised absence seizures that need further investigation.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 4682;14;"Prescrire bilan. Towards better patient care: drugs to avoid";;English;"Trimetazidine is not recommended for the treatment of angina.";"Trimetazidine can cause parkinsonism, hallucinations and thrombocytopenia. It is better to choose better-known treatments for angina: certain beta-blockers, or, as an alternative, calcium-channel blockers such as amlodipine and verapamil.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4683;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Vernakalant is not recommended as an injectable antiarrhythmic for atrial fibrillation.";"Vernakalant has not been shown to reduce mortality or the incidence of thromboembolic or cardiovascular events. Its adverse effects include various arrhythmias. It is better to use amiodarone for pharmacological cardioversion. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4684;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Mequitazine is not recommended as a sedating antihistamine for allergies. ";"Mequitazine carries a higher risk than other antihistamines of cardiac arrhythmias through QT prolongation in patients who are slow CYP2D6 metabolisers or when co-administered with drugs that inhibit CYP2D6. A ?nonsedating? antihistamine without antimuscarinic activity, such as cetirizine or loratadine, is a better option in this situation.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4941;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab, with pemetrexed and platinum chemotherapy is recommended for use within the Cancer Drugs Fund, as an option for untreated, metastatic, non-squamous non-small-cell lung cancer (NSCLC) in adults whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations. ";"It is only recommended if pembrolizumab is stopped at 2 years of uninterrupted treatment or earlier if disease progresses and the company provides pembrolizumab according to the managed access agreement. This recommendation is not intended to affect treatment with pembrolizumab with pemetrexed and platinum chemotherapy that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Standard care in people with untreated, metastatic non-squamous NSCLC whose tumours have no EGFR- or ALK?positive mutations is usually pemetrexed with carboplatin or cisplatin. For people who cannot tolerate this, docetaxel, gemcitabine, paclitaxel or vinorelbine with carboplatin or cisplatin can be offered. People on either of these combinations may also have pemetrexed maintenance therapy. Standard care for people whose tumours express at least a 50% tumour proportion score is usually pembrolizumab monotherapy.";2019;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5197;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend offering an antibiotic(s) for adults, young people and children with hospital-acquired pneumonia. When choosing an antibiotic(s), take account of:";"- the severity of symptoms or signs - the number of days in hospital before onset of symptoms - the risk of developing complications, for example, if the person has a relevant comorbidity such as severe lung disease or immunosuppression - local hospital and ward-based antimicrobial resistance data - recent antibiotic use - recent microbiological results, including colonisation with multidrug-resistant bacteria - recent contact with a health or social care setting before current admission - the risk of adverse effects with broad-spectrum antibiotics, such as Clostridium difficile infection. Start antibiotic treatment as soon as possible after establishing a diagnosis of hospital-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this). Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. Send a sample (for example, sputum sample, nasopharyngeal swab or tracheal aspirate) for microbiological testing. When microbiological results are available: - review the choice of antibiotic(s) and - change the antibiotic(s) according to results, using a narrower-spectrum antibiotic, if appropriate. Reassess adults, young people and children with hospital-acquired pneumonia if symptoms do not improve as expected or worsen rapidly or significantly. Seek specialist advice from a microbiologist for adults, young people and children with hospital-acquired pneumonia if they have: - symptoms that are not improving as expected with antibiotics or - multidrug-resistant bacteria. Follow the NICE guideline on care of dying adults in the last days of life when caring for adults with hospital-acquired pneumonia who are approaching their end of life.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4686;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Injectable promethazine is not recommended to treat severe urticaria.";"Injectable promethazine can cause thrombosis, skin necrosis and gangrene following extravasation or accidental injection into an artery. Injectable dexchlorpheniramine, which does not appear to carry these risks, is a better option.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4942;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Brigatinib is recommended, within its marketing authorisation, for treating anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults who have already had crizotinib. It is recommended only if the company provides it according to the commercial arrangement.";"People with ALK-positive advanced NSCLC that has been treated with crizotinib are currently offered ceritinib as their next treatment. Clinical evidence based on indirect comparisons of trials suggests that people having brigatinib live longer than those having ceritinib, and that they live longer before their condition worsens. Brigatinib may be more effective for brain metastases and better tolerated than existing treatments.";2019;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4943;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently adults with facial pain associated with persistent facial numbness or abnormal neurological signs for neuroimaging.";"Refer adults with unilateral facial pain that is triggered by touching the affected part of the face (trigeminal neuralgia) and is refractory to treatment, in line with the NICE guideline on neuropathic pain in adults. For adults with scalp tenderness or jaw claudication suggestive of temporal arteritis, consider blood tests and follow local pathways for suspected giant cell (temporal) arteritis. Be aware that a normal ESR (erythrocyte sedimentation rate) does not exclude a diagnosis of giant cell arteritis. Although atraumatic facial pain is a common symptom, no evidence on associated features that might indicate a need for referral was identified. The committee used their knowledge and experience to highlight signs and symptoms that might indicate a need for referral.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5199;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering testing C?reactive protein in people presenting with symptoms of lower respiratory tract infection in primary care, if after clinical assessment a diagnosis of pneumonia has not been made and it is not clear whether antibiotics should be prescribed. ";"Use the results of the test to guide antibiotic prescribing in people without a clinical diagnosis of pneumonia as follows: - 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.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4944;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Durvalumab monotherapy is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced unresectable non-small-cell lung cancer (NSCLC) in adults whose tumours express PD?L1 on at least 1% of tumour cells and whose disease has not progressed after platinum-based chemoradiation. ";"This recommendation is not intended to affect treatment with durvalumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Locally advanced NSCLC that is unresectable is usually treated with platinum-based chemoradiation. After this there are no treatment options to delay or stop the disease progressing. Durvalumab is a possible treatment at this stage.";2019;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5200;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend determining whether patients are at low, intermediate or high risk of death using the CRB65 score when a clinical diagnosis of community-acquired pneumonia is made in primary care.";"CRB65 score for mortality risk assessment in primary care CRB65 score is calculated by giving 1 point for each of the following prognostic features: - confusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time) - raised respiratory rate (30 breaths per minute or more) - low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg) - age 65 years or more. Patients are stratified for risk of death as follows: - 0: low risk (less than 1% mortality risk) - 1 or 2: intermediate risk (1?10% mortality risk) - 3 or 4: high risk (more than 10% mortality risk). Use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients need hospital assessment as follows: - consider home?based care for patients with a CRB65 score of 0 - consider hospital assessment for all other patients, particularly those with a CRB65 score of 2 or more.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4689;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Topical tacrolimus is not recommended as an immunosuppressant to treat atopic eczema.";"Topical tacrolimus can cause skin cancer and lymphoma. Judicious use of a topical corticosteroid to treat flare-ups is a better option in this situation. Oral or injectable tacrolimus is a standard immunosuppressant for transplant recipients, and in this situation its harm-benefit balance is clearly favourable.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4945;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For recommendations on assessing sudden-onset unsteady gait in adults, see the NICE guideline on stroke and transient ischaemic attack in over 16s.";"Refer urgently adults with rapidly (within days to weeks) progressive unsteady gait (gait ataxia) for neurological assessment. Refer adults with gradually progressive unsteady gait (gait ataxia) for neurological assessment. Refer adults who have difficulty initiating and coordinating walking (gait apraxia) to neurology or an elderly care clinic to exclude normal pressure hydrocephalus. For adults with unsteadiness of gait who are at risk of falling, follow the recommendations on multifactorial falls risk assessment in the NICE guideline on falls in older people, and consider referring to a falls prevention team.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5201;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend determining whether patients are at low, intermediate or high risk of death using the CURB65 score when a diagnosis of community-acquired pneumonia is made at presentation to hospital.";"CURB65 score for mortality risk assessment in hospital CURB65 score is calculated by giving 1 point for each of the following prognostic features: - confusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time) - raised blood urea nitrogen (over 7 mmol/litre) - raised respiratory rate (30 breaths per minute or more) - low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg) - age 65 years or more. Patients are stratified for risk of death as follows: - 0 or 1: low risk (less than 3% mortality risk) - 2: intermediate risk (3?15% mortality risk) - 3 to 5: high risk (more than 15% mortality risk). Use clinical judgement in conjunction with the CURB65 score to guide the management of community?acquired pneumonia, as follows: - consider home?based care for patients with a CURB65 score of 0 or 1 - consider hospital?based care for patients with a CURB65 score of 2 or more - consider intensive care assessment for patients with a CURB65 score of 3 or more. Stratify patients presenting with community?acquired pneumonia into those with low?, moderate? or high?severity disease. The grade of severity will usually correspond to the risk of death.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4946;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer adults who have sudden-onset difficulty with handwriting that has no obvious musculoskeletal cause for a neurological assessment according to local stroke pathways.";"Ask adults who have difficulty with handwriting that has no obvious musculoskeletal cause to demonstrate their handwriting and: if they have a problem with generating language rather than hand function, refer for neurological assessment if their handwriting is small and slow, consider referring for possible Parkinson's disease if their difficulty is specific to the task of handwriting and examination shows no other abnormalities, consider referring for possible focal dystonia.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5202;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely offering microbiological tests to patients with low?severity community?acquired pneumonia.";"For patients with moderate? or high?severity community?acquired pneumonia: - take blood and sputum cultures and - consider pneumococcal and legionella urinary antigen tests.";2019;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4947;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For adults with sudden-onset acute vestibular syndrome (vertigo, nausea or vomiting and gait unsteadiness), a HINTS (head-impulse?nystagmus?test-of-skew) test should be performed if a healthcare professional with training and experience in the use of this test is available.";"For adults with sudden-onset acute vestibular syndrome who have had a HINTS test: be aware that a negative HINTS test makes a diagnosis of stroke very unlikely refer immediately for neuroimaging if the HINTS test shows indications of stroke (a normal head impulse test, direction-changing nystagmus or skew deviation). Refer immediately adults with sudden-onset acute vestibular syndrome in whom benign paroxysmal positional vertigo or postural hypotension do not account for the presentation, in line with local stroke pathways, if a healthcare professional with training and experience in the use of the HINTS test is not available.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5203;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend putting in place processes to allow diagnosis (including X?rays) and treatment of community?acquired pneumonia within 4 hours of presentation to hospital.";" ";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4692;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"The gliptins: alogliptin, linagliptin, saxagliptin, sitagliptin and vildagliptin, used alone or in combination with metformin are not recommended to treat diabetes.";"They have an unfavourable adverse effect profile that includes serious hypersensitivity reactions such as anaphylaxis and Stevens-Johnson syndrome, infections (of the urinary tract and upper respiratory tract), pancreatitis, bullous pemphigoid, and intestinal obstruction.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4948;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer adults with recurrent fixed-pattern dizziness associated with alteration of consciousness to have an assessment for epilepsy in line with the NICE guideline on epilepsies.";"The committee noted that epilepsy can sometimes present as recurrent fixed-pattern dizziness associated with alteration of consciousness.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5204;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely offering a glucocorticoid to patients with community?acquired pneumonia unless they have other conditions for which glucocorticoid treatment is indicated.";" ";2019;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4949;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer immediately adults with rapidly (within 4 weeks) progressive symmetrical limb weakness for neurological assessment and assessment of bulbar and respiratory function.";"The committee agreed that rapidly progressive symmetrical limb weakness can indicate a potentially life-threatening neuromuscular disorder or cervical myelopathy. These disorders can affect the respiratory muscles and cause respiratory failure. Their presenting features can be difficult to recognise in the early stages of the disorder.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative" 5205;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering measuring a baseline C?reactive protein concentration in patients with community?acquired pneumonia on admission to hospital, and repeat the test if clinical progress is uncertain after 48 to 72 hours.";" ";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4950;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer immediately, in line with local pathways, adults who have severe low back pain radiating into the leg and new-onset disturbance of bladder, bowel or sexual function, or new-onset perineal numbness, to have an assessment for cauda equina syndrome.";"The committee agreed that these symptoms can indicate cauda equina syndrome, which is a medical emergency.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5206;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely discharging patients with community?acquired pneumonia if in the past 24 hours they have had 2 or more of the following findings:";"- temperature higher than 37.5�C - respiratory rate 24 breaths per minute or more - heart rate over 100 beats per minute - systolic blood pressure 90 mmHg or less - oxygen saturation under 90% on room air - abnormal mental status - inability to eat without assistance Consider delaying discharge for patients with community?acquired pneumonia if their temperature is higher than 37.5�C.";2019;;;"Low value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4695;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Pioglitazone is not recommended to treat diabetes. ";"Pioglitazone has a long list of adverse effects, including heart failure, bone fractures and bladder cancer.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4951;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently adults with very rapidly (within hours to days) progressive weakness of a single limb or hemiparesis for investigation, including neuroimaging, in line with the recommendation on brain and central nervous system cancers in adults in the NICE guideline on suspected cancer.";"The committee agreed that this symptom can indicate potentially serious neurological disease and needs to be assessed urgently.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5207;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend explaining to patients with community?acquired pneumonia that after starting treatment their symptoms should steadily improve, although the rate of improvement will vary with the severity of the pneumonia, and most people can expect that by:";"- 1 week: fever should have resolved - 4 weeks: chest pain and sputum production should have substantially reduced - 6 weeks: cough and breathlessness should have substantially reduced - 3 months: most symptoms should have resolved but fatigue may still be present - 6 months: most people will feel back to normal. Advise patients with community?acquired pneumonia to consult their healthcare professional if they feel that their condition is deteriorating or not improving as expected.";2019;;;"High value";"Healthcare-associated infections";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4952;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely refer adults with an uncomplicated episode of Bell's palsy (unilateral lower motor neurone pattern facial weakness affecting all parts of the face and including weakness of eye closure) and no evidence of another medical condition such as middle ear disease.";"Advise adults with Bell's palsy about eye care, and explain that Bell's palsy improves at different rates and maximum recovery can take several months. Consider referring adults with Bell's palsy who have developed symptoms of aberrant reinnervation (including gustatory sweating or jaw-winking) 5 months or more after the onset of Bell's palsy for neurological assessment and possible treatment. The committee agreed that uncomplicated Bell's palsy can be diagnosed and managed in primary care. They thought it important that people with this condition know that recovery time can vary and that recovery might not be complete. Referral for specialist treatment can be beneficial for people who develop troublesome symptoms after recovering from Bell's palsy.";2019;;;"Low value";"Brain cancers";"Link to the recommendation on the website of the initiative " 4953;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Do not routinely refer adults for neurological assessment if they have concentration difficulties associated with myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome or fibromyalgia.";"The committee pointed out that difficulties with memory and concentration are common in myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome or fibromyalgia, and that these symptoms can be managed as part of the management of those conditions.";2019;;;"Low value";"Brain cancers";"Link to the recommendation on the website of the initiative" 4954;1;"NICE ";;English;"Refer adults with recurrent episodes of dense amnesia to have an assessment for epileptic amnesia.";"The committee thought it important to raise awareness of transient global amnesia, which presents as a single episode of dense amnesia with complete recovery and no features of epilepsy, and has a very low recurrence rate. The committee wanted to help non-specialists differentiate this from transient epileptic amnesia, which is recurrent and needs further investigation.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 4955;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently adults with recurrent, brief (less than 2 minutes), fixed-pattern disturbances of sensation to have an assessment for epilepsy.";"Refer adults with persistent, distally predominant altered sensation in the limbs, and brisk deep tendon reflexes, to have an assessment for possible brain or spine disease. Suspect migraine with aura in adults who have sensory symptoms that occur with or without headache For adults with persistent, distally predominant ('stocking' or 'glove and stocking') altered sensation in the limbs and depressed deep tendon reflexes: be alert to the possibility of peripheral neuropathy and consider checking. if no causes of peripheral neuropathy are found, refer for neurological assessment.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 4956;1;"NICE ";;English;"Refer in line with local pathways if symptoms of carpal tunnel syndrome are severe or persistent after initial management.";"The committee noted that carpal tunnel syndrome is common and many regions have established management pathways that might not involve neurological services.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 6749;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"It is not recommended to treat adults with mild grade 1 hypertension with no other cardiovascular risk factors with hypertensive drugs, as it may have very little benefit. ";"It is under discussion. Give antihypertensive drug therapy plus lifestyle advice for adults younger than 60 years with stage 1 hypertension and an estimated 10-year risk of less than 10%. Note that 10-year cardiovascular risk may underestimate the lifetime probability of developing cardiovascular disease. Discuss starting antihypertensive drug treatment, in addition to lifestyle advice, with adults aged under 80 with persistent stage 1 hypertension who have 1 or more of the following: -target organ damage -established cardiovascular disease -renal disease -diabetes -an estimated 10?year risk of cardiovascular disease of 10% or more. Use clinical judgement for people with frailty or multimorbidity";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative " 5984;6;"Less Is More Collection - JAMA Network";"Smith MA. JAMA Intern Med. 2019;179(7):990-992. ";English;"It is recommended to avoid the use of antimicrobials in hospitalized patients due to the association of an increased colony count for urinary pathogens.";"Two prior studies suggest that UC growth from hospitalized patients with low colony counts of organisms was infrequently associated with urinary tract infection (UTI) but generated substantial antimicrobial prescribing for ASB/C. When clinicians requested low-colony-count UCs to be worked up, patients were more likely to have a UTI. There were no significant changes in clinical outcomes between groups (pacients with high-colony-count UC and pacients with low-colony- count UC). The intervention was associated with reduction in antimicrobial prescribing for ASB/C among the low-colony-count group compared with the high-colony-count group. This intervention only addresses approximately one-third of ASB/C cases among hospitalized patients and for this reason, it should be combined with other improvement strategies. The simple change of raising the threshold for identifying potential urinary pathogens may avert nearly a third of ASB/C treatment among hospitalized patients and could have scalable impact on improving antimicrobial use in acute care hospitals.";2019;;;"High value";Treatment;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5217;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend offering patients and carers clear, consistent information and advice throughout all stages of their care. This should include the risks of surgical site infections, what is being done to reduce them and how they are managed. ";"Offer patients and carers information and advice on how to care for their wound after discharge. Offer patients and carers information and advice about how to recognise a surgical site infection and who to contact if they are concerned. Use an integrated care pathway for healthcare-associated infections to help communicate this information to both patients and all those involved in their care after discharge. Always inform patients after their operation if they have been given antibiotics.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5985;6;"Less Is More Collection - JAMA Network";"Nafaji N. JAMA Intern Med. 2019;179(1):11-15.";English;"It is recomended to introduce a targeted electronic health record alert to reduce unnecesary cardiac monitoring in hospitalized patients.";"Physicians frequently use cardiac monitoring beyond the duration recommended by published practice standards, resulting in ?alarm fatigue? and excess cost. This cluster-randomized clinical trial was conducted on the general medicine service of the Division of Hospital Medicine at the University of California, San Francisco Medical Center and included physicians of 12 inpatient medical teams (6 intervention, 6 control). The alert displayed during daytime hours when physicians attempted to place an order for patients not in the intensive care unit whose telemetry order duration exceeded the recommended duration for a given indication. The most common physician response to the alert was to discontinue telemetry monitoring (62%). The alert prompted a significant reduction in telemetry monitoring duration (mean ?8.7 hours per hospitalization) with no significant change in rapid-response calls or medical emergency events. ";2019;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative" 7009;1;"NICE ";NICE;English;" No se recomienda el uso de terapia con progesterona durante el primer trimestre en mujeres con abortos espont�neos recurrentes inexplicables.";"Women with previous pregnancy losses are at increased risk of miscarriage in subsequent pregnancies. Progesterone is essential for maintaining a healthy pregnancy and there is evidence that it is safe for both women and fetuses. A recent randomized controlled trial evaluated the effectiveness of micronized vaginal progesterone supplementation in women with 3 or more first trimester losses and did not show a benefit with the use of progesterone therapy during the first trimester, concluding that there is insufficient evidence to support support its use.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5218;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend advising patients to shower or have a bath (or help patients to shower, bath or bed bath) using soap, either the day before, or on the day of, surgery. ";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5986;6;"Less Is More Collection - JAMA Network";"Pack QR. JAMA Intern Med. 2019;179(9):1176-1185.";English;"It?s recommended a more selective use of the echocardiogram in adult patients with acute miocardial infarct in hospital. ";"It?s a restrospectives cohor study. Greater use of echocardiography did not appear to be associated with better patient outcomes in patients with acute myocardial infarction. In models that adjusted for hospital and patient characteristics, no difference was found in inpatient mortality or 3-month readmission between the highest and lowest quartiles of echocardiography use. In patients with AMI, hospitals in the quartile with the highest rates of echocardiography showed greater hospital costs and length of stay but few differences in clinical outcomes compared with hospitals in the quartile with the lowest rates of echocardiography. These findings suggest that more selective use of echocardiography might be used without adversely affecting clinical outcomes, particularly in hospitals with high rates of echocardiography use. Even so, it is true that patients who underwent an echocardiogram compared with patients without an echocardiogram were more likely to have heart failure and pulmonary disease. However, our findings are consistent with several studies showing that higher rates of echocardiography testing are not associated with improved patient outcomes.Higher rates were not associated with better clinical outcomes but were associated with higher costs and longer length of stay. Although echocardiography plays an important role in the treatment of many patients with AMI, these findings suggest that a more selective approach may be safe and may reduce costs, particularly at high-use hospitals.";2019;;;"High value";diagnosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4963;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Oral bisphosphonates (alendronic acid, ibandronic acid, and risedronate sodium) and intravenous bisphosphonates (ibandronic acid and zoledronic acid) are recommended as options for treating osteoporosis in adults.";"Are recomended in adults: - who are eligible for risk assessment as defined in NICE's guideline on osteoporosis (recommendations 1.1 and 1.2) and NICE's quality standard on osteoporosis and - who have been assessed as being at higher risk of osteoporotic fragility fracture using the methods recommended in NICE's guideline on osteoporosis (recommendations 1.3 to 1.12) and NICE's quality standard on osteoporosis and - when bisphosphonate treatment is appropriate, taking into account their risk of fracture, their risk of adverse effects from bisphosphonates, and their clinical circumstances and preferences. The choice of treatment should be made on an individual basis after discussion between the responsible clinician and the patient, or their carers, about the advantages and disadvantages of the treatments available. If generic products are available, start treatment with the least expensive formulation, taking into account administration costs, the dose needed and the cost per dose. These recommendations are not intended to affect treatment with alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid that was started in the NHS before this guidance was published. Adults having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop";2019;;;"High value";Osteoporosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5219;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering nasal mupirocin in combination with a chlorhexidine body wash before procedures in which Staphylococcus aureus is a likely cause of a surgical site infection. This should be locally determined and take into account:";"- the type of procedure - individual patient risk factors - the increased risk of side effects in preterm infants - the potential impact of infection. Maintain surveillance on antimicrobial resistance associated with the use of mupirocin. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5220;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using hair removal routinely to reduce the risk of surgical site infection.";"If hair has to be removed, use electric clippers with a single-use head on the day of surgery. Do not use razors for hair removal, because they increase the risk of surgical site infection.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4965;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nusinersen is recommended to treat 5MA spinal muscular atrophy (SMA) only if people have pre-symptomatic SMA, or SMA types 1, 2, or 3 and the conditions of the managed access agreement are followed.";"SMA is a rare genetic condition, the most severe types of which affect babies and young children. Currently, there is an unmet need for effective treatments that could slow disease progression. Clinical trial evidence shows that nusinersen improves a range of outcomes that are important to people with early- (type 1) and later-onset (types 2 and 3) SMA. Also, there is some evidence suggesting that nusinersen is effective for pre-symptomatic SMA. However, there is no long-term evidence, so the long-term benefits are highly uncertain. The committee considered that further data collection would help address these uncertainties. The cost-effectiveness estimates presented are higher than what NICE usually considers a cost-effective use of NHS resources. However, these estimates are difficult to interpret because of the limited evidence base to substantiate longer-term benefits, the difficulty in clearly distinguishing between the SMA subtypes, and the difference in what can be achieved for these various patients without nusinersen. The proposed managed access agreement details various risk management strategies, including patient selection, starting and stopping rules, data collection, patient consent, exit strategy and commercial offer. Taking these into account, nusinersen is recommended for people with pre-symptomatic SMA, or SMA types 1, 2 or 3 if the conditions in the managed access agreement are followed, including the collection of more data to address the uncertainties. This recommendation will be reviewed based on data collected in the managed access arrangement. The review of the guidance will be published by the end of the fifth year.";2019;;;"High value";"Spinal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5221;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend giving patients specific theatre wear that is appropriate for the procedure and clinical setting, and that provides easy access to the operative site and areas for placing devices, such as intravenous cannulas. Take into account the patient's comfort and dignity. ";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5222;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend that all staff wear specific non-sterile theatre wear in all areas where operations are undertaken.";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5990;6;"Less Is More Collection - JAMA Network";"John N. Mafi. JAMA Intern Med. 2019;179(5):648-657.";Spanish;"It is adviced to reduce the low-value preoperative interventions for patients undergoing cataract surgery.";"This study took place at 2 academic safety-net medical centers to compare pre- and postintervention vs control group low value care utilization and cost changes. This intervention was associated with sustained reductions in low-value preoperative testing among patients undergoing cataract surgery and modest cost savings for the health system. The findings suggest that reducing low-value care may be associated with cost savings for financially capitated health systems and society but also with losses for FFS health systems, highlighting a potential barrier to eliminating low-value care. ";2019;;;"Low value";Diagn�stico;"Link to the recommendation on the website of the initiative." 5223;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend that staff wearing non-sterile theatre wear keep their movements in and out of the operating area to a minimum.";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4968;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Enzalutamide is not recommended, within its marketing authorisation, for treating high-risk hormone-relapsed non-metastatic prostate cancer in adults.";"This recommendation is not intended to affect treatment with enzalutamide that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Currently, when prostate cancer no longer responds to hormone treatment (androgen deprivation therapy), but has not yet spread beyond the prostate, the only option is to continue hormone treatment. The company proposes using enzalutamide in this setting. Clinical trial evidence shows that adding in enzalutamide extends the time until the cancer starts spreading to other parts of the body. But there is no evidence that it increases how long people live.";2019;;;"Low value";"Prostate cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5224;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using mechanical bowel preparation routinely to reduce the risk of surgical site infection.";" ";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5992;6;"Less Is More Collection - JAMA Network";"Christopher W. Goodman.JAMA Intern Med. 2019;179(5):695-701. doi:10.1001/jamainternmed.2019.0086 aut";Spanish;"There is uncertainty regarding the use of off-label gabapentinoids in patients with pain. ";"This report summarizes the limited published evidence supporting the unauthorized use of gabapentinoids and the clinical issues associated with their use. Regardless of the limitations in their indications, gapentinoids are widely prescribed off-label for different syndromes. Clinicians who prescribe gabapentinoids off-label for pain should be aware of the limited evidence and should acknowledge to patients that potential benefits are uncertain for most off-label uses. ";2019;;;Uncertain;Treatment;"https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2728959" 6760;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"It is recommended to reduce the use of unnecessary drugs in frail patients, leaving only those for symptomatic treatment. ";"When patients are particularly frail or in their last year of life, unless there is a clear preference otherwise by the patient or advocate, discuss with the patient and family/carers the option of decreasing the number of medicines to only those used for control of symptoms.";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4969;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Follow the recommendations in the NICE service guidelines on improving outcomes in urological cancers and improving supportive and palliative care for adults with cancer.";"Offer people with prostate cancer information tailored to their own needs. This information should be given by a healthcare professional (for example, a consultant or specialist nurse) and may be supported by written and visual media. Offer people with prostate cancer advice on how to get information and support from websites, local and national cancer information services, and from cancer support groups. Choose or recommend information resources for people with prostate cancer that are clear, reliable and up to date. Ask for feedback from people with prostate cancer and their carers to identify the highest quality information resources.";2019;;;"High value";"Prostate cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5225;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend that the operating team remove hand jewellery before operations. Do recommend that the operating team remove artificial nails and nail polish before operations.";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5226;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend giving antibiotic prophylaxis to patients before:";"- clean surgery involving the placement of a prosthesis or implant - clean-contaminated surgery - contaminated surgery Do not use antibiotic prophylaxis routinely for clean non-prosthetic uncomplicated surgery. Use the local antibiotic formulary and always take into account the potential adverse effects when choosing specific antibiotics for prophylaxis. Consider giving a single dose of antibiotic prophylaxis intravenously on starting anaesthesia. However, give prophylaxis earlier for operations in which a tourniquet is used. Before giving antibiotic prophylaxis, take into account the timing and pharmacokinetics (for example, the serum half-life) and necessary infusion time of the antibiotic. Give a repeat dose of antibiotic prophylaxis when the operation is longer than the half-life of the antibiotic given. Give antibiotic treatment (in addition to prophylaxis) to patients having surgery on a dirty or infected wound. Inform patients before the operation, whenever possible, if they will need antibiotic prophylaxis, and afterwards if they have been given antibiotics during their operation. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5227;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend that the operating should wash their hands prior to the first operation on the list using an aqueous antiseptic surgical solution, with a single-use brush or pick for the nails, and ensure that hands and nails are visibly clean.";"Before subsequent operations, hands should be washed using either an alcoholic hand rub or an antiseptic surgical solution. If hands are soiled then they should be washed again with an antiseptic surgical solution.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5995;6;"Less Is More Collection - JAMA Network";"Seib CD. JAMA Intern Med. 2019;179(3):391-393.";English;"It is recommended to perform a routine assessment of preoperative frailty before performing a TAVR in patients with severe aortic stenosis.";"Over the past years, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR) for severe aortic stenosis and is increasingly being used in older patients with a high burden of comorbidity. Although prior studies that focused on disease-specific outcomes contributed to the expansion of TAVR use, multi-institutional observational studies have demonstrated that patient frailty results in an increased risk of mortality and disability at 1 year following TAVR and SAVR. This single-center, prospective cohort study evaluated 246 patients 70 years or older undergoing TAVR or SAVR with a preoperative comprehensive geriatric assessment (CGA). The goal was to characterize the longitudinal functional recovery for patients undergoing these types of surgeries. The authors found that patients with high preoperative frailty who underwent TAVR were more likely to demonstrate progressive or accelerated functional decline compared with nonfrail patients who underwent TAVR and those who underwent SAVR. Based on these findings and taking into consideration that cognitive and functional outcomes affect treatment preferences more than mortality in patients at the end of life, the investigators recommended routine assessment of preoperative frailty to improve shared decisionmaking. ";2019;;;"High value";Prevention;"Link to the recommendation on the website of the initiative" 5228;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using non-iodophor-impregnated incise drapes routinely for surgery as they may increase the risk of surgical site infection. ";"If an incise drape is required, use an iodophor-impregnated drape unless the patient has an iodine allergy.";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5996;6;"Less Is More Collection - JAMA Network";"Tamma PD. JAMA Intern Med. 2019;179(3):316-323.";English;"It is recommended to convert to oral step-down therapy early in adults with controlled Enterobacteriaceae bacteremia.";"In this multicenter cohort study of 1478 unique patients with Enterobacteriaceae bacteremia, no difference in 30-day mortality or recurrent bacteremia was observed between patients converted to early (within the first 5 days of treatment), oral step-down therapy and propensity score?matched patients who continued to receive intravenous antibiotics for the duration of therapy. The findings suggest that transitioning to oral step-down therapy may be an effective treatment approach for patients with Enterobacteriaceae bacteremia who have received source control and demonstrated an appropriate clinical response, and that it may be associated with a decrease in the duration of hospital stay for these patients. ";2019;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 5229;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend that the operating team wear sterile gowns in the operating theatre during the operation.";"Consider wearing 2 pairs of sterile gloves when there is a high risk of glove perforation and the consequences of contamination may be serious. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5230;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend preparing the skin at the surgical site immediately before incision using an antiseptic preparation.";"Be aware of the risks of using skin antiseptics in babies, in particular the risk of severe chemical injuries with the use of chlorhexidine (both alcohol-based and aqueous solutions) in preterm babies. When deciding which antiseptic skin preparation to use, options may include those in table 1. If diathermy is to be carried out: - use evaporation to dry antiseptic skin preparations and - avoid pooling of alcohol-based preparations. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5998;6;"Less Is More Collection - JAMA Network";"George F. Sawaya, MD.JAMA Intern Med. 2019;179(7):867-878.";Spanish;"It is recomended to perform cytologic testing every 3 years for women aged 21 to 29 years or switching it to a low-cost hrHPV test every 5 years in women aged 30- 65 years.";"The cross-sectional portion of this study enrolled a convenience sample of 451 women aged 21 to 65 years to estimate the cos-effectiveness of 12 cervical cancer screeining strategies. Of 12 strategies evaluated in a cost-effectiveness model, cytologic testing every 3 years for women aged 21 to 29 years with either continued triennial cytologic testing or switching to a low-cost high-risk human papillomavirus test every 5 years from age 30 to 65 years conferred a reasonable balance of benefits, harms, and costs from both a societal and health care sector perspective. ";2019;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative." 4975;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hyperparathyroidism (primary): diagnosis, assessment and initial management Recommendations for 1.1 Diagnostic testing in primary care 1.2 Testing and assessment in secondary care 1.3 Referral for surgery 1.4 Surgical management 1.5 Non-surgical management 1.6 Monitoring 1.7 Pregnancy";"Follow the recommendations on enabling people to actively participate in their care in the NICE guideline on patient experience in adult NHS services. Give people with primary hyperparathyroidism information about the condition, including: what primary hyperparathyroidism is, what the parathyroid glands do, causes of primary hyperparathyroidism, symptoms, diagnosis, including diagnosis if calcium or PTH levels are normal, prognosis, possible effects on daily life, possible long-term effects. Give people information about treatments for primary hyperparathyroidism that includes: the surgical and non-surgical treatments that are available, how well the treatments are likely to work, the advantages and disadvantages of each treatment, including possible complications and side effects, why these particular treatments are being offered, why other treatments are not advised. Give advice on how to reduce the symptoms of primary hyperparathyroidism and prepare for surgery or other treatment, including: exercise, diet, hydration, ain relief, what to expect after treatment, recovery time and return to daily activities, including return to work. Discuss ongoing care and monitoring for primary hyperparathyroidism, explaining the type and frequency of monitoring that will be offered and the purpose of each. ";2019;;;"High value";" Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5231;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using diathermy for surgical incision to reduce the risk of surgical site infection.";" ";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5999;6;"Less Is More Collection - JAMA Network";"Ruzicka M. JAMA Intern Med. 2019;179(10):1433-1434.";English;"It's recommended the use of rigorous adherence assessment and intervention methods such as Directly Observed Therapy (DOT) for patients with apparently refractory hypertension.";"It?s a prospective observational cohort study. The results suggest that nonadherence to BP-lowering drug regimens is high among referred patients with apparent treatment-resistant hypertension, even among those who said they were adherent on questioning before DOT, had pristine pharmacy filling records, and had accurate pill counts. The apparent nonadherence occurred despite more than 50% of these patients already having had an adverse vascular event related to uncontrolled hypertension. However, we cannot exclude the possibility that the process of being in the study or receiving treatment from a nurse in a clinic was associated with lower BP for some patients. Limitations of the study include that the patients were highly selected and likely do not represent most patients with hypertension in the community. In conclusion, he findings suggest that rigorous methods of adherence assessment and intervention such as DOT should be considered for patients with apparent treatment-resistant hypertension. ";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa " 4976;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sodium zirconium cyclosilicate is recommended as an option for treating hyperkalaemia in adults only if used: in emergency care for acute life-threatening hyperkalaemia alongside standard care or in outpatient care for people with persistent hyperkalaemia and chronic kidney disease stage 3b to 5 or heart failure. ";"This recommendation is not intended to affect treatment with sodium zirconium cyclosilicate that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Sodium zirconium cyclosilicate is a treatment for people with high blood potassium levels (hyperkalaemia). It may benefit adults with chronic kidney disease or heart failure, either: in emergency care for life-threatening hyperkalaemia or in outpatient care (in hospital) for persistent hyperkalaemia if they are able to have RAAS inhibitors. Treating acute life-threatening hyperkalaemia in emergency care is established clinical practice. Evidence from people with hyperkalaemia having treatment in outpatient care suggests that sodium zirconium cyclosilicate could be a useful addition to emergency care. Other potassium-lowering treatments are rarely used in this setting because they are poorly tolerated. Clinical trials show that sodium zirconium cyclosilicate lowers serum potassium when used in outpatient care. But there is no clinical evidence that it extends life or improves quality of life. Sodium zirconium cyclosilicate may allow people to stay on RAAS inhibitors (drugs used to treat heart failure and kidney disease) for longer. Staying on these drugs may extend life and improve quality of life.";2019;;;"Low value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5232;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend maintaining patient temperature in line with NICE's guideline on hypothermia: prevention and management in adults having surgery.";"Maintain optimal oxygenation during surgery. In particular, give patients sufficient oxygen during major surgery and in the recovery period to ensure that a haemoglobin saturation of more than 95% is maintained. Maintain adequate perfusion during surgery. Do not give insulin routinely to patients who do not have diabetes to optimise blood glucose postoperatively as a means of reducing the risk of surgical site infection.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4721;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"Obeticholic acid is not recommended as a bile acid derivative for primary biliary cholangitis.";"Obeticholic acid does not improve patients? health status. It often worsens the main symptoms of the disease (pruritus and fatigue) and appears to provoke severe and sometimes fatal hepatic adverse effects.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5233;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using wound irrigation to reduce the risk of surgical site infection. Do not recommend using intracavity lavage to reduce the risk of surgical site infection.";" ";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6001;6;"Less Is More Collection - JAMA Network";" Georgieva MV.JAMA Intern Med. 2019;179(10):1352-1362.";English;"Reduce the use of computed tomography for the early detection of cancer in patients with hematuria.";"It?s a microsimulation modeling study of a hypothetical cohort. The uniform CT imaging for patients with hematuria was associated with increased costs and harms of secondary cancers, procedural complications, and false positives, with only a marginal increase in cancer detection. Risk stratification may optimize the balance of advantages, harms, and costs of CT. Asymptomatic microscopic hematuria, the focus of these analyzes, has a relatively low pretest probability for cancer. Recommendations against uniform CT in this context explicitly cite concerns about costs and harms, in particular radiation exposure. The findings support these concerns, as the strategy of CT for all patients was associated with not only substantially greater costs but also a larger number of false-positive results, procedural complications, and an estimated risk of radiation-induced future cancer for 1 in 174 patients tested. In conclusion, well-intentioned efforts may lead to the widespread dissemination of clinical practices before their safety and effectiveness are clearly understood. This model-based comparison suggests that, in addition to its substantial costs, the potential harms of the intensive application of uniform CT urography may outweigh the advantages of early diagnosis of urinary tract malignant neoplasms. ";2019;;;"Low value";diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5234;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend only applying an antiseptic or antibiotic to the wound before closure as part of a clinical research trial.";"Consider using gentamicin-collagen implants in cardiac surgery. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6002;6;"Less Is More Collection - JAMA Network";"Ganguli I. JAMA Intern Med. 2019;179(9):1211-1219.";English;"Optimize the use of low-value preoperative EKGs in cataract surgeries for Fee-for-Service Medicare Beneficiaries.";"It?s a cohor study. Care cascades after preoperative EKG for cataract surgery are infrequent but costly. Policy and practice interventions to reduce low-value services and the cascades that follow could yield substantial savings. Robust evidence, codified in multiple guidelines, makes clear that routine testing before this prevalent, low-risk, elective surgery does not improve outcomes or lower the risk of adverse events among Medicare beneficiaries. As a result we coud see that beneficiaries receiving preoperative EKGs were older, had more medical conditions on average, and were more often urban dwellers compared with those not receiving preoperative EKGs. We found that 16% of beneficiaries who received a preoperative EKG experienced at least 1 potential cascade event. Thats meang that the people who experienced at least 1 potential cascade event, was people with a lots of comorbidity. Cascade events are relatively infrequent, but the cumulative cost of these events eclipses that of the initial low-value services. In future work, we should characterize cascades after other low-value services and determine whether they have similar incidence and cost. Our work demonstrates that low-value services that appear financially benign may have large downstream consequences; we should consider these cascades when measuring the consequences of low-value care and prioritizing efforts to reduce it.";2019;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5235;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend, when using sutures, considering using antimicrobial triclosan-coated sutures, especially for paediatric surgery, to reduce the risk of surgical site infection. ";"Consider using sutures rather than staples to close the skin after caesarean section to reduce the risk of superficial wound dehiscence.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6003;6;"Less Is More Collection - JAMA Network";"Lindsay A. JAMA Intern Med. 2019;179(11):1519-1527.";English;"Prevent inadequate treatment of asymptomatic bacteriuria in hospitalized patients.";"It?s a retrospective cohort study. Antibiotic treatment of asymptomatic bacteriuria in hospitalized patients appears to be common, may not be associated with improved clinical outcomes, and may be associated with longer duration of hospitalization after urine testing. To possibly reduce inappropriate antibiotic use, stewardship efforts should focus on improving urine testing practices and management strategies for elderly patients with altered mental status. Our study identified new characteristics associated with treatment: dementia and urinary incontinence. Acute AMS (alterations mental status) and dementia are particularly challenging because patients with these conditions are often not able to reliably communicate symptoms, causing clinician hesitation in withholding treatment. Despite common misperceptions, positive urinalysis or UC results do not define a UTI or necessitate antibiotic therapy. To decrease inappropriate testing and treatment of ASB, diagnostic stewardship interventions and education should emphasize the poor positive predictive value of abnormal urinalysis results and emphasize symptoms as the correct prompt for urine testing and UTI diagnosis. In addition, we found no difference in mortality, readmission, emergency department visits, or CDI within 30 days in patients with ASB treated with antibiotics compared with those who received no treatment. Moreover we find that ATB treatment increase the duration of hospitalization in almost a 37% cases. In conclusion, treatment was associated with certain patient characteristics (elderly, dementia, and AMS) and laboratory test findings (particularly abnormal urinalysis results), which were possibly related to a misunderstanding of the diagnostic criteria for UTI. Treatment did not improve clinical outcomes; rather, it may have been associated with an increase in duration of hospitalization after urine testing. Our findings suggest that, to reduce inappropriate antibiotic use, stewardship efforts should focus on improving urine testing practices and management strategies for stable elderly patients with AMS. ";2019;;;"Low value";"Treatment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5236;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend covering surgical incisions with an appropriate interactive dressing at the end of the operation. ";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5237;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend using an aseptic non-touch technique for changing or removing surgical wound dressings. ";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5238;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend using sterile saline for wound cleansing up to 48 hours after surgery.";"Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5750;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The effects of interactive training for healthcare professionals to manage life-threatening emergencies in the hospital are unclear";"COVID-19 is placing a great strain on healthcare workers. Training healthcare providers to manage life-threatening emergencies may help them to prepare for events such as the COVID-19 pandemic. Interactive training can provide opportunities for discussion, rehearsal and interaction with other workers and other learning resources. A Cochrane systematic review, whose authors searched for randomized trials evaluating the effects of interactive training of healthcare staff on the management of life?threatening emergencies in hospital. They did not restrict by language of publication and did their searches in March 2019. They identified 11 studies (more than 2000 healthcare workers and 300,000 patients). ";2019;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4983;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer children with concentration or memory difficulties that interfere with learning, school progress or behaviour to community paediatric or paediatric neurodevelopmental services for assessment.";"Be aware that some children with attention and concentration difficulties do not have hyperactivity. The committee agreed that concentration and memory difficulties that interfere with a child's learning should have further assessment to avoid unscheduled healthcare visits for learning difficulties in the future. The committee discussed the common perception of children with attention and concentration problems as having hyperactive, noisy and destructive behaviour. Such children readily come to the attention of primary care, school and paediatric neurodevelopmental services. The committee wanted to ensure that children who do not have hyperactivity but do have significant attention and concentration problems are also recognised. Because they do not behave in a disruptive manner, these children may not be identified promptly, and may later present with learning difficulties.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5239;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection.";" ";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4984;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently children with new-onset blackouts (transient loss of consciousness) accompanied by seizure markers for neurological assessment, in line with the recommendation for people with suspected epilepsy in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s";"Refer urgently children with mid-activity vacant spells or behavioural outbursts associated with altered consciousness or amnesia for the events to have a paediatric assessment. Blackouts in children can be caused by neurological disorders, predominantly epilepsy, cardiac disorders or simple syncope. The committee observed that, even with a clear first-hand description of the event, it is not always possible to make a confident diagnosis without specialist assessment and investigations. The committee agreed that the recommendation for people with suspected epilepsy in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s is applicable to children aged under 16. Vacant spells ? often called absences ? as a result of epilepsy in children can be difficult to distinguish from day-dreaming and loss of concentration, and need further assessment.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5240;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using Eusol and gauze, or moist cotton gauze or mercuric antiseptic solutions to manage surgical wounds that are healing by secondary intention.";"Use an appropriate interactive dressing to manage surgical wounds that are healing by secondary intention. Ask a tissue viability nurse (or another healthcare professional with tissue viability expertise) for advice on appropriate dressings for the management of surgical wounds that are healing by secondary intention. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4985;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently all children aged under 12 years with blackouts for paediatric assessment.";"The committee agreed that all children under 12 with blackouts or transient loss of consciousness should be referred for urgent assessment because history and examination do not always allow a diagnosis to be made confidently and there are a number of potentially serious causes that need to be excluded.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative" 5241;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend, when surgical site infection is suspected by the presence of cellulitis, either by a new infection or an infection caused by treatment failure, giving the patient an antibiotic that covers the likely causative organisms. Consider local resistance patterns and the results of microbiological tests in choosing an antibiotic.";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4986;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely refer children aged over 12 years with blackouts if there are clear features of vasovagal syncope, even if associated with brief jerking of the limbs, in line with recommendation 1.1.4.3 on uncomplicated faint in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s.";"Vasovagal syncope is common in young people, and is often inappropriately referred because of concern that it represents seizures. The committee considered that the recommendation on vasovagal syncope in the NICE guideline on transient loss of consciousness ('blackouts') in over 16s is applicable to children aged 12 to 15 years.";2019;;;"Low value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5242;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend using Eusol and gauze, or dextranomer or enzymatic treatments for debridement in the management of surgical site infection.";" ";2019;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4987;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For children who have blackouts, seizures or amnesia for events after a head injury, follow the recommendations on pre-hospital assessment, advice and referral to hospital in the NICE guideline on head injury.";"Transient loss of consciousness after a head injury in children is usually immediate or within a few minutes. Much-delayed paroxysmal events after head injury in children ? days or weeks later ? are rare but warrant urgent referral for neurological assessment. The committee considered that the recommendations on pre-hospital assessment, advice and referral to hospital in the NICE guideline on head injury should be followed.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5243;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend using a structured approach to care to improve overall management of surgical wounds. This should include preoperative assessments to identify people with potential wound healing problems. Enhanced education of healthcare workers, patients and carers, and sharing of clinical expertise is needed to support this. ";" ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6011;33;"Choosing Wisely � : Things we do for no reason";"Holleck, JL. Journal of hospital medicine";Spanish;"The routine use of IPC (Intermittent Pneumatic Compression) in waiting ward patients is not recommended.";"No current evidence supports IPC efficacy in general medical ward patients despite its widespread use; thus, prospective trials in this population are needed. Given costs, potential side effects, and uncertain efficacy in general medical ward patients, IPC should be reserved for surgical, trauma, critical care, or stroke patients. It may be considered for moderate to high-risk medical patients with excessive bleeding risk";2019;;;"Low value";"Patiens management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4988;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In children with dizziness, examine the ears for any signs of infection, inflammation or eardrum perforation.";"The committee agreed that middle ear infection and middle ear effusion can be a cause of dizziness in children. They noted that the child may have fever, pain and diminished hearing, or a recent history of these, and that the eardrum might appear red and inflamed or bulging.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5244;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely using the oral and rectal routes to measure the body temperature of children aged 0?5 years.";" ";2019;;;"Low value";" Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4989;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer urgently all children aged under 4 years with headache for neurological assessment.";"The committee agreed that headache in a child aged under 4 years is an unusual symptom and, when present, has a high chance of being associated with a significant intracranial disease. Because the child is unable to articulate clearly what is wrong, parents may report excessive crying, a high-pitched cry or excessive irritability.";2019;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5245;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend measuring body temperature with an electronic thermometer in the axilla in infants under the age of 4 weeks.";"In children aged 4 weeks to 5 years, measure body temperature by one of the following methods: - electronic thermometer in the axilla - chemical dot thermometer in the axilla - infra-red tympanic thermometer Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required. Forehead chemical thermometers are unreliable and should not be used by healthcare professionals.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5757;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the effects of interventions to redirect low-acuity patients at prehospital form or from the emergency department";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to redirect patients away from emergency departments (ED) might inform policies and actions to ease this. In this systematic review, the authors searched for comparative effectiveness studies that evaluated the redirection of patients before they arrive at the hospital or ED. They restricted the search to articles published in English between 1990 and 2016, and did their search in 2017. They included 10 clinical trials and 5 observational cohort studies. Overall, 11 studies evaluated pre-hospital diversion (7 clinical trials and 4 cohort studies) and 4 studies evaluated ED-based diversion (1 randomized trial and 3 cohort studies). Pre-hospital diversion of patients did not significantly decrease the proportion of patients transferred to the ED, compared to standard care. In the three pre-hospital studies that reported a cost analysis, none found a significant difference in total healthcare costs between diverted and non-diverted patients. It is uncertain whether pre-hospital or ED-based diversion should, or should not, be used. ";2019;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6013;33;"Choosing Wisely � : Things we do for no reason";"Fakheri, RJ. Journal of Hospital Medicine";Spanish;"The use of sliding scale insulin as generalized monotherapy is not recommended in all diabetic patients.";"Using SSI (Sliding-Scale Insulin) as monotherapy for hyperglycemia is a common practice, and although well-intentioned, it is an ineffective and possibly dangerous approach. Continued efforts must be made to address the gap between guidelines and suboptimal practice patterns locally and nationally.";2019;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5246;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering valid and taking seriously the reported parental perception of a fever.";" ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4991;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lanadelumab is recommended as an option for preventing recurrent attacks of hereditary angioedema in people aged 12 and older,";"It is recommended only if: they are eligible for preventive C1-esterase inhibitor (C1-INH) treatment in line with NHS England's commissioning policy, that is, they are having 2 or more clinically significant attacks (as defined in the policy) per week over 8 weeks despite oral preventive therapy, or oral therapy is contraindicated or not tolerated the lowest dosing frequency of lanadelumab is used in line with the summary of product characteristics, that is, when the condition is in a stable, attack-free phase (see section 2) and the company provides lanadelumab according to the commercial arrangement. This recommendation is not intended to affect treatment with lanadelumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. For young people, this decision should be made jointly by the clinician and the young person or the young person's parents or carers. People with hereditary angioedema have attacks that cause severe swelling of various parts of the body. Despite long-term oral preventive therapy (such as attenuated androgens) and C1-INH treatments, some people still have frequent severe attacks. Lanadelumab's marketing authorisation is broad and covers prevention of recurrent attacks of hereditary angioedema. But there is no trial evidence comparing lanadelumab with long-term oral preventive therapy so it cannot be used instead of this therapy. Therefore the company wants lanadelumab to be used only for people who are eligible for long-term preventive C1-INH treatments in line with NHS England's commissioning policy. So C1-INH treatments are the most appropriate comparator for the company's proposed positioning. Evidence from a randomised controlled trial suggests that people having lanadelumab have fewer hereditary angioedema attacks than with placebo. There are data indirectly comparing lanadelumab with C1-INHs.";2019;;;"High value";Allergies;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5247;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend identifying any immediately life-threatening features, including compromise of the airway, breathing or circulation, and decreased level of consciousness.";"Think ""Could this be sepsis?"" and refer to the NICE guideline on sepsis: recognition, diagnosis and early management if a child presents with fever and symptoms or signs that indicate possible sepsis. ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6015;33;"Choosing Wisely � : Things we do for no reason";"Chow, S. Journal of Hospital Medicine";Spanish;"Routine neuroimaging is not recommended in patients with delirium of unidentified cause.";"Performing neuroimaging in undifferentiated patients who develop delirium while hospitalized has a low diagnostic yield, is costly, and is potentially harmful. Neuroimaging should be reserved for those with identified risk factors for intracranial pathology. For the patient described in the initial vignette with no risk factors for intracranial cause, neuroimaging would be unlikely to contribute to her care. To change provider beliefs and behaviors regarding neuroimaging, prospective studies evaluating guideline implementation are needed. However, based on the current evidence, neuroimaging should be reserved for those with identified risk factors.";2019;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4736;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescire International";English;"Cimetidine is not recomended in various gastro-oesophageal disorders compared with other H2-receptor antagonists.";"Cimetidine has an unfavourable harm-benefit balance when compared with other H2-receptor antagonists because it can cause an accumulation of and increase in dose-dependent adverse effects of a number of other drugs, as cimetidine inhibits many P450 cytochrome isoenzymes.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5248;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend assessing children with feverish illness for the presence or absence of symptoms and signs that can be used to predict the risk of serious illness using the traffic light system.";"When assessing children with learning disabilities, take the individual child's learning disability into account when interpreting the traffic light table. Recognise that children with any of the following symptoms or signs are in a high-risk group for serious illness: - pale/mottled/ashen/blue skin, lips or tongue - no response to social cues - appearing ill to a healthcare professional - does not wake or if roused does not stay awake - weak, high-pitched or continuous cry - grunting - respiratory rate greater than 60 breaths per minute - moderate or severe chest indrawing - reduced skin turgor - bulging fontanelle Recognise that children with any of the following symptoms or signs are in at least an intermediate-risk group for serious illness: - pallor of skin, lips or tongue reported by parent or carer - not responding normally to social cues - no smile - wakes only with prolonged stimulation - decreased activity - nasal flaring - dry mucous membranes - poor feeding in infants - reduced urine output - rigors Recognise that children who have all of the following features, and none of the high- or intermediate-risk features, are in a low-risk group for serious illness: - normal colour of skin, lips and tongue - responds normally to social cues - content/smiles - stays awake or awakens quickly - strong normal cry or not crying - normal skin and eyes - moist mucous membranes Measure and record temperature, heart rate, respiratory rate and capillary refill time as part of the routine assessment of a child with fever. Recognise that a capillary refill time of 3 seconds or longer is an intermediate-risk group marker for serious illness ('amber' sign). Measure the blood pressure of children with fever if the heart rate or capillary refill time is abnormal and the facilities to measure blood pressure are available. In children older than 6 months do not use height of body temperature alone to identify those with serious illness. Recognise that children younger than 3 months with a temperature of 38�C or higher are in a high-risk group for serious illness. Recognise that children aged 3?6 months with a temperature of 39�C or higher are in at least an intermediate-risk group for serious illness. Do not use duration of fever to predict the likelihood of serious illness. However, children with a fever lasting 5 days or longer should be assessed for Kawasaki disease. Recognise that children with tachycardia are in at least an intermediate-risk group for serious illness. Use the Advanced Paediatric Life Support (APLS) criteria to define tachycardia. Assess children with fever for signs of dehydration. Look for: - prolonged capillary refill time - abnormal skin turgor - abnormal respiratory pattern - weak pulse - cool extremities";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6016;33;"Choosing Wisely � : Things we do for no reason";"Fakheri R. J. Hosp. Med. 2019 February;14(2):110-113 ";English;"It is not recommended to prescribe docusate neither for preventing nor treating constipation in hospitalzed patients";"A lot of studies (the vast majority of them randomized with high accuracy) which included control groups with placebo could not prove real effect when giving docusate to pacients to prevent or treat them from constipation. It is recommended, instead, giving laxants whose effect have been proved such as Polyethylene glycol, lactulose, etc. ";2019;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4737;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescire International";English;"It is not recommended to use neuroleptics domperidone, droperidol and metopimazine to treat nausea and vomiting, and gastroesophageal reflux.";"The neuroleptics domperidone, droperidol and metopimazine can provoke arrhythmias and sudden death. These adverse effects are unacceptable given the symptoms they are used to treat (nausea and vomiting, and gastroesophageal reflux in the case of domperidone) and their weak efficacy.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4993;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Rucaparib is recommended for use within the Cancer Drugs Fund as an option for maintenance treatment of relapsed platinum-sensitive high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer that has responded to platinum-based chemotherapy in adults, only if the conditions in the managed access agreement for rucaparib are followed.";"This recommendation is not intended to affect treatment with rucaparib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. The clinical evidence shows that rucaparib extends the time until cancer progresses compared with routine care. How much longer people live after taking rucaparib is uncertain because the data from the trial are not available yet. Because of the uncertainty in the clinical evidence, the estimates of cost effectiveness are very uncertain. Therefore, rucaparib cannot be recommended for routine use in the NHS. Rucaparib has the potential to be cost effective if further data confirm the estimated overall-survival benefit. Rucaparib is therefore recommended for use within the Cancer Drugs Fund as an option for the maintenance treatment of relapsed platinum-sensitive high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer that has responded to platinum-based chemotherapy in adults, while further data are collected.";2019;;;"High value";"Ovarian cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5249;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend looking for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases.";" ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6017;33;"Choosing Wisely � : Things we do for no reason";"Lippert W. J. Hosp. Med. 2019 May;14(5):315-317";English;"It is not recommended the indiscriminated usage of thickened liquids in treating hospitalized adult patients with dysphagia";"A lot of studies have been conduct in order to check the effectivity of the usage of thickened liquids for adult patients with dysphagia. Although there are situations where this is highly indicated, the restriction of water can lead however to other non-desirable effects such as dehydration, fever, and low life quality. The acces to water should be always considerated and, when posible, agreed with the patient. Drinking water provides the patient a better life quality and has not been demonstrated to significantly rise the risk of aspiration in disposed patients.";2019;;;"Low value";"Patient management";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4738;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire International";English;"It is not recommended to use Nifuroxazide as a diarrhoea treament.";"Nifuroxazide, an intestinal ?anti-infective? agent with no proven efficacy in diarrhoea, can provoke serious immunological reactions.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4994;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Rivaroxaban plus aspirin is recommended within its marketing authorisation, as an option for preventing atherothrombotic events in adults with coronary artery disease or symptomatic peripheral artery disease who are at high risk of ischaemic events.";"For people with coronary artery disease, high risk of ischaemic events is defined as: - aged 65 or over, or - atherosclerosis in at least 2 vascular territories (such as coronary, cerebrovascular, or peripheral arteries), or - 2 or more of the following risk factors: current smoking, diabetes, kidney dysfunction with an estimated glomerular filtration rate (eGFR) of less than 60 ml/min (note that rivaroxaban is contraindicated if the eGFR is less than 15 ml/min), heart failure, previous non-lacunar ischaemic stroke. Assess the person's risk of bleeding before considering rivaroxaban. Treatment should only be started after an informed discussion with them about the risks and benefits of rivaroxaban, weighing up the risk of atherothrombotic events against the risk of bleeding. The risks and benefits of continuing treatment with rivaroxaban should be regularly reviewed.";2019;;;"High value";"Acute coronary syndromes ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5250;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering meningococcal disease in any child with fever and a non-blanching rash, particularly if any of the following features are present:";"- an ill-looking child - lesions larger than 2 mm in diameter (purpura) - a capillary refill time of 3 seconds or longer - neck stiffness Consider bacterial meningitis in a child with fever and any of the following features: - neck stiffness - bulging fontanelle - decreased level of consciousness - convulsive status epilepticus Be aware that classic signs of meningitis (neck stiffness, bulging fontanelle, high-pitched cry) are often absent in infants with bacterial meningitis.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4739;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescire International";English;"It is not recommended to use Prucalopride as a chronic constipation treatment.";"Prucalopride is authorised for chronic constipation but shows only modest efficacy, and only in about one in six patients. Its adverse effect profile is poorly documented, particularly with respect to cardiovascular disorders (palpitations, ischaemic cardiovascular events, possible QT prolongation), depression and suicidal ideation, and teratogenicity.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4995;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Olaparib is recommended for use within the Cancer Drugs Fund as an option for the maintenance treatment of BRCA mutation?positive, advanced (FIGO stages 3 and 4), high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer that has responded to first-line platinum-based chemotherapy in adults.";"This recommendation is not intended to affect treatment with olaparib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. There are currently no maintenance treatments for BRCA mutation-positive advanced ovarian, fallopian tube or peritoneal cancer after a positive response to first-line platinum-based chemotherapy. Olaparib is currently recommended after 3 or more lines of platinum-based chemotherapy. Using olaparib earlier in the treatment pathway would be an important development because earlier use can achieve the greatest benefit and may have the potential to cure the disease.";2019;;;"High value";"Ovarian cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5251;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering herpes simplex encephalitis in children with fever and any of the following features:";"- focal neurological signs - focal seizures - decreased level of consciousness";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4740;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescire International";English;"It is not recommended to use Glyceryl trinitrate 0.4% ointment as a treatment for chronic anal fissures or to alleviat the pain they cause.";"Glyceryl trinitrate 0.4% ointment has no proven efficacy beyond the placebo effect in healing chronic anal fissures or alleviating the pain they cause. Headache is a very common adverse effect, and can be severe.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6532;33;"Choosing Wisely � : Things we do for no reason";"Kleris R., Lugar P.";English;"Failing to question a penicillin allergy history is not recommended";"RECOMMENDATIONS ? Obtain a thorough drug allergy history as many ?allergic reactions? can be removed by history alone. Update the medical record if you can confirm a patient has since tolerated PCN or a PCN derivative to which they were previously allergic. Offer a supervised oral challenge if the patient has any concerns. ? Perform PST if a patient has a PCN allergy listed in their chart and the allergy history is unclear. A negative skin test should be followed by a supervised oral challenge to PCN/PCN derivative if skin testing is negative. ? Test PCN-allergic patients preemptively who are at high risk of requiring PCN/PCN derivative antibiotics. High-risk patients include surgery, transplant, hematology/oncology, and immunosuppressed patients. ? Implement published protocols from allergists for health- care systems that lack access to allergy physicians. ? Do not perform PST on patients with a history that is suggestive of a non-IgE-mediated allergic reaction. For these cases, patients are advised to avoid the medication. A supervised graded oral challenge can be considered on a case-by-case basis if the reaction was not a severe cutaneous adverse re- action syndrome, like SJS, and the benefit of using the medication outweighs the potential harm.";2019;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4741;2;"Choosing Wisely�";"American Academy of Otolaryngology, Head and Neck Surgery Foundation";English;"Do not recommend to administer or prescribe perioperative antibiotics to children undergoing tonsillectomy.";"Oral antibiotics may have significant adverse effects and do not provide demonstrable benefit after tonsillectomy. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5253;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering pneumonia in children with fever and any of the following signs:";"- tachypnoea (respiratory rate greater than 60 breaths per minute, age 0?5 months; greater than 50 breaths per minute, age 6?12 months; greater than 40 breaths per minute, age older than 12 months) - crackles in the chest - nasal flaring - chest indrawing - cyanosis - oxygen saturation of 95% or less when breathing air";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6021;33;"Choosing Wisely � : Things we do for no reason";"Amanda L. J. Hosp. Med. 2019 June;14(6):374-376. Published online first April 8, 2019";Spanish;"Consider a broad differential diagnosis when presented with a hospitalized patient with new thrombocytopenia given the low incidence of Heparin-induced thrombocytopenia (HIT) (<5%).";" Diagnosis of HIT can be made initially through the enzyme-linked immunosorbent assay (ELISA). Management of HIT involves immediate cessation of heparin and initiation of therapeutic anticoagulation with nonheparin agents in order to prevent or treat the thrombotic events.4,5 The true incidence of HIT remains low, occurring in 0.2% to 5% of patients exposed to heparin and less than 1% in the ICU population.2,3,6,7 However, given the high incidence of thrombocytopenia in the ICU, the diagnosis of HIT is often considered, resulting in over-testing in this population";2019;;;Uncertain;diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6022;33;"Choosing Wisely � : Things we do for no reason";"Lacy M. J. Hosp. Med. 2019 April;14(4):239-241. Published online first October 31, 2018. | 10.12788/";English;"Do not use prealbumin to screen for or diagnose malnutrition in the Hospitalized Patients.";"Prealbumin Is Not Specific, an ideal nutritional marker should be specific enough that changes in this marker reflect changes in nutritional status. Prealbumin is a negative acute phase reactant that decreases in concentration during the stress response due to slowed synthesis and extravasation. Neither prealbumin nor CRP, however, correlated with total body protein changes. A consensus statement from the Academy of Nutrition and Dietetics (AND) and ASPEN noted that prealbumin is an indicator of inflammation and lacks the specificity to diagnose malnutrition. Prealbumin Is Not Sensitive, a sensitive laboratory test for malnutrition should allow for detection of malnutrition at an early stage. However, patients who demonstrate severe malnutrition without a coexisting inflammatory state do not consistently show low levels of prealbumin. Analysis by AND found insufficient evidence to support a correlation between prealbumin and weight loss in anorexia nervosa, calorie restricted diets, or starvation. The data suggest that prealbumin lacks sufficient sensitivity to consistently detect cases of malnutrition easily diagnosed by history and/or physical exam. Consult with local dietitians to ensure that your institutional approach is in agreement with consensus recommendations. Data was extracted from a systematic review among others.";2019;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6534;33;"Choosing Wisely � : Things we do for no reason";"Lim M., Pagano M., Metcalf R.";English;"Routinely prescribing transfusion premedication to prevent acute transfusion reactions is not recommended ";"The most frequent complications of blood transfusion are allergic transfusion reactions (ATRs) and febrile nonhemolytic transfusion reactions (FNHTRs), with a combined incidence of approximately 1%-4% per transfusion. ATRs may range in severity from mild urticaria to life-threatening anaphylaxis. FNHTRs manifest as a fever (oral temperature greater than or equal to 38 �C/100.4 �F and an increase of at least 1 �C/1.8� F from pretransfusion values) or chills/rigors. With approximately 17 million blood transfusions, including RBCs, plasma, platelet, and cryoprecipitate components, administered annually in the United States, often to those with severe illnesses, ATRs and FNHTRs confer a substantial public health burden. Currently, the prevalence of premedication to prevent acute transfusion reactions in the United States and Canada is variable, ranging from 1.6% in one Canadian institution to as high as 80% in one large US hospital. RECOMMENDATIONS: ? Do not prescribe an antihistamine or acetaminophen prior to transfusion. ? Reduce the risk of FNHTRs in all transfusion recipients with universal prestorage leukoreduction. ? For individuals with multiple recurrent ATRs to platelets, em- ploy platelet additive solution or platelet volume reduction. ? Reserve washing RBC and platelet components for patients with a history of severe ATRs. Make sure epinephrine is at the patient?s bedside. ? Curb unnecessary blood transfusions to reduce avoidable transfusion reactions. ? Monitor patients undergoing transfusion closely.";2019;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4743;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Do not recommend weak reading glasses for children who do not have vision problems.";"Low amounts of ?farsightedness? is a normal finding in children. Most children can easily focus to see at near and distance because of their large accommodative (focusing) abilities, thereby making weak prescription glasses unnecessary ? and often rejected by the child. Unless the eyes are crossing, a prescription of weak farsighted glasses is generally not necessary.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4999;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to suspect familial hypercholesterolaemia (FH) as a possible diagnosis in adults with a total cholesterol level greater than 7,5 mmol/l or a personal or family history of premature coronary heart disease.";"For further information please visit the website.";2019;;;"High value";"Lipid disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5255;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer an aminosalicylate or antibiotics to prevent recurrent acute diverticulitis.";"The committee noted that the evidence supported current practice of not using an aminosalicylate in managing recurrent diverticulitis. Aminosalicylates are not licensed to treat diverticulitis in the UK and there is little evidence to support their use in this area. The committee agreed that there was insufficient evidence to support the use of antibiotics to prevent recurrent diverticular disease. In support of antibiotic stewardship and to avoid antibiotic resistance the committee recommended not offering antibiotic treatment.";2019;;;"Low value";"Diverticular disease";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6023;33;"Choosing Wisely � : Things we do for no reason";"Amanda L. J. Hosp. Med. 2019 June;14(6):374-376. Published online first April 8, 2019";Spanish;"Apply the 4T?s (platelet count, timing of platelet fall, presence of thrombotic events, and the likelihood of another cause of thrombocytopenia) score in those who have thrombocytopenia and recent heparin exposure";"A low scores 4T?s score (?3) predicts a low pretest probability and further testing is not required. Patients with moderate or high 4T?s score (?4) should have the ELISA (confers high sensitivity, due to its detection of nonpathogenic antibodies) test. During this time, heparin should be discontinued and nonheparin agents initiated while waiting for test results. Negative ELISA (OD < 0.4) helps to rule out HIT and allow heparin to be safely reintroduced without any further testing. Confirmatory testing with SRA (serotonin release assay) should be performed for all positive ELISAs (DO ? 0,4) ; however, they can be deferred in patients with strongly positive OD (?2.00) on ELISA.";2019;;;"High value";diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4744;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Do not recommend annual comprehensive eye exams (exams done in an eye doctor?s office) for children who pass routine vision screening assessments.";"Early childhood vision screening done as part of routine well-child care accurately identifies most children with significant eye problems who are otherwise asymptomatic. Annual comprehensive eye examinations increase financial costs, a child?s absence from school and parental time away from work, with no evidence that the comprehensive eye exams detect asymptomatic vision problems better than timely, methodical and recurrent screening efforts. Comprehensive eye exams are appropriate for children who do not pass a vision screening.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5256;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering urinary tract infection in any child younger than 3 months with fever.";"Consider urinary tract infection in a child aged 3 months or older with fever and 1 or more of the following: - vomiting - poor feeding - lethargy - irritability - abdominal pain or tenderness - urinary frequency or dysuria";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6024;33;"Choosing Wisely � : Things we do for no reason";"David P. . Hosp. Med. 2020 February;15(2):107-110. Published online first September 18, 2019";Spanish;"Do not obtain blood culture routinely for children aged >3 months hospitalized for uncomplicated CAP (community-acquired pneumonia).";"New evidence has revealed a decreasing incidence of bacteremia in pediatric populations. Moreover, viruses were the most frequently identified pathogens in children hospitalized with CAP in a large study, which were isolated in 66% of patients, whereas typical bacteria (either alone or in combination with a virus) were identified in only 7% of cases. Blood cultures are obtained for pediatric CAP has an incidence of a true bacterial bloodstream pathogen is 1.4%-7% of patients in USA in the conjugate vaccine era. True incidence of bacteremia in children with CAP would likely be lower if blood cultures were performed in all patients. ";2019;;;"Low value";diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5257;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend considering septic arthritis/osteomyelitis in children with fever and any of the following signs:";"- swelling of a limb or joint - not using an extremity - non-weight bearing";2019;;;"Low value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6025;33;"Choosing Wisely � : Things we do for no reason";"David P. J. Hosp. Med. 2020 February;15(2):107-110. Published online first September 18, 2019";Spanish;"Obtain a blood culture for the hospitalized patients with complicated CAP (Community Acquired Pneumonia), requiring ICU care (in shock or with advanced respiratory support), and requiring antibiotic treatment with an agent other than ampicillin / penicillin recommended by the IDSA (Infectious Diseases Society of America)";"Given the low prevalence of penicillin resistance among these types of patients, they should use blood cultures to identify patients with non-pneumococcal CAP (they are more likely to require antibiotics other than penicillin or aminopenicillin). Children with complicated pneumonia are more likely to have nonpneumococcal etiologies than uncomplicated ones. Furthermore, the IDSA guidelines indicate that the incidence of bacteremia in complicated pneumonia is higher than in uncomplicated pneumonia. According to the different cohort studies, we can interpret complicated as patients admitted to the ICU or who underwent a pleural drainage procedure, including lung abscess / necrosis, parapneumonic effusion / empyema or bronchopleural fistula. In fact, the British Thoracic Society guidelines do not recommend microbiological investigations of children with CAP, including blood culture, unless the child requires ICU care.";2019;;;"High value";diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4746;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t recommend vision therapy for patients with dyslexia";"Dyslexia is a language-based learning disability resulting in difficulties with written and oral language skills, particularly reading. Dyslexia is not due to a vision disorder. Children with dyslexia do not have any more visual problems than children without dyslexia. While it is important to rule out vision and eye problems, vision therapy is ineffective in the treatment of dyslexia because the eyes are not the cause of the reading problem. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5002;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety of therapeutic hypothermia for acute ischaemic stroke shows that there are serious complications. Evidence on efficacy does not show any meaningful improvement in outcomes. Therefore, this procedure should not be used.";"It is not recommended to use the therapeutic hypothermia procedure for acute ischaemic stroke as evidence on efficacy does not show any meaningful improvement in outcomes";2019;;;"Low value";" Stroke and transient ischaemic attack";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5258;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely investigate or treat for GOR if an infant or child without overt regurgitation presents with only 1 of the following:";"With only 1 of the following: - Unexplained feeding difficulties (for example, refusing to feed, gagging or choking) - Distressed behaviour - Faltering growth - Chronic cough - Hoarseness - A single episode of pneumonia. ";2019;;;"Low value";"Gastro-oesophageal reflux, including Barrett's oesophagus";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6026;33;"Choosing Wisely � : Things we do for no reason";"Society of Hospital Medicine";Spanish;"Things We Do for No Reason: Routine Echocardiography in Hemodynamically Stable Patients with Acute Pulmonary Embolism";"Echocardiography is a common method for evaluating RVD, and echocardiographic RVD confers an increased risk of adverse outcomes in PE.10-12 In the earliest meta-analysis to evaluate this association, Sanchez et al. combined data from five studies that included 623 patients from emergency room and inpatient settings. They found that echocardiographic RVD conferred an unadjusted relative risk for short-term mortality of 2.53 (95%CI 1.17-5.50).12 A subsequent meta-analysis by Cho et al. pooled data from both prospective and retrospective cohorts to examine short-term mortality in a total of 3,283 hemodynamically stable patients with PE, of whom 1,223 (37.3%) had RVD diagnosed by echocardiogram.10 In this population, RVD was associated with an odds ratio of 2.29 (95%CI 1.61-3.26) for short-term death. Thus, echocardiography could be viewed as a risk stratification tool, even in hemodynamically stable PE.";2019;;;"High value";"patient management";https://www.journalofhospitalmedicine.com/jhospmed/article/197593/hospital-medicine/things-we-do-no-reason-routine-echocardiography?channel=27621#jhm1404-sec-0007 5259;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend being aware of the possibility of Kawasaki disease in children with fever that has lasted 5 days or longer. Additional features of Kawasaki disease may include:";"- bilateral conjunctival injection without exudate - erythema and cracking of lips; strawberry tongue; or erythema of oral and pharyngeal mucosa - oedema and erythema in the hands and feet - polymorphous rash - cervical lymphadenopathy Ask parents or carers about the presence of these features since the onset of fever, because they may have resolved by the time of assessment. Be aware that children under 1 year may present with fewer clinical features of Kawasaki disease in addition to fever, but may be at higher risk of coronary artery abnormalities than older children.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6027;33;"Choosing Wisely � : Things we do for no reason";"Haber L. J. Hosp. Med. 2019 October;14(10):633-635.";English;"Continue outpatient buprenorphine treatment for patients admitted with acute pain.";"Evolving understanding of buprenorphine pharmacology and the absence of high-quality evidence has resulted in providers holding buprenorphine in the setting of acute pain. For patients on buprenorphine admitted to the hospital with anticipated or unanticipated acute pain needs, hospitalists should continue buprenorphine. Continuation of buprenorphine meets a patient?s baseline opioid requirement. Providers may consider holding buprenorphine if a patient with opioid use disorder has not been taking buprenorphine before hospitalization and has severe acute pain needs. Adjust buprenorphine to address acute pain by dividing the total daily amount into three or four times a day dosing, and/or up-titrate the buprenorphine dose (federal prescribing regulations recommend a maximum of 24 mg daily, but state regulations may vary). And make plans collaboratively with the patient and outpatient provider, and communicate medication changes and plan at discharge.";2019;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6283;1;"NICE ";NICE;English;"It is not recommended to routinely use the oral and rectal routes to measure the body temperature of children aged 0?5 years.";"In infants under the age of 4 weeks, it is recommended to measure body temperature with an electronic thermometer in the axilla. In children aged 4 weeks to 5 years, measure body temperature by one of the following methods: electronic thermometer in the axilla, chemical dot thermometer in the axilla or infra-red tympanic thermometer. The aim is to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care. Healthcare professionals should identify any immediately life-threatening features, including compromise of the airway, breathing or circulation and decreased level of consciousness. Also, it is important to look for a source of fever and check for the presence of symptoms and signs that are associated with specific diseases like: Meningococcal disease and bacterial meningitis, Herpes simplex encephalitis, Pnemonia, Urinary tract infection, Septic arthritis/osteomielitis or Kawasaki disease.";2019;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4748;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t routinely order neuro-imaging for all patients with double vision.";"Many patients with double vision, or diplopia, request a CT scan or MRI fearing they have a brain tumor or other serious problem. Much of the time, results of a comprehensive eye evaluation determine that neither test is necessary. Other common causes of double vision are refractive error, dry eyes, cataract, and non-neurologic eye misalignment, all readily diagnosed by a complete exam, precluding the need for brain imaging. Only a minority of cases of diplopia result from problems within the brain.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5260;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use positional management to treat GOR in sleeping infants. ";"In line with NHS advice, infants should be placed on their back when sleeping.";2019;;;"Low value";" Gastro-oesophageal reflux, including Barrett's oesophagus ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6028;33;"Choosing Wisely � : Things we do for no reason";"Haber L. J. Hosp. Med. 2019 October;14(10):633-635.";English;"Add short-acting opioid agonists on an as-needed basis in conjunction with a defined plan to discontinue short-acting opioid agonists to avoid a return to use.";"Despite buprenorphine?s high affinity at the mu receptor, additional receptors remain available for full opioid agonists to bind and activate, providing effective pain relief even in patients using buprenorphine. Studies in this patient population have found that patients receiving buprenorphine may require higher doses of short-acting opioids to achieve adequate analgesia, but they experience similar pain control, lengths of stay, and functional outcomes to controls. Ana make plans collaboratively with the patient and outpatient provider, and communicate medication changes and plan at discharge.";2019;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4749;2;"Choosing Wisely�";"Asociaci�n Espa�ola Fisioterapia (AEF)";English;"Don?t order retinal imaging for patients without symptoms or signs of eye disease.";"Retinal imaging, such as taking a photograph or obtaining an ocular coherence tomography (OCT) image of the back of the eye, is useful for documenting or following retinal or optic nerve disease, but these imaging studies should not be obtained routinely for documentation of normal ocular anatomy in asymptomatic people.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5261;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer endoscopy to diagnose Barrett's oesophagus, but consider it if the person has GORD. ";"Discuss the person's preferences and their individual risk factors (for example, long duration of symptoms, increased frequency of symptoms, previous oesophagitis, previous hiatus hernia, oesophageal stricture or oesophageal ulcers, or male gender)";2019;;;"Low value";"Gastro-oesophageal reflux, including Barrett's oesophagus";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6029;33;"Choosing Wisely � : Things we do for no reason";"Haber L. J. Hosp. Med. 2019 October;14(10):633-635.";English;"Use adjunctive nonopioid pain medications and nonpharmacologic modalities to address acute pain.";"As with all pain, multimodal pain management should be provided with adjunctive medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, neuropathic agents, topical analgesics, and regional anesthesia. Make plans collaboratively with the patient and outpatient provider, and communicate medication changes and plan at discharge.";2019;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4750;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not routinely monitor coagulation tests during a course of therapeutic plasma exchange, unless the procedure is performed daily.";"Clinical circumstances may indicate baseline laboratory coagulation parameters be measured. For most indications, therapeutic plasma exchange (TPE) can be performed on an intermittent schedule using clotting factor deficient replacement fluid without the need for repeated routine monitoring of the patient?s hemostasis status. Of note, daily TPE significantly reduces clotting factors; therefore, coagulation testing may be warranted. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5006;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of percutaneous mitral valve leaflet repair for mitral regurgitation is adequate to support the use of this procedure, in patients for whom open surgery is contraindicated following risk assessment, provided that standard arrangements are in place for clinical governance, consent and audit.";"Patient selection should be done by a multidisciplinary structural heart team, typically including an interventional cardiologist, an expert in transoesophageal echocardiography, an expert in heart failure, a cardiac anaesthetist, a cardiac surgeon and a specialist nurse. Percutaneous mitral valve leaflet repair for mitral regurgitation should only be done in specialised centres with access to both cardiac surgical and vascular surgical support in case emergency treatment of complications is needed. This procedure should only be done by clinicians with specialist training and supervision by an experienced mentor for at least the first 20 procedures.";2019;;;"High value";"Heart failure";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5262;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend enquiring about recent travel abroad and considering the possibility of imported infections according to the region visited, when assessing a child with feverish illness.";" ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6030;33;"Choosing Wisely � : Things we do for no reason";"Society of Hospital Medicine";Spanish;"Things We Do for No Reason: Routine Echocardiography in Hemodynamically Stable Patients with Acute Pulmonary Embolism";"For most hemodynamically stable patients, echocardiographic findings will not enhance prognostication and/or have a therapeutic impact. The following four reasons explain why echocardiography adds little value to the care of these patients. Phenotypic expression of RVD varies from asymptomatic, despite abnormalities on diagnostic testing, to obstructive shock. Unfortunately, available prognostic models classify echocardiographic RVD in a binary fashion (present/absent) whereas RVD exists on a continuum. Consequently, RVD is commonly found in acute PE and has been identified in more than half of patients hospitalized with PE referred for echocardiography. Existing data do not allow clinicians to judge the clinical impact of the severity of echocardiographic RVD, and only the phenotypic expression of refractory hypotension has clear therapeutic implications. Second, while echocardiographic RVD is associated with short-term mortality, absolute rates of adverse outcomes are quite low when RVD is identified. For example, in a study merging multiple prospective cohorts, Becattini et al. demonstrated that RVD diagnosed by echocardiography or CT occurred in 41% of hospitalized patients stratified to low-risk PE by the simplified Pulmonary Embolism Severity Index (sPESI).8 For these patients, the 30-day mortality was 1.2%,8 which approximates the expected mortality from a low-risk sPESI score alone (1.1%).13 Even among intermediate-risk acute PE patients with RVD and/or elevated troponin enrolled in thrombolysis trials, the overall risk of death at 30 days was approximately 2%-3%, irrespective of the treatment arm. Third, RVD identified by echocardiography does not inform or enhance prognostication as compared with cardiac biomarker testing. In a meta-analysis by Sanchez et al., echocardiographic RVD predicted death with a risk ratio of 2.53 (95% CI 1.17-5.50).12 However, both elevated cardiac troponin and brain natriuretic peptide indicated a significantly worse outcome than imaging findings, with risk ratios of 8.3 (95% CI 3.6-19.3) and 9.5 (95% CI 3.2-28.6), respectively. More recently, Jim�nez derived and validated a multivariable risk prediction model for stable PE. In their data, echocardiographic RVD had an unadjusted odds ratio of 2.62 (95% CI 1.54-4.45) for predicting a 30-day complicated course. After multivariable adjustment that included sPESI scores, lower extremity ultrasound results, and cardiac biomarker testing, these odds became insignificant. In other words, identifying echocardiographic RVD did not improve prognostication in hemodynamically stable PE patients when other commonly available variables were used.";2019;;;"Low value";"diagnosis, patient management";"

https://www.journalofhospitalmedicine.com/jhospmed/article/197593/hospital-medicine/things-we-do-no-reason-routine-echocardiography?channel=27621#jhm1404-sec-0005

" 4751;14;"Prescrire bilan. Towards better patient care: drugs to avoid";;English;"It is not recommended the use of the combination of conjugated estrogens and bazedoxifen in menopausal women.";"The risks of thrombosis and hormone-dependent cancers have not been adequately evaluated.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5007;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of valve-in-valve transcatheter aortic valve implantation (ViV?TAVI) for aortic bioprosthetic dysfunction is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.";"Device-related adverse events should be reported to the Medicines and Healthcare products Regulatory Agency. Patient selection should be done by a multidisciplinary team, which must include interventional cardiologists experienced in the procedure, cardiac surgeons, an expert in cardiac imaging and, when appropriate, a cardiac anaesthetist and a specialist in elderly medicine. The multidisciplinary team should determine the risk level for each patient and the device most suitable for them. During the consent process, patients should be told about all treatment options, and their advantages and disadvantages. ViV?TAVI is a technically challenging procedure that should only be done in specialised centres, and only by clinicians and teams with special training and experience in complex endovascular interventions. Units doing this procedure should have both cardiac and vascular surgical support for the emergency treatment of complications and subsequent patient care.";2019;;;"High value";"Structural heart defects";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5263;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommeng seeking to identify symptoms and signs of serious illness and specific diseases when performing a remote assessment of a child with fever.";"Children whose symptoms or combination of symptoms suggest an immediately life-threatening illness should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance). Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be urgently assessed by a healthcare professional in a face-to-face setting within 2 hours. Children with 'amber' but no 'red' features should be assessed by a healthcare professional in a face-to-face setting. The urgency of this assessment should be determined by the clinical judgement of the healthcare professional carrying out the remote assessment. Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6031;33;"Choosing Wisely � : Things we do for no reason";"Society of Hospital Medicine";Spanish;"Things We Do for No Reason: Routine Echocardiography in Hemodynamically Stable Patients with Acute Pulmonary Embolism";"Echocardiography should be used to exclude other causes of hypotension in patients with presumed PE-related shock and to improve clinicians? confidence prescribing systemic thrombolytics in the face of hemodynamic instability. Otherwise, echocardiography should be reserved for highly selected intermediate-risk patients with acute PE. Among patients with intermediate-risk PE, those most likely to decompensate or die typically satisfy all of the following conditions: (1) highest-risk PESI or sPESI scores, (2) elevated natriuretic peptides, (3) elevated troponin, and (4) proximal deep vein thrombosis (DVT) on lower extremity ultrasound. In such patients, the echocardiogram may reveal a critical ?tipping point,? such as a right atrial or ventricular thrombus-in-transit, that may warrant more intensive monitoring and multidisciplinary input into the most appropriate treatment plan. Echocardiography could aid therapeutic decisions when the benefits from thrombolysis may outweigh the risks, such as for patients with minimal physiologic reserve and/or a low risk of major bleeding complications. Prognostic models like sPESI utilize binary variables, such as the presence/absence of chronic cardiopulmonary disease or oxygen saturation above/below 90%. Clearly, these variables exist on a spectrum; intuitively, patients with severe comorbidities and more alarming vital signs have a higher risk of death or decompensation than predicted by sPESI. Analogously, echocardiographic findings of RVD also encompass a spectrum. Because prognostic models and clinical trials cannot guide decisions for each individual patient, clinicians could justify using echocardiography to ?fine tune? prognostication and to provide a personalized approach for carefully selected patients.";2019;;;Uncertain;"diagnosis, patient management";https://www.journalofhospitalmedicine.com/jhospmed/article/197593/hospital-medicine/things-we-do-no-reason-routine-echocardiography?channel=27621#jhm1404-sec-0005 4752;2;"Choosing Wisely�";"North American Spine Society";English;"Do not recommend imaging of the spine within the first 6 weeks of an acute episode of low back pain in the absence of red flags. ";"Red flags include, but are not limited to: trauma history, unintentional weight loss, immunosuppression, history of cancer, intravenous drug use, steroid use, fracture, infection, deformity, osteoporosis or osteopenia, progressive paresthesias or weakness involving the pelvis and lower extremities, urinary retention, saddle anesthesia, age > 50, focal neurologic deficit, and progression of symptoms.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5264;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend starting management by a non-paediatric practitioner with a clinical assessment. Healthcare practitioners should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2.";"Children whose symptoms or combination of symptoms and signs suggest an immediately life-threatening illness should be referred immediately for emergency medical care by the most appropriate means of transport (usually 999 ambulance). Children with any 'red' features but who are not considered to have an immediately life-threatening illness should be referred urgently to the care of a paediatric specialist. If any 'amber' features are present and no diagnosis has been reached, provide parents or carers with a 'safety net' or refer to specialist paediatric care for further assessment. The safety net should be 1 or more of the following: - providing the parent or carer with verbal and/or written information on warning symptoms and how further healthcare can be accessed - arranging further follow-up at a specified time and place - liaising with other healthcare professionals, including out-of-hours providers, to ensure direct access for the child if further assessment is required Children with 'green' features and none of the 'amber' or 'red' features can be cared for at home with appropriate advice for parents and carers, including advice on when to seek further attention from the healthcare services.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5265;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely ordering a chest X-ray for children with symptoms and signs suggesting pneumonia who are not admitted to hospital.";"Test urine in children with fever as recommended in NICE's guideline on urinary tract infection in under 16s. When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature to differentiate between serious and non-serious illness.";2019;;;"Low value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5521;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"In acute uncomplicated cystitis, follow-up is not required if symptoms resolve with the antibiotic, and therefore, control urine cultures are not indicated.";"Acute uncomplicated cystitis is the most common form of urinary infection in nonpregnant premenopausal women, and the diagnosis is basically clinical. In acute uncomplicated cystitis, follow-up is not required if symptoms resolve with the antibiotic, and therefore, control urine cultures are not indicated. There is no evidence that the control urine culture has an impact on the prognosis and treatment of uncomplicated cystitis. The control urine culture will only be indicated in uncomplicated acute cystitis that have persistent symptoms after 48-72 hours of adequate antibiotic treatment or recurrence of symptoms two weeks after finishing treatment. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4754;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended to use tibolone in menopausal women.";"Tibolone has androgenic, oestrogenic and progestogenic properties and carries a risk of cardiovascular disorders, breast cancer and ovarian cancer.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5010;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for adopting the Debrisoft monofilament debridement pad as part of the management of acute or chronic wounds in the community is supported by the evidence. The available evidence is limited, but the likely benefits of using the Debrisoft pad on appropriate wounds are that they will be fully debrided more quickly, with fewer nurse visits needed, compared with other debridement methods. In ";"The Debrisoft pad is indicated for adults and children with acute or chronic wounds. The available evidence is mainly in adults with chronic wounds needing debridement in the community. The data show that the device is particularly effective for chronic sloughy wounds and hyperkeratotic skin around acute or chronic wounds.";2019;;;"High value";"The Debrisoft monofilament debridement pad for use in acute or chronic wounds";https://www.nice.org.uk/guidance/mtg17/chapter/1-Recommendations 5266;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend prescribing oral antibiotics to children with fever without apparent source. ";"Give parenteral antibiotics to children with suspected meningococcal disease at the earliest opportunity (either benzylpenicillin or a third-generation cephalosporin). See NICE's guideline on meningitis (bacterial) and meningococcal septicaemia in under 16s.";2019;;;"Low value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5522;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Cardiologia";Spanish;"Antiplatelet therapy is not recommended to prevent thromboembolic events in patients with nonvalvular atrial fibrillation.";"Nonvalvular atrial fibrillation increases the risk of having a stroke or other thromboembolic events. In Catalonia, its prevalence is 4.4% in those over 40 years of age and increases with age. Prevention of thromboembolic complications has to be based on long-term oral anticoagulant therapy, as it has been shown to reduce your risk. Antiplatelet therapy with acetylsalicylic acid (monotherapy or double antiplatelet therapy) is less effective than oral anticoagulant therapy and has shown no benefit in the risk of bleeding. Antiplatelets are not an alternative to anticoagulants in the prevention of strokes and thromboembolic events in atrial fibrillation.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5011;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ertugliflozin as monotherapy is recommended as an option for treating type 2 diabetes in adults for whom metformin is contraindicated or not tolerated and when diet and exercise alone do not provide adequate glycaemic control, only if: - dipeptidyl peptidase 4 (DPP?4) inhibitor would otherwise be prescribed and - a sulfonylurea or pioglitazone is not appropriate.";"Ertugliflozin in a dual-therapy regimen in combination with metformin is recommended as an option for treating type 2 diabetes, only if: - a sulfonylurea is contraindicated or not tolerated or - the person is at significant risk of hypoglycaemia or its consequences. Indirect comparisons show that ertugliflozin has similar overall health benefits to canagliflozin, dapagliflozin and empagliflozin. The acquisition cost of ertugliflozin is lower than the acquisition costs of these other drugs. Ertugliflozin is therefore recommended as an option for treating type 2 diabetes as monotherapy or with metformin in line with the previous recommendations for SGLT?2 inhibitors.";2019;;;"High value";"Diabetes and other endocrinal, nutritional and metabolic conditions";"www.nice.org.uk/guidance/ta572/chapter/1-Recommendations" 5267;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend starting management by the paediatric specialist with a clinical assessment. The healthcare professional should attempt to identify symptoms and signs of serious illness and specific diseases as summarised in tables 1 and 2. ";" ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5523;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"It is not recommended the use of parenteral treatment as the first choice in patients with pain.";"Whenever feasible, for pain control, non-parenteral treatment should be chosen as the first choice. The unnecessary use of parenteral analgesic treatment for pain control is associated with a higher risk of avoidable complications for the patient, especially when there is an analgesic alternative with good effectiveness and better safety (orally, topically).";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5012;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ertugliflozin with metformin and a dipeptidyl peptidase?4 (DPP?4) inhibitor is recommended as an option for treating type 2 diabetes in adults when diet and exercise alone do not provide adequate glycaemic control, only if: the disease is uncontrolled with metformin and a DPP?4 inhibitor, and a sulfonylurea or pioglitazone is not appropriate.";"If patients and their clinicians consider ertugliflozin to be 1 of a range of suitable treatments, including canagliflozin, dapagliflozin and empagliflozin, the least expensive should be chosen. Ertugliflozin is a sodium-glucose cotransporter 2 (SGLT?2) inhibitor. Other SGLT?2 inhibitors are already used with metformin and a DPP?4 inhibitor for treating type 2 diabetes. Ertugliflozin appears to have similar health benefits to other SGLT?2 inhibitors when taken with metformin and a DPP?4 inhibitor, and it has a lower acquisition cost. But it has only been compared with other SGLT?2 inhibitors, not with other third-line treatments for type 2 diabetes (sulfonylureas or pioglitazone). Ertugliflozin is therefore recommended as an option for treating type 2 diabetes that is uncontrolled with metformin and a DPP?4 inhibitor, only if a sulfonylurea or pioglitazone is not appropriate.";2019;;;"High value";"Ertugliflozin with metformin and a dipeptidyl peptidase-4 inhibitor for treating type 2 diabetes";"/www.nice.org.uk/guidance/ta583/chapter/1-Recommendations" 5268;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend observing infants younger than 3 months with fever and having the following vital signs measured and recorded:";"- temperature - heart rate - respiratory rate Perform the following investigations in infants younger than 3 months with fever: - full blood count - blood culture - C-reactive protein - urine testing for urinary tract infection (see NICE's guideline on urinary tract infection in under 16s) - chest X-ray only if respiratory signs are present - stool culture, if diarrhoea is present Perform lumbar puncture in the following children with fever (unless contraindicated): - infants younger than 1 month - all infants aged 1?3 months who appear unwell - infants aged 1?3 months with a white blood cell count (WBC) less than 5 � 109/litre or greater than 15 � 109/litre. When indicated, perform a lumbar puncture without delay and, whenever possible, before the administration of antibiotics. Give parenteral antibiotics to: - infants younger than 1 month with fever - all infants aged 1?3 months with fever who appear unwell - infants aged 1?3 months with WBC less than 5 � 109/litre or greater than 15 � 109/litre. When parenteral antibiotics are indicated for infants younger than 3 months of age, a third-generation cephalosporin (for example cefotaxime or ceftriaxone) should be given plus an antibiotic active against listeria (for example, ampicillin or amoxicillin). ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5524;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Comisi�n de Mejora de la Pr�ctica Cl�nica y Servicio de Neumolog�a Hospital Universitario Vall d'Heb";Spanish;"In patients admitted in acute situations, the administration of oxygen is not recommended without establishing the saturation ranges that correspond to the patient according to their clinical characteristics.";"Oxygen is one of the most widely used therapeutic agents in the healthcare field. Therapeutic use of oxygen has evolved to more controlled use as toxicity has been documented with uncontrolled use. The optimal range can be controlled from the measurement of oxygen saturation. In patients admitted in acute situations, the administration of oxygen is not recommended without establishing the saturation ranges that correspond to the patient according to their clinical characteristics.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5013;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately.";"Refer immediately people who have had a suspected TIA for specialist assessment and investigation, to be seen within 24 hours of onset of symptoms. Do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA. Offer secondary prevention, in addition to aspirin, as soon as possible after the diagnosis of TIA is confirmed. Do not offer CT brain scanning to people with a suspected TIA unless there is clinical suspicion of an alternative diagnosis that CT could detect. After specialist assessment in the TIA clinic, consider MRI (including diffusion-weighted and blood-sensitive sequences) to determine the territory of ischaemia, or to detect haemorrhage or alternative pathologies. If MRI is done, perform it on the same day as the assessment. Everyone with TIA who after specialist assessment is considered as a candidate for carotid endarterectomy should have urgent carotid imaging. Ensure that people with stable neurological symptoms from acute non-disabling stroke or TIA who have symptomatic carotid stenosis of 50 to 99% according to the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria: - are assessed and referred urgently for carotid endarterectomy to a service following current national standards. - receive best medical treatment (control of blood pressure, antiplatelet agents, cholesterol lowering through diet and drugs, lifestyle advice). If thrombectomy might be indicated, perform imaging with CT contrast angiography following initial non-enhanced CT. Add CT perfusion imaging (or MR equivalent) if thrombectomy might be indicated beyond 6 hours of symptom onset. Offer thrombectomy as soon as possible and within 6 hours of symptom onset, together with intravenous thrombolysis (if not contraindicated and within the licensed time window), to people who have: - acute ischaemic stroke and - confirmed occlusion of the proximal anterior circulation demonstrated by computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) taking into account the factors in recommendation 1.4.8. Offer thrombectomy[6] as soon as possible to people who were last known to be well between 6 hours and 24 hours previously (including wake-up strokes): - who have acute ischaemic stroke and confirmed occlusion of the proximal anterior circulation demonstrated by CTA or MRA and - if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume taking into account the factors in recommendation 1.4.8. within the licensed time window) as soon as possible for people last known to be well up to 24 hours previously (including wake-up strokes): - who have acute ischaemic stroke and confirmed occlusion of the proximal posterior circulation (that is, basilar or posterior cerebral artery) demonstrated by CTA or MRA and - if there is the potential to salvage brain tissue, as shown by imaging such as CT perfusion or diffusion-weighted MRI sequences showing limited infarct core volume taking into account the factors in recommendation 1.4.8. 1.4.8Take into account the person's overall clinical status and the extent of established infarction on initial brain imaging to inform decisions about thrombectomy. Select people who have (in addition to the factors in recommendations 1.4.5 to 1.4.7): - a pre-stroke functional status of less than 3 on the modified Rankin scale and - a score of more than 5 on the National Institutes of Health Stroke Scale (NIHSS). Offer either anticoagulants or antiplatelet agents to people who have stroke secondary to acute arterial dissection. Return clotting levels to normal as soon as possible in people with a primary intracerebral haemorrhage who were receiving warfarin before their stroke (and have elevated international normalised ratio). Do this by reversing the effects of the warfarin using a combination of prothrombin complex concentrate and intravenous vitamin K. Do not offer rapid blood pressure lowering to people who: - have an underlying structural cause (for example, tumour, arteriovenous malformation or aneurysm) - have a score on the Glasgow Coma Scale of below 6 - are going to have early neurosurgery to evacuate the haematoma - have a massive haematoma with a poor expected prognosis. Anti-hypertensive treatment in people with acute ischaemic stroke is recommended only if there is a hypertensive emergency with one or more of the following serious concomitant medical issues: - hypertensive encephalopathy - hypertensive nephropathy - hypertensive cardiac failure/myocardial infarction - aortic dissection - pre-eclampsia/eclampsia. People with acute stroke who are unable to take adequate nutrition, fluids and medication orally should: - receive tube feeding with a nasogastric tube within 24 hours of admission unless they have had thrombolysis - be considered for a nasal bridle tube or gastrostomy if they are unable to tolerate a nasogastric tube - be referred to an appropriately trained healthcare professional for detailed nutritional assessment, individualised advice and monitoring - have their oral medication reviewed to amend either the formulation or the route of administration. Assess the individual clinical needs and personal preferences of people with acute stroke to determine their optimal head position. Take into account factors such as their comfort, physical and cognitive abilities and postural control. Help people with acute stroke to sit out of bed, stand or walk as soon as their clinical condition permits as part of an active management programme in a specialist stroke unit. If people need help to sit out of bed, stand or walk, do not offer high-intensity mobilisation in the first 24 hours after symptom onset.";2019;;;"High value";"Stroke and transient ischaemic attack";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5269;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend the following investigations in children with fever without apparent source who present to paediatric specialists with 1 or more 'red' features:";"- full blood count - blood culture - C-reactive protein - urine testing for urinary tract infection (see NICE's guideline on urinary tract infection in under 16s). The following investigations should also be considered in children with 'red' features, as guided by the clinical assessment: - lumbar puncture in children of all ages (if not contraindicated) - chest X-ray irrespective of body temperature and WBC - serum electrolytes and blood gas Children with fever without apparent source presenting to paediatric specialists who have 1 or more 'amber' features, should have the following investigations performed unless deemed unnecessary by an experienced paediatrician. - urine should be collected and tested for urinary tract infection (see NICE's guideline on urinary tract infection in under 16s) - blood tests: full blood count, C-reactive protein and blood cultures - lumbar puncture should be considered for children younger than 1 year - chest X-ray in a child with a fever greater than 39�C and WBC greater than 20 � 109/litre Children who have been referred to a paediatric specialist with fever without apparent source and who have no features of serious illness (that is, the 'green' group), should have urine tested for urinary tract infection and be assessed for symptoms and signs of pneumonia (see table 2 and NICE's guideline on urinary tract infection in under 16s). Do not routinely perform blood tests and chest X-rays in children with fever who have no features of serious illness (that is, the 'green' group). ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5525;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";;Spanish;"It is not recommended absolute or relative rest in women at risk of developing hypertensive diseases during pregnancy.";"There is no evidence that bed rest is effective in reducing the risk of developing hypertensive diseases during pregnancy. Absolute prolonged bed rest is a risk factor for venous thromboembolism. By consensus, it is recommended that rest and physical activity in women at risk of developing hypertensive diseases during pregnancy should be the same as healthy pregnant women. In conclusion, for women with (high or moderate) risk of developing hypertensive diseases during pregnancy, neither absolute nor relative rest is recommended.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4758;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended to use of ulipristal in patients with leiomyoma (fibroids).";"Ulipristal can cause serious liver lesions that require Liver transplant. When the treatment is considered desirable to postpone surgery or wait for menopause, there are other less risky options available: insertion of an intrauterine device (IUD) of levonorgestrel is the first option despite its limitations; an alternative in some cases is an oral progestogen, but the benefit-benefit balance of the duration of treatment over a few months is uncertain.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5270;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend assessing febrile children with proven respiratory syncytial virus or influenza infection for features of serious illness. Consideration should be given to urine testing for urinary tract infection (see NICE's guideline on urinary tract infection in under 16s)";" ";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5526;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat de Salut P�blica de Catalunya i de Balears";Spanish;"It is not recommended a systematic prescription of statins for primary cardiovascular prevention in a population with low or moderate coronary risk.";"Cardiovascular diseases are one of the main causes of mortality in Catalonia. Its two main components are ischemic heart disease and cerebrovascular disease. Cardiovascular disease can be prevented or delayed with good control of risk factors. Prevention is done from primary care and is based on the control of risk factors: cholesterol, blood pressure, tobacco use, lifestyle and diabetes. Preventive interventions are based on cardiovascular risk. To assess this risk, a personalized clinical judgment and the use of existing specific risk tables are required, which allow patients to be classified as low risk (14.9%). Pharmacological treatment with statins for primary cardiovascular prevention is never a medical emergency and corresponds to the individual risk of each patient. Systematic prescription of statins is not recommended for primary cardiovascular prevention in a population with low coronary risk, except in cases of familial dyslipidemia; or in a population with moderate coronary risk without having assessed other factors to clinically reclassify the risk and identify the suitable candidates.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5782;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Effects of telemonitoring for patients with COPD are unclear";"The COVID-19 pandemic is placing a great strain on health systems, affecting routine health and social care for people with other conditions. Ways to deliver this care remotely might include telemonitoring for conditions such as chronic obstructive pulmonary disease (COPD). In this systematic review, the authors searched for studies of the use of telemonitoring to manage patients with COPD. They restricted their search to articles published in English from 1 February 2011 to 1 February 2017. They identified 29 eligible studies. The effects of telemonitoring for patients with COPD are uncetain. Although some studies reported that telemonitoring for patients with COPD reduced the need for in-person visits, improved disease management and bolstered patient-provider relationship; other studies did not find benefits, and important barriers included low-quality data, increased workload for providers and cost.";2019;;;Uncertain;"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6038;33;"Choosing Wisely � : Things we do for no reason";"O Jones";English;"Do not routinely treat with costicosteroids preschool-aged children who have episodic wheezing triggered by viral respiratory tract infections and who do not have risk factors for persistent asthma.";"""There are few randomized controlled trials evaluating the efficacy of SCS in preschool-aged children with viral-induced wheezing, and these children are often grouped with younger or older children in studies. While limited in number, these studies have evaluated SCS efficacy with acute wheezing in preschool-aged children in outpatient, ED, and inpatient setting. The majority of trials of SCS in this age group have shown mixed or negative results. For preschool-aged children with a history of atopy, a positive API, or elevated PARS, SCS can be considered during admissions for respiratory distress and wheezing. Preschool-aged children presenting with severe disease or requiring intensive care may benefit from SCS, but there is insufficient evidence to conclude whether this practice provides benefit.""";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5271;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering a period of observation in hospital (with or without investigations) as part of the assessment to help differentiate non-serious from serious illness, In children aged 3 months or older with fever without apparent source.";"When a child has been given antipyretics, do not rely on a decrease or lack of decrease in temperature at 1?2 hours to differentiate between serious and non-serious illness. Nevertheless, in order to detect possible clinical deterioration, all children in hospital with 'amber' or 'red' features should still be reassessed after 1?2 hours.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5527;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Atenci�n a la Salud Sexual y Reproductiva (ASSIR) de Atenci�n Primaria.";Spanish;"In healthy women using an intrauterine device (IUD) who are asymptomatic, annual monitoring of the device is not recommended.";"The IUD is a safe, effective, and reversible method of contraception that can be used for years in both nulliparous and multiparous women. After IUD insertion, its control is recommended between 1-3 months following to assess the bleeding pattern and rule out the appearance of complications such as displacement or migration, infection, perforation or expulsion of the IUD. In female IUD users who are asymptomatic, annual systematic monitoring of the device is not necessary, unless they have a related problem or want to change the contraceptive method.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6039;33;"Choosing Wisely � : Things we do for no reason";"Berk, J. ";English;"Lumbar punctures are not recommended in low-risk febrile infants with bronchiolitis.";"For low-risk febrile infants with signs of bronchiolitis, evaluation for bacterial meningitis is not necessary. The low prevalence of meningitis in this age range along with the even lower likelihood of meningitis when bronchiolitis is identified suggests that the procedure is unnecessary. Moreover, the risks associated with LP?including trauma, hospitalization, costs, and family stress?likely outweigh the benefits of cerebrospinal fluid analysis. In febrile infants, determine the risk of serious bacterial infections using published algorithms before considering lumbar puncture.";2019;;;"Low value";"Lumbar punction, bronchiolitis, infants, fever. ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5016;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fluocinolone acetonide intravitreal implant is not recommended as an option for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies in an eye with a natural lens (phakic eye).";"This recommendation is not intended to affect treatment with fluocinolone acetonide intravitreal implant that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Treatments for untreated chronic diabetic macular oedema include laser therapy and anti-vascular endothelial growth factors (VEGFs). There are no further treatment options for eyes with a natural lens (phakic eyes). The company submitted evidence for people with phakic eyes and symptomatic cataracts. Clinical trial evidence compares the effectiveness of fluocinolone acetonide intravitreal implant and sham in people with chronic diabetic macular oedema who already had at least 1 laser treatment. Only very few people had anti?VEGFs before the trial and few people had phakic eyes with symptomatic cataracts. Also, non-comparative studies used to support the company's submission only include few people with phakic eyes and symptomatic cataract. No other data for this group have been identified. This makes it difficult to establish if fluocinolone acetonide intravitreal implant works better than usual care for these people, especially in the long term. Because of the lack of clinical evidence, the cost-effectiveness estimates for fluocinolone acetonide intravitreal implant are also uncertain. Even the lowest clinically plausible cost-effectiveness estimates are substantially higher than what NICE normally considers an acceptable use of NHS resources. Therefore, fluocinolone acetonide intravitreal implant is not recommended for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies in an eye with a natural lens (phakic eye).";2019;;;"Low value";"Diabetes and other endocrinal, nutritional and metabolic conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5528;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Asociaci�n de Enfermer�a Familiar y Comunitaria de Catalu�a";Spanish;"It is not recommended routinely microbiological testing in chronic wounds, except when there is clinical suspicion of wound infection.";"Routine microbiological analysis is not recommended for chronic wounds, except when there is clinical suspicion of wound infection. The diagnosis of infection of chronic wounds is mainly clinical. In patients at high risk of dissemination of the infection such as: diabetic patients, with arterial insufficiency, immunocompromised patients or those on corticosteroid therapy, it is recommended to perform microbiological analysis when suspected local infection of the chronic wound. The evidence is still insufficient to recommend one method over the other in microbiology tests.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4761;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of moxifloxacino in infectious diseases.";"Moxifloxacin is no more effective than other antibiotics of this class, can cause toxic epidermal necrolysis and fulminant hepatitis, and has also been linked to an increased risk of cardiac disorders. Another fluoroquinolone such as ciprofloxacin or ofloxacin is a better option. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5273;1;"NICE ";;English;"Assessing risk of acute kidney injury";"Identifying acute kidney injury in people with acute illness 1.1.1Investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in adults with acute illness if any of the following are likely or present: chronic kidney disease (adults with an estimated glomerular filtration rate [eGFR] less than 60 ml/min/1.73 m2 are at particular risk) heart failure liver disease diabetes history of acute kidney injury oliguria (urine output less than 0.5 ml/kg/hour) neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a carer hypovolaemia use of drugs that can cause or exacerbate kidney injury (such as non?steroidal anti?inflammatory drugs [NSAIDs], aminoglycosides, angiotensin?converting enzyme [ACE] inhibitors, angiotensin II receptor antagonists [ARBs] and diuretics) within the past week, especially if hypovolaemic use of iodine-based contrast media within the past week symptoms or history of urological obstruction, or conditions that may lead to obstruction sepsis deteriorating early warning scores age 65 years or over. [2013] 1.1.2Investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in children and young people with acute illness if any of the following are likely or present: chronic kidney disease heart failure liver disease history of acute kidney injury oliguria (urine output less than 0.5 ml/kg/hour) young age, neurological or cognitive impairment or disability, which may mean limited access to fluids because of reliance on a parent or carer hypovolaemia use of drugs that can cause or exacerbate kidney injury (such as NSAIDs, aminoglycosides, ACE inhibitors, ARBs and diuretics) within the past week, especially if hypovolaemic symptoms or history of urological obstruction, or conditions that may lead to obstruction sepsis a deteriorating paediatric early warning score severe diarrhoea (children and young people with bloody diarrhoea are at particular risk) symptoms or signs of nephritis (such as oedema or haematuria) haematological malignancy hypotension. [2013] Identifying acute kidney injury in people with no obvious acute illness 1.1.3Be aware that in adults, children and young people with chronic kidney disease and no obvious acute illness, a rise in serum creatinine may indicate acute kidney injury rather than a worsening of their chronic disease. [2013] 1.1.4Ensure that acute kidney injury is considered when an adult, child or young person presents with an illness with no clear acute component and has any of the following: chronic kidney disease, especially stage 3B, 4 or 5, or urological disease new onset or significant worsening of urological symptoms symptoms suggesting complications of acute kidney injury symptoms or signs of a multi?system disease affecting the kidneys and other organ systems (for example, signs or symptoms of acute kidney injury, plus a purpuric rash). [2013] Assessing risk factors in adults having iodine-based contrast media 1.1.5Before offering iodine-based contrast media to adults for non?emergency imaging, investigate for chronic kidney disease by measuring eGFR or by checking an eGFR result obtained within the past 3 months. [2013] 1.1.6Before offering iodine-based contrast media to adults, assess their risk of acute kidney injury but do not delay emergency imaging. Be aware that increased risk is associated with: chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk) diabetes but only with chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk) heart failure renal transplant age 75 years or over hypovolaemia increasing volume of contrast agent intra-arterial administration of contrast medium with first-pass renal exposure. [2013] 1.1.7Include the risks of developing acute kidney injury in the routine discussion of risks and benefits of the imaging procedure. Follow the recommendations on shared decision making in the NICE guideline on patient experience in adult NHS services. [2013] Assessing risk factors in adults having surgery 1.1.8Assess the risk of acute kidney injury in adults before surgery. Be aware that increased risk is associated with: emergency surgery, especially when the person has sepsis or hypovolaemia intraperitoneal surgery chronic kidney disease (adults with an eGFR less than 60 ml/min/1.73 m2 are at particular risk) diabetes heart failure age 65 years or over liver disease use of drugs that can cause or exacerbate kidney injury in the perioperative period (in particular, NSAIDs after surgery). Use the risk assessment to inform a clinical management plan. [2013] 1.1.9Include the risks of developing acute kidney injury in the routine discussion of risks and benefits of surgery. Follow the recommendations on shared decision making in the NICE guideline on patient experience in adult NHS services. ";2019;;;"High value";"kidney conditions"; 5529;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.";"Recomendaci�n tipo GRADE A";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5274;1;"NICE ";;Spanish;"Assessing risk factors in adults having iodine-based contrast media";"1.1.5Before offering iodine-based contrast media to adults for non?emergency imaging, investigate for chronic kidney disease by measuring eGFR or by checking an eGFR result obtained within the past 3 months. [2013] 1.1.6Before offering iodine-based contrast media to adults, assess their risk of acute kidney injury but do not delay emergency imaging. Be aware that increased risk is associated with: chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk) diabetes but only with chronic kidney disease (adults with an eGFR less than 40 ml/min/1.73 m2 are at particular risk) heart failure renal transplant age 75 years or over hypovolaemia increasing volume of contrast agent intra-arterial administration of contrast medium with first-pass renal exposure. [2013] 1.1.7Include the risks of developing acute kidney injury in the routine discussion of risks and benefits of the imaging procedure. Follow the recommendations on shared decision making in the NICE guideline on patient experience in adult NHS services. [2013]";2019;;;"High value";"kidney conditions"; 5530;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions.";"Recommendation type GRADE B";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5019;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Reinforcement of a permanent stoma with biological or synthetic mesh is not recommended for the prevention of peristomal hernia.";"The evidence on the safety of reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia shows there are serious but well-recognised complications. The evidence on efficacy is limited in quantity and quality. Therefore, this procedure should not be used unless special arrangements are in place for clinical governance, consent, and audit or research. 1.2 Clinicians wishing to do reinforcement of a permanent stoma with a synthetic or biological mesh to prevent a parastomal hernia should: Inform the clinical governance leads in their NHS trusts. Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended. Audit and review clinical outcomes of all patients having the procedure. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion). 1.3 All adverse events involving the medical devices (including the synthetic or biological mesh) used in this procedure should be reported to the Medicines and Healthcare products Regulatory Agency. 1.4 Further research could be in the form of randomised controlled trials, observational studies and analysis of registry data. It should report details of patient selection, the type of synthetic or biological mesh used, mesh-associated complications and long-term outcomes (at least 3 years). In participating centres, clinicians should encourage patients to take part in the National Institute for Health Research CIPHER study.";2019;;;"Low value";"Periestomal hernia";"https://www.nice.org.uk/guidance/ipg654/chapter/1-Recommendations" 5275;1;"NICE ";;Spanish;"Assessing risk factors in adults having surgery";"Assess the risk of acute kidney injury in adults before surgery. Be aware that increased risk is associated with: emergency surgery, especially when the person has sepsis or hypovolaemia intraperitoneal surgery chronic kidney disease (adults with an eGFR less than 60 ml/min/1.73 m2 are at particular risk) diabetes heart failure age 65 years or over liver disease use of drugs that can cause or exacerbate kidney injury in the perioperative period (in particular, NSAIDs after surgery). Use the risk assessment to inform a clinical management plan. [2013] 1.1.9Include the risks of developing acute kidney injury in the routine discussion of risks and benefits of surgery. Follow the recommendations on shared decision making in the NICE guideline on patient experience in adult NHS services. ";2019;;;"High value";"kidney conditions"; 5531;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic pregnant persons.";"Recommendation with uncertainty ";2019;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5020;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Darvadstrocel is not recommended, within its marketing authorisation, for previously treated complex perianal fistulas in adults with non-active or mildly active luminal Crohn's disease.";"In a single clinical trial comparing remission rates for darvadstrocel and placebo, only an additional 14% of people showed a beneficial effect from darvadstrocel over and above placebo. Reliable follow?up results are only available for up to 1 year during which time more than 50% of patients who had remission subsequently relapsed in both the darvadstrocel and placebo arms, so it is unclear how long the treatment benefit will last. The additional evidence submitted after consultation did not clarify the uncertainties around long-term benefits of darvadstrocel. The committee considered that further research in this area would be beneficial (see section 4 for further details). The cost-effectiveness estimates are therefore highly uncertain and the committee was unable to decide on the most plausible cost-effectiveness estimate. Because of this, darvadstrocel cannot be recommended for routine commissioning for treating complex perianal fistulas in people with Crohn's disease.";2019;;;"Low value";"Crohn's disease";"https://www.nice.org.uk/guidance/ta556/chapter/1-Recommendations" 5276;1;"NICE ";;English;"Assessment and diagnosis of alcohol-related liver disease";"It is recomended: - Exclude alternative causes of liver disease in people with a history of harmful or hazardous drinking who have abnormal liver blood test results. - Refer people to a specialist experienced in the management of alcohol-related liver disease to confirm a clinical diagnosis of alcohol-related liver disease. - Consider liver biopsy for the investigation of alcohol-related liver disease. [2010] *When considering liver biopsy for the investigation of alcohol-related liver disease: take into account the small but definite risks of morbidity and mortality discuss the benefits and risks with the patient and ensure informed consent is obtained. - In people with suspected acute alcohol-related hepatitis, consider a liver biopsy to confirm the diagnosis if the hepatitis is severe enough to require corticosteroid treatment";2019;;;"High value";"Liver conditions"; 5532;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in asymptomatic children. ";"Recommendation with Uncertainty";2019;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5533;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition. ";"Recommendation type GRADE A ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4766;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of donepezil in the treatment of Alzheimer's disease.";"The drugs available in early 2019 for Alzheimer?s disease have only minimal and transient efficacy. They are also difficult to use because of their disproportionate adverse effects and many interactions with other drugs. None of the available drugs has been shown to slow progression toward dependence, yet all carry a risk of life-threatening adverse effects and severe drug interactions.It is better to focus on reorganising the patient?s daily life, keeping him or her active, and providing support and help for caregivers and family members. can provoke gastrointestinal disorders (including severe vomiting), neuropsychiatric disorders, cardiac disorders (bradycardia, collapse and syncope), and cardiac conduction disorders. Donepezil can also cause compulsive sexual behaviour.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5278;1;"NICE ";;English;"Corticosteroid treatment for alcohol-related hepatitis";"It is not recomended due to: - has been shown to improve survival in the short term (1 month) - has not been shown to improve survival over a longer term (3 months to 1 year) - has been shown to increase the risk of serious infections within the first 3 months of starting treatment. ";2019;;;"High value";"Liver conditions"; 5534;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown.";"Recommendation type GRADE A ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5790;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the effects of the implementation of control measures for the detection of infectious diseases in travelers";"Entry and exit screening measures at airports, ports and ground crossings might be used to attempt to reduce the transmission of COVID-19. Existing research into such strategies for other infectious diseases may provide important information for policy makers to help with this. In this systematic review, the authors searched for reports of worldwide practices, implementation of guidelines, experiences, structures, processes and evaluation results for national routine or ad hoc entry or exit screening of travelers as part of a country?s response to a global health emergency. They restricted their search to articles published in peer-reviewed journals or national and international organizations? publications in English, German, Dutch or Greek between 2003 and 2018. They included 82 scientific articles, 6 documents/reports from public health agencies of countries and 26 guidelines/reports from international organizations which reported screening measures for Severe Acute Respiratory Syndrome (SARS), Influenza Pandemic (H1N1) 2009, Dengue fever, Zika virus disease, Chikungunya infection, and Ebola virus disease. The implementation of screening measures should be examined on a case-by-case basis after considering the disease and outbreak characteristics, the country situation and available resources; but the effects are uncertain.";2019;;;Uncertain;Diagnostico;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5279;1;"NICE ";;English;"Pancreatic surgery versus endoscopic therapy for chronic alcohol-related pancreatitis";"It is recomended: - People with pain from chronic alcohol-related pancreatitis to a specialist centre for multidisciplinary assessment. - Offer surgery, in preference to endoscopic therapy, to people with pain from large-duct (obstructive) chronic alcohol-related pancreatitis. ";2019;;;"High value";"liver conditions"; 5535;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened.";"Recommendation type GRADE A ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5024;1;"NICE ";NICE;English;"DuraGraft improves the patency of vein grafts and minimises vein graft damage during coronary artery bypass graft (CABG)";"It was noted that a retrospective study in the USA has seen a reduction in vein graft dysfunction in people having CABG in the short term. Also it could improve flow pattern in the short term (4 to 6 weeks) after CABG, and may potentially reduce the need for repeat revascularisations in the long term. Most of the experts agreed that the technology would be of most benefit for patients having CABG using saphenous vein conduits, and especially patients who are prone to early graft failure as 2 experts said.";2019;;;"Low value";"coronary vein graft";"Link to the recommendation on the website of the initiative" 5536;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit";"Recommendation type GRADE A";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5025;1;"NICE ";NICE;English;"Kendall DL for ECG monitoring in people having cardiac surgery";"The technology described in this briefing is Kendall DL, a single-patient-use electrocardiogram (ECG) cable and lead wire system. It is used for diagnostic and ongoing patient monitoring. This briefing focuses on its use for people having cardiac surgery. Two commentators thought disposable ECG cables and leads would reduce the possibility of cross-contamination between patients. They also thought that using the new technology with its disposable design would reduce the risk of equipment failure associated with repeated use of cables and leads. One of the experts stated that the technology would most benefit patients who have surgery associated with a long hospital stay. One commentator noted that Kendall DL may be associated with reduced infection rates, but evidence was weak and this clinical benefit might be offset by substantial increase in the cost of Kendall DL.";2019;;;"High value";"ECG surgical monitoring";"Link to the recommendation on the website of the initiative" 5281;1;"NICE ";;English;"Cabozantinib for previously treated advanced hepatocellular carcinoma";"It is not recomended to use cabozantinib for previously treated advanced hepatocellular carcinoma because it is not provide an evidence";2019;;;"High value";https://www.nice.org.uk/guidance/ta582; 5537;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends against screening for pancreatic cancer in asymptomatic adults.";"Recommendation type GRADE D";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5026;1;"NICE ";NICE;Spanish;"PIUR tUS for abdominal aortic aneurysm surveillance and endovascular aneurysm repair endoleak detection";"The technology described in this briefing is PIUR tUS (3D tomographic ultrasound). It is for abdominal aortic aneurysm (AAA) surveillance and endovascular aneurysm repair (EVAR) endoleak detection or surveillance. Three expert commentators noted that using PIUR tUS avoids exposure to ionising radiation and nephrotoxic contrast media from CT scanning. Three commentators noted that using PIUR tUS would mean quicker results (because of availability of ultrasound imaging), shorter appointments and faster interpretation of results, compared with CT scans. Two commentators noted that scanning might be more convenient for patients because they would not have to travel to a centre with a CT scanner. One expert commentator stated that 3D ultrasound can measure change in aneurysm repair. This is a more sensitive marker than the diameter measurements produced by 2D ultrasound.";2019;;;"High value";"aortic aneurism";"Link to the recommendation on the website of the initiative" 5538;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. ";" Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. Recommendation type GRADE A";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5027;1;"NICE ";NICE;English;"Endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms is recommended";"Endovascular insertion of an intrasaccular wire-mesh blood-flow disruption device for intracranial aneurysms is used for the embolisation of ruptured and unruptured intracranial aneurysms. It may be particularly suitable for people with wide-necked aneurysms. The procedure is usually done under general anaesthesia. A catheter is inserted into the femoral artery and advanced into the cerebral circulation under X?ray guidance. A second, smaller catheter is put inside the first and is inserted into the aneurysm. A basket-like device made of fine wire mesh is then pushed through the second catheter and placed into the aneurysm sac. The mesh device covers the aneurysm neck and obstructs blood flow into the aneurysm sac, creating blood stasis and promoting endothelial growth across the neck of the aneurysm. The appropriate device size is selected according to the aneurysm width and height. The aim is to prevent the aneurysm from rupturing or to stop further bleeding from an aneurysm that has already ruptured.";2019;;;"High value";"intracranial aneurysm";"Link to the recommendation on the website of the initiative" 5283;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Diagnostics guidance";English;"Is not recommended to use for routine the rapid tests for strep A infections for people with a sore throat. ";"This is because their effect on improving antimicrobial prescribing and stewardship, and on patient outcomes, as compared with clinical scoring tools alone, is likely to be limited. Therefore, they are unlikely to be a cost-effective use of NHS resources.";2019;;;"Low value";Sepsis;"https://www.nice.org.uk/guidance/dg38/chapter/1-Recommendations" 5539;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations.";"Recommendation type GRADE D ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4772;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of galantamine in patients with Alzheimer's disease.";"The drugs available in early 2019 for Alzheimer?s disease have only minimal and transient efficacy. They are also difficult to use because of their disproportionate adverse effects and many interactions with other drugs. None of the available drugs has been shown to slow progression toward dependence, yet all carry a risk of life-threatening adverse effects and severe drug interactions.It is better to focus on reorganising the patient?s daily life, keeping him or her active, and providing support and help for caregivers and family members. can provoke gastrointestinal disorders (including severe vomiting), neuropsychiatric disorders, cardiac disorders (bradycardia, collapse and syncope), and cardiac conduction disorders. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5028;1;"NICE ";NICE;Spanish;"Percutaneous insertion of a cerebral protection device to prevent cerebral embolism during TAVI is recommended";"The evidence on percutaneous insertion of a cerebral protection device to prevent cerebral embolism during TAVI raises no major safety concerns other than those associated with the TAVI procedure. However, the evidence on efficacy for preventing TAVI-related stroke is inconclusive. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. The specialist advisers and the committee considered the key efficacy outcome to be: reduction in TAVI-related embolic strokes. The specialist advisers and the committee considered the key safety outcomes to be: vascular damage and bleeding. Patient commentary was sought but none was received.";2019;;;"Low value";"embolism and thrombosis";"Link to the recommendation on the website of the initiative" 5540;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects.";"Recommendation type GRADE B ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5029;1;"NICE ";NICE;Spanish;"Percutaneous mechanical thrombectomy for acute deep vein thrombosis of the leg is recommended";"Current evidence on the safety of percutaneous mechanical thrombectomy for acute deep vein thrombosis (DVT) of the leg shows there are well-recognised but infrequent complications. - For acute iliofemoral DVT the evidence on efficacy is limited in quality and quantity, therefore this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. - For distal DVT that does not extend into the common femoral vein the evidence on efficacy is inconclusive, therefore this procedure should only be used in the context of research. Clinicians wishing to do percutaneous mechanical thrombectomy for acute iliofemoral DVT should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended. Clinicians should enter details of all patients who have the procedure onto the BSIR Venous Registry. Further research should report the patient selection criteria including the site of the clot, symptom severity and age of patients. ";2019;;;"High value";thrombosis;"Link to the recommendation on the website of the initiative/ " 5285;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"National Institute for Health and Clinical Excellence (NICE)";English;"It isn't recommended antibiotic prophylaxis to prevent recurrent cellulitis or erysipelas and give advice about seeking medical help if symptoms of cellulitis or cellulitis or erysipelas develop. In cases of recurrent episodes in less than 12 months, it is recommend to use antibiotic prophylaxis trial.";"In the case of pacients with recurrent episodies who choose medication, they must be treated with the following warnings: -the risk of developing complications underlying conditions (such as oedema, diabetes or venous insufficiency) and their management. -the risk of resistance with long-term antibiotic use.";2019;;;"High value";"Skin infection";"https://www.nice.org.uk/guidance/ng141/chapter/Recommendations#treatment" 5541;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer.";"Recommendation type GRADE A ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4774;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Rivastigmina in patients with Alzheimer's disease.";"The drugs available in early 2019 for Alzheimer?s disease have only minimal and transient efficacy. They are also difficult to use because of their disproportionate adverse effects and many interactions with other drugs. None of the available drugs has been shown to slow progression toward dependence, yet all carry a risk of life-threatening adverse effects and severe drug interactions.It is better to focus on reorganising the patient?s daily life, keeping him or her active, and providing support and help for caregivers and family members. can provoke gastrointestinal disorders (including severe vomiting), neuropsychiatric disorders, cardiac disorders (bradycardia, collapse and syncope), and cardiac conduction disorders. ";2019;;;"Low value";-;"file:///C:/Users/epidemiologiaalu02/Downloads/towards_better_patient_care__drugs_to_avoid_in_2019.pdf" 5286;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Interventional procedures guidance";English;"It is recommended to use an ednoscopic ablation for a pilonidal sinus raises no major safety concers";"The evidence on efficacy is adequate in quality and quantity.";2019;;;"High value";"Skin infection";"https://www.nice.org.uk/guidance/ipg646/chapter/1-Recommendations" 5542;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for asymptomatic bacteriuria using urine culture in pregnant persons.";"Recommendation type GRADE B ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4775;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"The use of memantine is not recommended in patients with Alzheimer's disease.";"It can cause neuropsychiatric disorders (hallucinations, confusion, dizziness and headache) that can lead to violent behaviour, as well as seizures and heart failure.";2019;;;"Low value";"- ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5031;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Darvadstrocel is not recommended, within its marketing authorisation, for previously treated complex perianal fistulas in adults with non-active or mildly active luminal Crohn's disease.";"In a single clinical trial comparing remission rates for darvadstrocel and placebo, only an additional 14% of people showed a beneficial effect from darvadstrocel over and above placebo. Reliable follow?up results are only available for up to 1 year during which time more than 50% of patients who had remission subsequently relapsed in both the darvadstrocel and placebo arms, so it is unclear how long the treatment benefit will last. The additional evidence submitted after consultation did not clarify the uncertainties around long-term benefits of darvadstrocel. The committee considered that further research in this area would be beneficial (see section 4 for further details). The cost-effectiveness estimates are therefore highly uncertain and the committee was unable to decide on the most plausible cost-effectiveness estimate. Because of this, darvadstrocel cannot be recommended for routine commissioning for treating complex perianal fistulas in people with Crohn's disease.";2019;;;"Low value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5287;1;"NICE ";"National Institute for Health and Care Excellence";English;"Fluocinolone acetonide intravitreal implant is not recommended as an option for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies in an eye with a natural lens (phakic eye).";"This recommendation is not intended to affect treatment with fluocinolone acetonide intravitreal implant that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Treatments for untreated chronic diabetic macular oedema include laser therapy and anti-vascular endothelial growth factors (VEGFs). There are no further treatment options for eyes with a natural lens (phakic eyes). The company submitted evidence for people with phakic eyes and symptomatic cataracts. Clinical trial evidence compares the effectiveness of fluocinolone acetonide intravitreal implant and sham in people with chronic diabetic macular oedema who already had at least 1 laser treatment. Only very few people had anti?VEGFs before the trial and few people had phakic eyes with symptomatic cataracts. Also, non-comparative studies used to support the company's submission only include few people with phakic eyes and symptomatic cataract. No other data for this group have been identified. This makes it difficult to establish if fluocinolone acetonide intravitreal implant works better than usual care for these people, especially in the long term. Because of the lack of clinical evidence, the cost-effectiveness estimates for fluocinolone acetonide intravitreal implant are also uncertain. Even the lowest clinically plausible cost-effectiveness estimates are substantially higher than what NICE normally considers an acceptable use of NHS resources. Therefore, fluocinolone acetonide intravitreal implant is not recommended for treating chronic diabetic macular oedema that is insufficiently responsive to available therapies in an eye with a natural lens (phakic eye). ";2019;;;"Low value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5543;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends against screening for asymptomatic bacteriuria in nonpregnant adults. ";"Recommendation type GRADE D ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5032;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of radially emitting laser fibre treatment of an anal fistula is limited in quantity and quality. Therefore, although there are no major safety concerns, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";"Clinicians wishing to do radially emitting laser fibre treatment of an anal fistula should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended. - Audit and review clinical outcomes of all patients having radially emitting laser fibre treatment of an anal fistula. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion). The procedure should only be done by clinicians experienced in cannulating fistulas, and who are trained in the use of lasers. Further research should report details of patient selection, including fistula size, recurrence rates in the medium and long term, and quality-of-life outcomes.";2019;;;"Low value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5288;1;"NICE ";"National Institute for Health and Care Excellence";English;"Voretigene neparvovec is recommended, within its marketing authorisation, as an option for treating RPE65-mediated inherited retinal dystrophies in people with vision loss caused by inherited retinal dystrophy from confirmed biallelic RPE65 mutations and who have sufficient viable retinal cells. Recommended only if the company provides voretigene neparvovec according to commercial arrangement. ";"RPE65-mediated inherited retinal dystrophies are rare and serious. They involve progressive loss of vision. This ultimately leads to near-total blindness, and severely affects the quality of life of people with the condition, and their families and carers. Current treatment is supportive care. Clinical trial evidence shows that, in the short term, voretigene neparvovec improves vision and prevents the condition from getting worse. There is no long-term clinical evidence, but it is biologically plausible that the treatment effect is likely to continue for decades. Some assumptions in the economic modelling are uncertain, particularly around the utility values and how long the treatment effect lasts. Despite the uncertainties, voretigene neparvovec is likely to provide important clinical benefits for people with RPE65-mediated inherited retinal dystrophies, and is considered an appropriate use of NHS resources within the context of a highly specialised service. It is therefore recommended for use in the NHS.";2019;;;"High value";"Eye conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5544;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 to 75 years who have ever smoked.";"Recommendation type GRADE B ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4777;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Alemtuzumab in patients with multiple sclerosis.";"It has no proven efficacy and can provoke serious and sometimes fatal adverse effects, in particular: infusion-related reactions (including atrial fibrillation and hypotension), infections, frequent autoimmune disorders (including autoimmune thyroid disease, immune thrombocytopenic purpura, cytopenia and renal disease).";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5033;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Naltrexone?bupropion is not recommended within its marketing authorisation for managing overweight and obesity in adults alongside a reduced-calorie diet and increased physical activity.";"This recommendation is not intended to affect treatment with naltrexone?bupropion that was started in the NHS before this guidance was published. Adults having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Obesity is very common in England, affecting about 30% of the population. Current management for overweight and obesity is lifestyle measures alone, lifestyle measures with orlistat or bariatric surgery. The estimate of cost effectiveness for naltrexone?bupropion with lifestyle measures, compared with lifestyle measures alone, is highly uncertain because of uncertainties in the modelling assumptions. Large numbers of people could be eligible for treatment which could potentially be long-term, leading to high overall costs for naltrexone?bupropion. Therefore, in these circumstances more certainty is needed that naltrexone?bupropion will provide value for the NHS. ";2019;;;"Low value";Obesity;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5289;1;"NICE ";"National Institute for Health and Care Excellence";English;"It is not recommended the use of high-intensity focused ultrasound for glaucoma since evidence on the safety and efficacy of it is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";"Research should ideally take the form of randomised controlled trials comparing this procedure with standard therapies and should report safety events and long-term outcomes. NICE may update the guidance on publication of further evidence.";2019;;;"Low value";"Eye conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5545;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends to selectively offer screening for abdominal aortic aneurysm with ultrasonography in men aged 65 to 75 years who have never smoked rather than routinely screening all men in this group. ";"Evidence indicates that the net benefit of screening all men in this group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of evidence relevant to the patient's medical history, family history, other risk factors, and personal values. Recommendation type GRADE C";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5290;1;"NICE ";"National Institute for Health and Care Excellence";English;"Fluocinolone acetonide intravitreal implant is recommended, within its marketing authorisation, as an option for preventing relapse in recurrent non-infectious uveitis affecting the posterior segment of the eye. It is recommended only if the company provides it according to the commercial arrangement.";"Treatments for recurrent non-infectious uveitis affecting the posterior segment of the eye include systemic corticosteroids, immunosuppressants and dexamethasone implants. These treatments can be disruptive to daily life, needing frequent hospital visits. The clinical trial results for the fluocinolone acetonide intravitreal implant compared with limited current practice are difficult to interpret and very uncertain. The trial didn't directly measure health-related quality of life and the number of recurrences reported may be overestimated. The cost-effectiveness estimates are also uncertain. However, if all the most plausible assumptions had been included in the model, most of the cost-effectiveness estimates would be within the range that NICE normally considers a cost-effective use of NHS resources, so the fluocinolone acetonide implant is recommended.";2019;;;"High value";"Eye conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5546;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends against routine screening for abdominal aortic aneurysm with ultrasonography in women who have never smoked and have no family history of abdominal aortic aneurysm.";"Recommendation type GRADE D";2019;;;"Low value";-;"https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/abdominal-aortic-aneurysm-screening" 4779;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Natalizumab in patients with multiple sclerosis.";"It can lead to fatal opportunistic infections, including progressive multifocal leukoencephalopathy, potentially serious hypersensitivity reactions, and liver damage.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5547;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for abdominal aortic aneurysm with ultrasonography in women aged 65 to 75 years who have ever smoked or have a family history of abdominal aortic aneurysm.";"Recommendation with uncertainty";2019;;;Uncertain;-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4780;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"The use of Natalizumabno is not recommended in patients with multiple sclerosis.";"It can lead to fatal opportunistic infections, including progressive multifocal leukoencephalopathy, potentially serious hypersensitivity reactions, and liver damage.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5037;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence on the safety of high-intensity focused ultrasound for symptomatic benign thyroid nodules raises no major safety concerns, however the current evidence on its efficacy is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.";"Clinicians wishing to do high-intensity focused ultrasound for symptomatic benign thyroid nodules should: Inform the clinical governance leads in their NHS trusts. Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public is recommended. Audit and review clinical outcomes of all patients having high-intensity focused ultrasound for symptomatic benign thyroid nodules. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion). ";2019;;;"Low value";" Thyroid disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5293;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cladribine is recommended for treating highly active MS in adults, only if the person has: rapidly evolving severe relapsing?remitting MS, with at least: 2 relapses in the previous year and 1 T1 gadolinium-enhancing lesion at baseline MRI or a significant increase in T2?lesion load compared with a previous MRI; or relapsing?remitting MS that has responded inadequately to disease-modifying therapy";"This recommendation is not intended to affect treatment with cladribine that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Highly active relapsing?remitting multiple sclerosis is currently treated with alemtuzumab, fingolimod or natalizumab. This appraisal focuses on 2 subgroups of people with highly active relapsing?remitting multiple sclerosis, that is, those with rapidly evolving severe disease and those with suboptimally treated relapsing?remitting multiple sclerosis (disease that has responded inadequately to disease-modifying therapy). Clinical trial results show that cladribine tablets (hereafter referred to as cladribine) reduce relapses and slow the progression of disability compared with placebo for people with relapsing?remitting multiple sclerosis. The effectiveness of cladribine for treating rapidly evolving severe or suboptimally treated relapsing?remitting multiple sclerosis is not proven, but it is likely to be more effective than placebo. Based on indirect analyses, there is not enough evidence to determine whether cladribine is more or less effective than other treatments for people with rapidly evolving severe and suboptimally treated multiple sclerosis. Because of this, cladribine and alternative treatments are considered equally effective for this appraisal.";2019;;;"High value";"Multiple sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4782;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the uso of Teriflunomide in patients with multiple sclerosis.";"It has serious and potentially fatal adverse effects, including liver damage, leukopenia and infections. There is also a risk of peripheral neuropathy. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5038;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Measure albumin-adjusted serum calcium for people with any of the following features, which might indicate primary hyperparathyroidism: symptoms of hypercalcaemia, such as thirst, frequent or excessive urination, or constipation osteoporosis or a previous fragility fracture (for recommendations on assessing the risk of fragility fracture in people with osteoporosis, see the NICE guideline on ost";"Consider measuring albumin-adjusted serum calcium for people with chronic non-differentiated symptoms.";2019;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5294;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ocrelizumab is recommended, within its marketing authorisation, as an option for treating early primary progressive multiple sclerosis with imaging features characteristic of inflammatory activity in adults. It is recommended only if the company provides it according to the commercial arrangement.";"There are currently no disease-modifying treatments available for primary progressive multiple sclerosis. Results of 1 clinical trial show that ocrelizumab can slow the worsening of disability, although the size and duration of this effect are uncertain. Given the unmet clinical need, the most plausible cost-effectiveness estimates for ocrelizumab at the agreed price compared with best supportive care alone are in the range that NICE considers an acceptable use of NHS resources. Because of this, ocrelizumab is recommended for treating early primary progressive multiple sclerosis with imaging features characteristic of inflammatory activity in adults.";2019;;;"High value";"Multiple sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5039;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on endoscopic ablation for an anal fistula raises no major safety concerns and the evidence on efficacy is adequate in quality and quantity.";"Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.";2019;;;"High value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5295;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Percutaneous venoplasty is not recommended for the treatment of chronic cerebrospinal venous insufficiency in multiple sclerosis. ";"Evidence shows that there are serious complications and that it provides no benefit.";2019;;;"Low value";"Multiple sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6575;1;"NICE ";NICE;English;"It is recommended diagnosing and managing non-small-cell and small-cell lung cancer.";"It is recommended to ensure that the most effective tests and treatments are used, and to have access to palliative care and adequate follow-up in patients with non-small cell and small cell lung cancer.";2019;;;"High value";"diagnosis and management";https://www.nice.org.uk/guidance/ng122 4784;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Flunarizine in patients with migraine.";"It can cause extrapyramidal disorders, cardiac disorders and weight gain. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5040;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with a probable diagnosis of primary hyperparathyroidism, measure vitamin D and offer vitamin D supplements if needed. ";"To differentiate primary hyperparathyroidism from familial hypocalciuric hypercalcaemia, measure urine calcium excretion using any one of the following tests: 24-hour urinary calcium excretion random renal calcium:creatinine excretion ratio random calcium:creatinine clearance ratio.";2019;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5808;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of mathematical models is recommended to determine the effectiveness of contact tracing for SARS and MERS";"Contact tracing is being used to prevent the transmission of COVID-19. Existing research on contact tracing models from previous coronavirus epidemics might provide useful information for policy makers. In this systematic review, the authors searched for modelling studies which incorporated contact tracing and follow-up control measures in transmission predictions of SARS or MERS infection. They restricted their searches to articles published in English and did the search in October 2018. They included seven studies, which looked at transmission on an individual (3 studies) or population level (4). Mathematical models can help inform policy makers about the potential effectiveness of different interventions, including contact tracing, in coronavirus epidemics, but their results should be interpreted with caution. ";2019;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4785;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use oxetorone in patients with migraine.";"It causes chronic diarrhoea. It is better to choose another drug such as propranolol.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5042;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of collagen paste for closing an anal fistula is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.";"Further research should report details of patient selection, the type of fistula treated, how the internal fistula opening was closed, and long-term outcomes including recurrence and the need for reoperation.";2019;;;"Low value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4787;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Tolcapone in patients with Parkinson's disease.";"It can cause life-threatening liver damage. Entecapone is a better option. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5043;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Refer people with a confirmed diagnosis of primary hyperparathyroidism to a surgeon with expertise in parathyroid surgery if they have: symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation or end-organ disease (renal stones, fragility fractures or osteoporosis) or an albumin-adjusted serum calcium level of 2.85 mmol/litre or above. ";"Consider referral to a surgeon with expertise in parathyroid surgery for people with a confirmed diagnosis of primary hyperparathyroidism even if they do not have the features listed in recommendation 1.3.1. ";2019;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5299;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Balloon dilation for eustachian tube dysfunction is recommended provided that standard arrangements are in place for clinical governance, consent and audit. ";"Evidence on the safety and efficacy are adequate to support the use of this procedure";2019;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5044;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of bioprosthetic plug insertion for anal fistula is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.";"The procedure should only be done by a surgeon experienced in managing anal fistulas.";2019;;;"High value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5300;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Rapid tests for strep A infections are not recommended for routine adoption for people aged 5 and over with a sore throat. ";"This is because their effect on improving antimicrobial prescribing and stewardship, and on patient outcomes, as compared with clinical scoring tools alone, is likely to be limited. Therefore, they are unlikely to be a cost-effective use of NHS resources. For children under 5, assessment is described in NICE's guideline on fever in under 5s: assessment and initial management. People who are at higher risk of complications, for example women who are pregnant or who have just had a baby, or people who are immunocompromised, should be offered antibiotics in line with NICE's guideline on antimicrobial prescribing for acute sore throat. This guidance also does not cover using the rapid tests: - For people presenting with scarlet fever. Scarlet fever is a notifiable condition; its diagnosis and management is covered in guidance from Public Health England - To help manage outbreaks of strep A infections because this is different to using the tests for people presenting to healthcare providers with an uncomplicated sore throat. Unnecessary use of antibiotics can contribute to antimicrobial resistance, which is a public health concern. NICE's guideline on antimicrobial prescribing for acute sore throat aims to limit antibiotic use and reduce antimicrobial resistance. It advises that sore throat is self-limiting and so, in people who are otherwise healthy, antibiotics are usually not needed regardless of the cause (bacterial or viral). So, it is uncertain whether there is a clinical need for rapid testing for strep A infections in the people covered by this guidance. Also, the diagnostic accuracy of the tests in routine clinical practice is uncertain and likely to be highly variable. There is no evidence to suggest that using the rapid tests could reduce antibiotic prescribing or improve clinical outcomes for people with a sore throat, as compared with clinical scoring tools alone.";2019;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5045;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Percutaneous mitral valve leaflet repair is recommended for mitral regurgitation. ";"Current evidence on the safety and efficacy of percutaneous mitral valve leaflet repair for mitral regurgitation is adequate to support the use of this procedure, in patients for whom open surgery is contraindicated following risk assessment, provided that standard arrangements are in place for clinical governance, consent and audit. Patient selection should be done by a multidisciplinary structural heart team, typically including an interventional cardiologist, an expert in transoesophageal echocardiography, an expert in heart failure, a cardiac anaesthetist, a cardiac surgeon and a specialist nurse. Percutaneous mitral valve leaflet repair for mitral regurgitation should only be done in specialised centres with access to both cardiac surgical and vascular surgical support in case emergency treatment of complications is needed. This procedure should only be done by clinicians with specialist training and supervision by an experienced mentor for at least the first 20 procedures. Clinicians should enter details about all patients having percutaneous mitral valve leaflet repair for mitral regurgitation onto the National Institute for Cardiovascular Outcomes Research database. ";2019;;;"High value";" Mitral regurgitation";"Link to the recommendation on the website of the initiative" 5301;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Implant insertion for prominent ears is not recommended since current evidence on the safety and efficacy of the procedure is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";"Further research should include comparisons of this procedure with current best therapy. It should address issues of patient selection, such as age and type of ear shape, nature of ear implants used, long-term efficacy and safety outcomes, and patient-reported outcomes using validated quality-of-life measures.";2019;;;"Low value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4790;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Defibrotidei in pacients with severe hepatic veno-occlusive disease following haemopoietic stem cell transplantation. ";"It has no more impact on mortality or complete disease remission than symptomatic treatment in a non-blinded trial, yet provokes sometimes fatal haemorrhages.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5046;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer preoperative imaging (usually ultrasound) to people having surgery for primary hyperparathyroidism if it will inform the surgical approach. ";"Consider a second preoperative imaging modality (usually a sestamibi scan) if it will further guide the surgical approach. Do not offer more preoperative imaging if the first-modality (usually ultrasound) and second-modality scans (usually a sestamibi scan) do not identify an adenoma or are discordant. Proceed with surgery, performed by a surgeon with expertise in 4?gland exploration, even if preoperative imaging has not identified an adenoma. If preoperative imaging shows an ectopic adenoma, refer the person to a centre with the relevant expertise.";2019;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5047;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Consider cinacalcet[1] for people with primary hyperparathyroidism if surgery has been unsuccessful, is unsuitable or has been declined, and if their albumin-adjusted serum calcium level is either: 2.85 mmol/litre or above with symptoms of hypercalcaemia or 3.0 mmol/litre or above with or without symptoms of hypercalcaemia.";"For people whose initial albumin-adjusted serum calcium level is 2.85 mmol/litre or above with symptoms of hypercalcaemia, base decisions on whether to continue treatment with cinacalcet[1] on how well it reduces symptoms. For people whose initial albumin-adjusted serum calcium level is 3.0 mmol/litre or above, base decisions on whether to continue treatment with cinacalcet[1] on how well it reduces either symptoms or albumin-adjusted serum calcium level";2019;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5048;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cardiac contractility modulation device implantation is not recommended for heart failure. ";"The evidence on cardiac contractility modulation device implantation for heart failure raises no major safety concerns. However, the evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. Further research should ideally be in the form of randomised controlled trials. These should report details of patient selection, duration and timing of stimulation, and duration of effect of stimulation. Outcomes should include ejection fraction, oxygen consumption, New York Heart Association classification and patient-reported outcomes, including quality of life.";2019;;;"Low value";"Heart failure. ";"Link to the recommendation on the website of the initiative" 5304;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Unilateral cochlear implantation is recommended as an option for people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids.";"1.2. Simultaneous bilateral cochlear implantation is recommended as an option for the following groups of people with severe to profound deafness who do not receive adequate benefit from acoustic hearing aids (1.5): - Children - Adults who are blind or who have other disabilities that increase their reliance on auditory stimuli as a primary sensory mechanism for spatial awareness. 1.3. Sequential bilateral cochlear implantation is not recommended as an option for people with severe to profound deafness. 1.4. People who had a unilateral implant before publication of this guidance, and who fall into one of the categories described in 1.2, should have the option of an additional contralateral implant only if this is considered to provide sufficient benefit by the responsible clinician after an informed discussion with the individual person and their carers. 1.5. For the purposes of this guidance, severe to profound deafness is defined as hearing only sounds that are louder than 80 dB HL (pure-tone audiometric threshold equal to or greater than 80 dB HL) at 2 or more frequencies (500 Hz, 1,000 Hz, 2,000 Hz, 3,000 Hz and 4,000 Hz) bilaterally without acoustic hearing aids. Adequate benefit from acoustic hearing aids is defined for this guidance as: - For adults, a phoneme score of 50% or greater on the Arthur Boothroyd word test presented at 70 dBA - For children, speech, language and listening skills appropriate to age, developmental stage and cognitive ability. 1.6. Cochlear implantation should be considered for children and adults only after an assessment by a multidisciplinary team. As part of the assessment children and adults should also have had a valid trial of an acoustic hearing aid for at least 3 months (unless contraindicated or inappropriate). 1.7. When considering the assessment of adequacy of acoustic hearing aids, the multidisciplinary team should be mindful of the need to ensure equality of access. Tests should take into account a person's disabilities (such as physical and cognitive impairments), or linguistic or other communication difficulties, and may need to be adapted. If it is not possible to administer tests in a language in which a person is sufficiently fluent for the tests to be appropriate, other methods of assessment should be considered. ";2019;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5049;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine adoption of lead-I electrocardiogram devices is not recommended to detect atrial fibrillation when used for single time point testing in primary care. ";"There is not enough evidence to recommend the routine adoption of lead-I electrocardiogram (ECG) devices (imPulse, Kardia Mobile, MyDiagnostick and Zenicor-ECG) to detect atrial fibrillation when used for single time point testing in primary care for people with signs or symptoms of the condition and an irregular pulse. Further research is recommended to show how using lead?I ECG devices in this way affects: - the number of people with atrial fibrillation detected, compared with current practice and - primary and secondary care services, particularly how ECGs generated by the devices would be interpreted in practice, including staff time needed to interpret the ECG traces and associated costs. Centres currently using these devices for this indication are encouraged to take part in research and data collection. ";2019;;;"Low value";"Atrial fibrillation";"Link to the recommendation on the website of the initiative" 5561;35;"Evidencias COVID-19";"National COVID-19 Clinical Evidence Task Force";English;"Do not use high-flow nasal oxygen (HFNO) therapy for patients with hypoxaemia associated with COVID-19 during inter-hospital patient transfer/retrieval.";"Please visit the link for further information";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5050;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"Suspect familial hypercholesterolaemia (FH) as a possible diagnosis in adults with: a total cholesterol level greater than 7.5 mmol/l or a personal or family history of premature coronary heart disease (an event before 60 years in an index individual or first-degree relative). [2008, amended 2019] ";"Systematically search primary care records for people: younger than 30 years, with a total cholesterol concentration greater than 7.5 mmol/l and 30 years or older, with a total cholesterol concentration greater than 9.0 mmol/l as these are the people who are at highest risk of FH. [2017] For people with a personal or family history of premature coronary heart disease (an event before 60 years in an index individual or first-degree relative), but whose total cholesterol is unknown, offer to measure their total cholesterol. [2017] Healthcare professionals should exclude secondary causes of hypercholesterolaemia before a diagnosis of FH is considered. [2008] Use the Simon Broome or Dutch Lipid Clinic Network (DLCN) criteria to make a clinical diagnosis of FH in primary care settings. This should be done by a healthcare professional competent in using the criteria. [2017] Refer the person to an FH specialist service for DNA testing if they meet the Simon Broome criteria for possible or definite FH, or they have a DLCN score greater than 5. [2017] Healthcare professionals should be aware that the absence of clinical signs (for example, tendon xanthomata) in adults and children/young people does not exclude a diagnosis of FH. [2008] Healthcare professionals should consider a clinical diagnosis of homozygous FH in adults with a low-density lipoprotein cholesterol (LDL?C) concentration greater than 13 mmol/l and in children/young people with an LDL?C concentration greater than 11 mmol/l. All people with a clinical diagnosis of homozygous FH should be offered referral to a specialist centre. [2008] To confirm a diagnosis of FH, healthcare professionals should undertake two measurements of LDL?C concentration because biological and analytical variability occurs. [2008] When considering a diagnosis of FH, healthcare professionals with expertise in FH should use standardised pedigree terminology to document, when possible, at least a three-generation pedigree. This should include relatives' age of onset of coronary heart disease, lipid concentrations and smoking history. For deceased relatives, the age and cause of death, and smoking history should be documented. If possible, the index individual should verify this information with other family members. [2008] Ultrasonography of the Achilles tendon is not recommended in the diagnosis of FH. [2008] Coronary heart disease risk estimation tools, such as QRISK2 and those based on the Framingham algorithm, should not be used because people with FH are already at a high risk of premature coronary heart disease. [2008, amended 2017] Inform all people who have an identified mutation diagnostic of FH that they have an unequivocal diagnosis of FH even if their LDL?C concentration does not meet the diagnostic criteria (see recommendation 1.1.5). [2008, amended 2017] ";2019;;;"High value";"Lipid disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6333;29;"Choosing Wisely Australia";"Medical Oncology Group of Australia";English;"Avoid cytotoxic chemotherapy in patients with advanced cancer who are unlikely to benefit from chemotherapy (ECOG performance status 3 or 4) and continue to focus on symptom relief and palliative care. ";"For some patients with advanced cancer, chemotherapy is no longer effective. Symptom relief and palliative care should become the primary modes of care. The Eastern Cooperative Oncology Group (ECOG) performance status is a valid predictor of poor survival, reduced response, and worsened toxicity from chemotherapy. Patients with advanced solid tumours, with an ECOG performance status of 3 or 4, generally exhibit a poor response to chemotherapy. There are well known exceptions to this. These are generally patients with untreated highly chemo-sensitive malignancies, and who have recently declined from a good performance status.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5310;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Planning alcohol education is recommended as part of a whole-school approach to relationships education, relationships and sex education (RSE) and health education or personal, social, health and economic education (PSHE).";"Planning alcohol education content - Use a spiral curriculum when planning and delivering alcohol education. - When planning alcohol education: ensure it is appropriate for age and maturity and aims to minimise the risk of any unintended adverse consequences. Tailor it to take account of each pupil's learning needs and abilities Tailor it to the group's knowledge and perceptions of alcohol and alcohol use. Take into account that those aged 18 and over can legally buy alcohol. - Think about how to adapt alcohol education for pupils with special educational needs and disabilities so that it is tailored to the pupil's learning needs, abilities and maturity (see chapter 6 of the Department for Education's SEND code of practice: 0 to 25 years).";2019;;;"High value";" Alcohol-use disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5823;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"Preventive telephone counseling increases quit rates in smokers";"There is moderate-certainty evidence that preventive telephone counseling helps smokers seeking help on smoking cessation lines, and moderate-certainty evidence that preventive telephone counseling increases quit rates in smokers from other settings. Current evidence is insufficient to assess potential variations in the effect of differences in the number of contacts, the type or timing of telephone counseling, or when telephone counseling is provided as an adjunct to other smoking cessation therapies. The evidence was not conclusive regarding the effect of reactive telephone counseling, due to the limited number of studies (representing the difficulty in studying this intervention).";2019;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6335;29;"Choosing Wisely Australia";"Medical Oncology Group of Australia";English;"Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease. ";"For patients with metastatic cancer (particularly but not restricted to those with life expectancy of less than five years), screening for new primary cancers is of little value and may even cause harm. Reductions in mortality due to earlier detection and management of cancer due to various forms of screening (e.g. breast, colorectal, and prostate) typically take approximately ten years to accrue. Also, patients who have suspected cancers detected after screening may need to undergo further tests (such as prostate biopsies) and treatments. Patients with metastatic disease are more susceptible to complications arising from such tests and treatments given that they are already in frail health. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 5312;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"People with attention deficit hyperactivity disorder (ADHD) would benefit from improved organisation of care and better integration of child health services, child and adolescent mental health services (CAMHS) and adult mental health services.";"Mental health services for children, young people and adults, and child health services, should form multidisciplinary specialist ADHD teams and/or clinics for children and young people, and separate teams and/or clinics for adults. These teams and clinics should have expertise in the diagnosis and management of ADHD, and should: -Provide diagnostic, treatment and consultation services for people with ADHD who have complex needs, or where general psychiatric services are in doubt about the diagnosis and/or management of ADHD -Put in place systems of communication and protocols for information sharing among paediatric, child and adolescent, forensic, and adult mental health services for people with ADHD, including arrangements for transition between child and adult services -Produce local protocols for shared care arrangements with primary care providers, and ensure that clear lines of communication between primary and secondary care are maintained -Ensure age-appropriate psychological services are available for children, young people and adults with ADHD, and for parents or carers. -The size and time commitment of these teams should depend on local circumstances (for example, the size of the trust, the population covered and the estimated referral rate for people with ADHD). [2008, amended 2018]";2019;;;"High value";"Attention deficit disorder";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5824;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;"There is uncertainty about the training of supervisors to improve employee well-being compared to no intervention.";"Based on a small and heterogeneous sample of controlled intervention studies and in contrast to prevailing consensus that supervisor behaviour influences employees' health and well?being, we found inconsistent evidence that supervisor training may or may not improve employees' well?being when compared to no intervention. For all other types of interventions and outcomes, there was no evidence of a considerable effect. However, due to the very low? to moderate?quality of the evidence base, clear conclusions are currently unwarranted. Well?designed studies are needed to clarify effects of supervisor training on employees' stress, absenteeism, and well?being.";2019;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4802;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Mifamurtide in patients with osteosarcoma.";"It has not been shown to prolong survival and can provoke serious hypersensitivity reactions, pleural and pericardial effusions, neurological adverse effects and hearing loss. It is better to propose chemotherapy without mifamurtide. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6338;29;"Choosing Wisely Australia";"Medical Oncology Group of Australia";English;"Avoid tests (biomarkers and imaging) for recurrent cancer in previously treated asymptomatic patients unless there is evidence that early detection of recurrence can improve survival or quality of life; including avoiding surveillance testing (biomarkers) or imaging (PET, CT and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.";"Some biomarker and imaging tests are effective in staging cancers. For instance, flourodeoxyglucose (FDG) PETs are most effective at staging NSCLC (non-small-cell lung cancer), restaging HL (Hodgkin lymphoma), staging/restaging colorectal cancer, and detection of SPN (solitary pulmonary nodule). However, the clinical impacts of these tests for surveillance of asymptomatic patients are unclear, particularly in cases where early detection of recurrence is unlikely to improve clinical outcomes. Moreover, despite more recent evidence that PET-CT scanning and serial measurement of serum tumour markers can be helpful for some asymptomatic patients by leading to appropriate treatment modifications, there are alternatives to these intensive approaches for detecting recurrence (e.g. surveillance mammography and clinical breast examination in the case of breast cancer). ";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 4803;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Nintedanib in the treatment of patients with lung cancer (non-small cell types).";"It has not been shown to prolong survival but can provoke many severe adverse effects due to its inhibitory effect on angiogenesis, including venous thromboembolism, bleeding, hypertension, gastrointestinal perforations and impaired wound healing.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4804;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Panobinostat for the treatment of patients with multiple refractory or relapsing myeloma.";"It has not been shown to prolong survival in refractory or relapsed multiple myeloma. It provokes many, often serious, adverse effects that affect many vital functions, hastening the death of many patients.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5060;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral bisphosphonates (alendronic acid, ibandronic acid and risedronate sodium) and intravenous bisphosphonates (ibandronic acid and zoledronic acid) are recommended, within their marketing authorisations, as options for treating osteoporosis in adultswho are eligible for risk assessment as defined in NICE's guideline on osteoporosis and NICE's quality standard on osteoporosis and who have been ass";"The choice of treatment should be made on an individual basis after discussion between the responsible clinician and the patient, or their carers, about the advantages and disadvantages of the treatments available. If generic products are available, start treatment with the least expensive formulation, taking into account administration costs, the dose needed and the cost per dose. These recommendations are not intended to affect treatment with alendronic acid, ibandronic acid, risedronate sodium and zoledronic acid that was started in the NHS before this guidance was published. Adults having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. ";2019;;;"High value";Osteoporosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5828;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"It is recommend the administration using combination of nicotine replenishment therapy (NRT) versus single?form NRT, and 4 mg versus 2 mg nicotine gum, which can increase the chances of successfully stopping smoking.";"There is high?certainty evidence that using combination NRT versus single?form NRT, and 4 mg versus 2 mg nicotine gum, can increase the chances of successfully stopping smoking. For patch dose comparisons, evidence was of moderate certainty, due to imprecision. Twenty?one mg patches resulted in higher quit rates than 14 mg (24?hour) patches, and using 25 mg patches resulted in higher quit rates than using 15 mg (16?hour) patches, although in the latter case the CI included one. There was no clear evidence of superiority for 42/44 mg over 21/22 mg (24?hour) patches. Using a fast?acting form of NRT, such as gum or lozenge, resulted in similar quit rates to nicotine patches. There is moderate?certainty evidence that using NRT prior to quitting may improve quit rates versus using it from quit date only; however, further research is needed to ensure the robustness of this finding. Evidence for the comparative safety and tolerability of different types of NRT use is of low and very low certainty. New studies should ensure that AEs, SAEs and withdrawals due to treatment are both measured and reported.";2019;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6340;29;"Choosing Wisely Australia";"Medical Oncology Group of Australia";English;"Testing for serum tumor markers is not recommended in patients with nonspecific symptoms except to evaluate or monitor a cancer known to produce these markers.";"In patients with non-specific symptoms, testing for a panel of tumour markers to try and diagnose an underlying cancer is not supported by evidence given the low sensitivity and specificity of these tests. An exception is in cases of suspected, strong underlying predisposition of specific cancers, in which case testing may prove a useful adjunct or in specific contexts where biomarkers may be useful such as CA-125 for suspected ovarian cancer and the use of PSA to detect prostate cancer in men with lower urinary tract symptoms (LUTS). The appropriate use of tumour biomarker testing is otherwise to monitor the progress of specific cancers under treatment or to detect changes in cancer activity or a secondary or recurring cancer. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4805;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of trabectedin for the treatment of patients with ovarian cancer or soft tissue sarcomas.";"It showed no tangible efficacy in comparative trials in ovarian cancer or soft-tissue sarcomas but has very frequent and severe gastrointestinal, haematological, hepatic and muscular adverse effects. It is unreasonable to add trabectedin to platinum-based chemotherapy for ovarian cancer. When chemotherapy is ineffective in patients with soft-tissue sarcomas, it is best to focus on symptomatic treatments, to limit the clinical consequences of the disease.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5317;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Percutaneous mitral valve leaflet repair is recommended for mitral regurgitation in patients for whom open surgery is contraindicated following risk assessment, provided that standard arrangements are in place for clinical governance, consent and audit. ";"Patient selection should be done by a multidisciplinary structural heart team, typically including an interventional cardiologist, an expert in transoesophageal echocardiography, an expert in heart failure, a cardiac anaesthetist, a cardiac surgeon and a specialist nurse. Percutaneous mitral valve leaflet repair for mitral regurgitation should only be done in specialised centres with access to both cardiac surgical and vascular surgical support in case emergency treatment of complications is needed. This procedure should only be done by clinicians with specialist training and supervision by an experienced mentor for at least the first 20 procedures. Clinicians should enter details about all patients having percutaneous mitral valve leaflet repair for mitral regurgitation onto the National Institute for Cardiovascular Outcomes Research database.";2019;;;"High value";"Heart failure ";"Link to the recommendation on the website of the initiative" 5318;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cardiac contractility modulation device implantation is not recommended for heart failure. ";"The evidence on cardiac contractility modulation device implantation for heart failure raises no major safety concerns. However, the evidence on efficacy is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research. Further research should ideally be in the form of randomised controlled trials. These should report details of patient selection, duration and timing of stimulation, and duration of effect of stimulation. Outcomes should include ejection fraction, oxygen consumption, New York Heart Association classification and patient-reported outcomes, including quality of life.";2019;;;"Low value";"Heart failure";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4807;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Vandetanib for the treatment of patients with metastatic or inoperable medullary thyroid cancer.";" Serious adverse effects (diarrhoea, pneumonia, hypertension) occur in about one-third of patients. There is also a risk of interstitial lung disease, torsades de pointes and sudden death.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4808;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Vinflunine for the treatment of patients with metastatic bladder cancer.";"Vinflunine increases median survival by two months at best compared with symptomatic treatment. There is a high risk of haematological adverse effects (including aplastic anaemia), and a risk of serious infections and cardiovascular disorders (torsades de pointes, myocardial infarction, ischaemic heart disease), sometimes resulting in death.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4809;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of topical cyclosporine for the treatment of dry eye with severe keratitis.";"It frequently provoke eye pain and irritation, have immunosuppressive effects and may cause ocular or periocular cancer, yet have no proven efficacy. It is better to use artificial tears for example for symptomatic relief, several types of which are available.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5321;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine adoption of lead-I electrocardiogram (ECG) devices (imPulse, Kardia Mobile, MyDiagnostick and Zenicor-ECG) is not recommended to detect atrial fibrillation when used for single time point testing in primary care for people with signs or symptoms of the condition and an irregular pulse.";"There is not enough evidence to recommend the routine adoption of lead-I electrocardiogram (ECG) devices (imPulse, Kardia Mobile, MyDiagnostick and Zenicor-ECG) to detect atrial fibrillation when used for single time point testing in primary care for people with signs or symptoms of the condition and an irregular pulse. Further research is recommended to show how using lead?I ECG devices in this way affects: - the number of people with atrial fibrillation detected, compared with current practice and - primary and secondary care services, particularly how ECGs generated by the devices would be interpreted in practice, including staff time needed to interpret the ECG traces and associated costs. ";2019;;;"Low value";"Heart rhythm conditions ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4810;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Idebenone for the treatment of hereditary optic neuropathy.";"It carries a risk of adverse effects including hepatic disorder.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5066;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Care within 24 hours of a person with diabetic foot problems being admitted to hospital, or the detection of diabetic foot problems (if the person is already in hospital)";"A named consultant should be accountable for the overall care of the person, and for ensuring that healthcare professionals provide timely care. Refer the person to the multidisciplinary foot care service within 24 hours of the initial examination of the person's feet. Transfer the responsibility of care to a consultant member of the multidisciplinary foot care service if a diabetic foot problem is the dominant clinical factor for inpatient care. The named consultant and the healthcare professionals from the existing team should remain accountable for the care of the person unless their care is transferred to the multidisciplinary foot care service. ";2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5322;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to build a relationship and work in an open, to engage and non-judgemental manner, to explore the person's worries in order to jointly understand the impact of GAD explore treatment options collaboratively with the person, to ensure that discussion takes place in settings in which confidentiality, privacy and dignity are respected in people with GAD and their environment.";"A stepped-care model (shown in the guide) is used to organise the provision of services and to help people with GAD, their families, carers and practitioners to choose the most effective interventions. Follow the stepped-care model, offering the least intrusive, most effective intervention first. ";2019;;;"High value";Anxiety;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6346;29;"Choosing Wisely Australia";"Medical Oncology Group of Australia";English;"It is not recommended to routinely offer pharmacological venous thromboembolism prophylaxis to ambulatory outpatients who are undergoing oncological treatment";"Patients receiving oncological treatment are at higher risk of thromboembolic disease and hence may require anticoagulant treatment. While there is some evidence that some of these treatments significantly reduce the risk of venous thromboembolic (VTE) events, this benefit must be weighed against the risk of haemorrhagic complications. Pharmacological VTE prophylaxis should not, therefore, be routinely offered to ambulant oncology patients. Exceptions may apply to high-risk cases, such as patients with multiple myeloma receiving antiangiogenesis agents, with chemotherapy and/or dexamethasone.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4811;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Agomelatine for the treatment of depression.";"It has no proven efficacy beyond the placebo effect, but can cause hepatitis and pancreatitis, suicide and aggressive outbursts, as well as serious skin disorders including Stevens-Johnson syndrome.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5067;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for the treatment of cellulite and erysipelas. ";"Consider taking a swab for microbiological testing from people with cellulitis or erysipelas to guide treatment. Before treating cellulitis or erysipelas, consider drawing around the extent of the infection with a single-use surgical marker pen to monitor progress. Be aware that redness may be less visible on darker skin tones. Offer an antibiotic for people with cellulitis or erysipelas. Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. Manage any underlying condition that may predispose to cellulitis or erysipelas. ";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5068;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;" Fulvestrant is not recommended, within its marketing authorisation, for treating locally advanced or metastatic oestrogen-receptor positive breast cancer in postmenopausal women who have not had endocrine therapy before.";"People with untreated disease are first offered an aromatase inhibitor, either anastrozole or letrozole. These drugs are considered to be similarly effective. Tamoxifen is used for women in whom an aromatase inhibitor is not tolerated or is contraindicated. Fulvestrant is a further treatment option that may have additional benefits for some women. However, the final results on overall survival from the FALCON trial are not available yet, so it is unclear whether fulvestrant will extend overall survival compared with aromatase inhibitors. Because of the uncertainty in the clinical evidence, the cost effectiveness of fulvestrant compared with existing treatments is highly uncertain. However, it is likely to be above the range normally considered a cost-effective use of NHS resources, so fulvestrant cannot be recommended.";2019;;;"Low value";"Breast cancer ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5324;1;"NICE ";" National Institute for Health and Clinical Excellence (NICE)";Spanish;"This clinical guideline describes methods of preventing, identifying, diagnosing and treating delirium. In particular, the guideline focuses on preventing delirium in people identified to be at risk, using a targeted, multicomponent, non?pharmacological intervention that addresses a number of modifiable risk factors ('clinical factors') in people aged 18 and over in hospital and long term.";"Indicators of delirium: at presentation - At presentation, assess people at risk for recent (within hours or days) changes or fluctuations in behaviour. These may be reported by the person at risk, or a carer or relative. Be particularly vigilant for behaviour indicating hypoactive delirium (marked*). These behaviour changes may affect: a) Cognitive function: for example, worsened concentration*, slow responses*, confusion. b) Perception: for example, visual or auditory hallucinations. c) Physical function: for example, reduced mobility*, reduced movement*, restlessness, agitation, changes in appetite*, sleep disturbance. d) Social behaviour: for example, lack of cooperation with reasonable requests, withdrawal*, or alterations in communication, mood and/or attitude. If any of these behaviour changes are present, a healthcare professional who is trained and competent in diagnosing delirium should carry out a clinical assessment to confirm the diagnosis.";2019;;;"High value";Delirium;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6860;1;"NICE ";NICE;English;"Treatment with stereotactic surgery is recommended in patients with trigeminal neuralgia.";"A systematic review was conducted to provide an objective summary of the published literature specific to the treatment of classical trigeminal neuralgia with stereotactic radiosurgery (SR) and to develop consensus guideline recommendations for the use of RS, endorsed by the International Society of Stereotactic Radiosurgery (SSRI). The literature is limited in its level of evidence, with only one comparative randomized trial (1 versus 2 isocenters) reported to date. At present, it can be concluded that RS is a safe and effective therapy for drug-resistant trigeminal neuralgia.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative" 5325;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to be based on the stepped care model for the identification and management of depression in children and young people from 5 to 18 years old. It aims to improve the recognition and evaluation and promotion of effective treatments for mild and moderate to severe depression.";" Stepped care The stepped?care model of depression draws attention to the different needs of children and young people with depression ? depending on the characteristics of their depression and their personal and social circumstances ? and the responses that are required from services. It provides a framework in which to organise the provision of services that support both healthcare professionals and patients and their parents or carers in identifying and accessing the most effective interventions";2019;;;"High value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4814;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of duloxetine for the treatment of depression.";"It not only has the adverse effects of the so-called ?selective? serotonin reuptake inhibitors (SSRIs) but also carries a risk of cardiac disorders (hypertension, tachycardia, arrhythmias) due to its noradrenergic activity. Duloxetine can also cause hepatitis and severe cutaneous hypersensitivity reactions such as Stevens-Johnson syndrome.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4815;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Citalopram for the treatment of depression.";"It expose patients to a higher incidence of QT prolongation and torsades de pointes than other SSRIs and worse outcomes in the event of overdose.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4816;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Escitalopram for the treatment of depression.";"It expose patients to a higher incidence of QT prolongation and torsades de pointes than other SSRIs and worse outcomes in the event of overdose.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5072;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for antibiotic regimen for adults, youth and children with community-acquired pneumonia. ";"Start antibiotic treatment as soon as possible after establishing a diagnosis of community-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this ? see the NICE guideline on sepsis). Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. For adults with community-acquired pneumonia, follow the recommendations on microbiological tests in the NICE guideline on pneumonia in adults. For children and young people in hospital with community-acquired pneumonia, and severe symptoms or signs or a comorbidity, consider sending a sample (for example, sputum sample) for microbiological testing.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4819;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Milnacipran for the treatment of depression.";"It not only have the adverse effects of SSRI antidepressants, it can also cause heart disorders (hypertension, tachycardia, arrhythmias, prolongation of the QT interval) due to it's noradrenergic exercise. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5075;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for managing of hospital-acquired pneumonia: treatment for adults, young people and children";"Offer an antibiotic(s) for adults, young people and children with hospital-acquired pneumonia. Start antibiotic treatment as soon as possible after establishing a diagnosis of hospital-acquired pneumonia, and certainly within 4 hours (within 1 hour if the person has suspected sepsis and meets any of the high risk criteria for this. Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. If intravenous antibiotics are given, review by 48 hours and consider switching to oral antibiotics if possible. Send a sample (for example, sputum sample, nasopharyngeal swab or tracheal aspirate) for microbiological testing.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5843;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is not recommended that general health checks in adults have little or no effect on reducing severe morbidity and mortality";"In this Cochrane review, the authors searched for randomised trials of the effects of health checks on illness and deaths. They did not restrict their searches by language of publication and did the most recent search in January 31 2018. They included 17 trials. Health checks have little or no effect on total mortality or cancer mortality and were found likely to have little or no effect on cardiovascular mortality. Health checks had little or no effect on fatal and non-fatal ischaemic heart disease and were found likely to have little or no effect on fatal and non-fatal stroke. ";2019;;;"Low value";"management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4821;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Venlafaxine for the treatment of depression.";"It not only have the adverse effect effects of SSRI antidepressants, it can also cause heart disorders (hypertension, tachycardia, arrhythmias, prolongation of the QT interval) due to it noradrenergic exercise. Venlafaxine overdoses are associated with a high risk of cardiac arrest.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4824;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Thianeptin for the treatment of depression.";"This drug with no proven efficacy, can cause hepatitis, life-threatening skin reactions (including bullous rash) and addiction.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6361;29;"Choosing Wisely Australia";"Australasian Chapter of Addiction Medicine";English;"It is not recommended to deprescribe or interrupt opioid treatment in a patient with concurrent chronic pain and opioid dependence without considering the impact on morbidity and mortality of discontinuation of opioid medications.";"Efforts to reduce opioid-related harm must be carefully balanced against considerations of potential harms that might result from abrupt discontinuation or rapid tapering of drug dosages. These include risks related to withdrawal symptoms and increased pain as well as to seeking other, at time more dangerous, sources of opioids. The adverse physical and psychological outcomes of abrupt reduction or discontinuation of long-time medication include uncontrolled pain, related loss of function and quality of life, depression, accidental overdose and suicide. Clinical decisions must account for unique circumstances of patients as clinicians compassionately work with them to minimise opioid-related harms, be it by mitigating risks associated with high-dose opioids for patients who continue to use them, dosing at a rate minimising withdrawal symptoms for those who agree to taper and/or maximising non-opioid treatment options as appropriate.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4827;2;"Choosing Wisely�";"American Urological Association";English;"A routine bone scan is unnecessary in men with very low-risk or low-risk prostate cancer.";"Very low-risk or low-risk patients (defined by using commonly accepted categories such as American Urological Association guidelines) are unlikely to have disease identified by bone scan. Accordingly, bone scans are generally unnecessary in patients with newly diagnosed prostate cancer who have a PSA <10.0 ng/mL and a Gleason score less than 7 unless the patient?s history or clinical examination suggests bony involvement. Progression to the bone is much more common in advanced local disease or in high-grade disease that is characterized by fast and aggressive growth into surrounding areas such as bones or lymph nodes.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5083;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab, with pemetrexed and platinum chemotherapy is recommended for use within the Cancer Drugs Fund, as an option for untreated, metastatic, non-squamous non-small-cell lung cancer (NSCLC) in adults whose tumours have no epidermal growth factor receptor (EGFR)- or anaplastic lymphoma kinase (ALK)-positive mutations";"Standard care in people with untreated, metastatic non-squamous NSCLC whose tumours have no EGFR- or ALK?positive mutations is usually pemetrexed with carboplatin or cisplatin. For people who cannot tolerate this, docetaxel, gemcitabine, paclitaxel or vinorelbine with carboplatin or cisplatin can be offered. People on either of these combinations may also have pemetrexed maintenance therapy. Standard care for people whose tumours express at least a 50% tumour proportion score is usually pembrolizumab monotherapy. Clinical-effectiveness evidence comes from an ongoing trial (KEYNOTE-189). Pembrolizumab with pemetrexed and carboplatin or cisplatin (pembrolizumab combination) is likely to improve how long people live but it is difficult to establish the size of the benefit in the long term, because the trial is ongoing. Therefore, the cost-effectiveness estimates are also very uncertain. Pembrolizumab combination meets NICE's criteria to be considered a life-extending end-of-life treatment compared with standard care and chemotherapy but does not meet the criteria when compared with pembrolizumab monotherapy. Pembrolizumab combination has the potential to be cost effective, but more evidence from the trial is needed to address the clinical uncertainties. Therefore, pembrolizumab combination is recommended for use in the Cancer Drugs Fund for adults who have untreated, metastatic, non-squamous NSCLC whose tumours have no EGFR- or ALK-positive mutations. Pembrolizumab should be stopped at 2 years of uninterrupted treatment or earlier if disease progresses because the clinical- and cost-effectiveness evidence was limited to 2 years of treatment and the best duration of treatment is unknown.";2019;;;"High value";"Lung cancer ";"https://www.nice.org.uk/guidance/ta557/chapter/1-Recommendations" 4828;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"It is not recommended the use of Dapoxetine for the treatment of dissatisfaction related to early eyaculation.";"Its adverse effects are disproportionate to its very modest efficacy and include aggressive outbursts, serotonin syndrome, and syncope. A psychological and behavioural approach, or application of the anaesthetic combination lidocaine + prilocaine on the glans penis are better options in this situation.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5084;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;" Nivolumab is recommended for use within the Cancer Drugs Fund as an option for the adjuvant treatment of completely resected melanoma in adults with lymph node involvement or metastatic disease. It is recommended only if the conditions in the managed access agreement are followed.";"There are currently no adjuvant immunotherapies recommended by NICE for routine use in people who have melanoma with lymph node involvement or metastatic disease, who have had complete resection. Clinical evidence from CheckMate 238, an ongoing randomised trial, shows that nivolumab improves recurrence-free survival compared with ipilimumab. There are currently no trials comparing nivolumab with routine surveillance, which is the standard of care in the NHS. An indirect treatment comparison using ipilimumab as a common comparator showed that nivolumab is likely to improve recurrence-free survival compared with routine surveillance. However, there is currently no reliable clinical evidence to show that it improves overall survival. This means that the clinical and cost effectiveness of adjuvant nivolumab is uncertain. Nivolumab has the potential to be cost effective, but more evidence is needed to address the clinical uncertainties. Longer follow?up data from CheckMate 238 on how long people live and how long people live without their disease coming back would help to address these uncertainties. Therefore, adjuvant nivolumab is recommended for use in the Cancer Drugs Fund for people who have melanoma with lymph node involvement or metastatic disease.";2019;;;"High value";"Metastases ";"https://www.nice.org.uk/guidance/ta558" 5340;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The currently available evidence is insufficient to determine the effectiveness of corticosteroids for people with influenza.";"There is one RCT of adjunctive corticosteroid therapy for treating people with community?acquired pneumonia, but the number of people with laboratory?confirmed influenza in the treatment and placebo arms was too small to draw conclusions regarding the effect of corticosteroids in this group, and we did not include it in our meta?analyses of observational studies. The certainty of the available evidence from observational studies was very low, with confounding by indication a major potential concern. Although we found that adjunctive corticosteroid therapy is associated with increased mortality, this result should be interpreted with caution. In the context of clinical trials of adjunctive corticosteroid therapy in sepsis and pneumonia that report improved outcomes, including decreased mortality, more high?quality research is needed (both RCTs and observational studies that adjust for confounding by indication).";2019;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4573;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Counselling about healthy eating and keeping physically active during pregnancy is recommended for pregnant women to stay healthy and to prevent excessive weight gain during pregnancy.";"(Recommended) Remarks ? A healthy diet contains adequate energy, protein, vitamins and minerals, obtained through the consumption of a variety of foods, including green and orange vegetables, meat, fish, beans, nuts, whole grains and fruit. ? Stakeholders may wish to consider culturally appropriate healthy eating and exercise interventions to prevent excessive weight gain in pregnancy, particularly for populations with a high prevalence of overweight and obesity, depending on resources and women?s preferences. Interventions should be woman-centred and delivered in a non-judgemental manner, and developed to ensure appropriate weight gain (see further information in points below). ? A healthy lifestyle includes aerobic physical activity and strength-conditioning exercise aimed at maintaining a good level of fitness throughout pregnancy, without trying to reach peak fitness level or train for athletic competition. Women should choose activities with minimal risk of loss of balance and fetal trauma. ? Most normal gestational weight gain occurs after 20 weeks of gestation and the definition of ?normal? is subject to regional variations, but should take into consideration pre-pregnant body mass index (BMI). According to the Institute of Medicine classification, women who are underweight at the start of pregnancy (i.e. BMI < 18.5 kg/m2) should aim to gain 12.5?18 kg, women who are normal weight at the start of pregnancy (i.e. BMI 18.5?24.9 kg/m2) should aim to gain 11.5?16 kg, overweight women (i.e. BMI 25?29.9 kg/m2) should aim to gain 7?11.5 kg, and obese women(i.e. BMI > 30 kg/m2) should aim to gain 5?9 kg. ? Most evidence on healthy eating and exercise interventions comes from high-income countries (HICs), and the GDG noted that that there are at least 40 ongoing trials in HICs in this field. The GDG noted that research is needed on the effects, feasibility and acceptability of healthy eating and exercise interventions in LMICs. ? Pregnancy may be an optimal time for behaviour change interventions among populations with a high prevalence of overweight and obesity, and the longer-term impact of these interventions on women, children and partners needs investigation. ? The GDG noted that a strong training package is needed for practitioners, including standardized guidance on nutrition. This guidance should be evidence-based, sustainable, reproducible, accessible and adaptable to different cultural settings.";2019;;;"High value";"Nutritional interventions";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5085;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Encorafenib with binimetinib is recommended, within its marketing authorisation, as an option for treating unresectable or metastatic BRAF V600 mutation-positive melanoma in adults. It is recommended only if the company provides encorafenib and binimetinib according to the commercial arrangements.";"Current treatments for unresectable or metastatic BRAF V600 mutation-positive melanoma include targeted therapy, usually using a combination of a BRAF and MEK inhibitor (dabrafenib with trametinib) or sometimes monotherapy with a BRAF inhibitor (vemurafenib or dabrafenib). Clinical trial evidence shows that, compared with vemurafenib, encorafenib with binimetinib extends the time until melanoma progresses and also how long people live. There are no trials directly comparing it against dabrafenib with trametinib. But compared indirectly, encorafenib with binimetinib appears to be as effective as dabrafenib with trametinib. When the commercial arrangements for encorafenib, binimetinib, dabrafenib and trametinib are taken into account, encorafenib with binimetinib is considered to be a cost-effective use of NHS resources. It is therefore recommended.";2019;;;"High value";metastases;"https://www.nice.org.uk/guidance/ta562" 6621;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"It is not recommended to use platelet-rich plasma (PRP) in tendinopathy, osteoarthritis, pseudoarthrosis and muscle injury.";"With the currently available evidence, no indications with solid results and minimally relevant and verifiable clinical significance have been identified that can be recommended. Therefore, the use of platelet-rich plasma is NOT recommended in the following indications until solid scientific evidence is generated to support this practice: a) Tendinopathies; b) Osteoarthritis; c) Pseudarthrosis; d) Muscle injury. The use of platelet-rich plasma in the aforementioned indications should be restricted exclusively to the framework of clinical studies duly authorized by Clinical Research Ethics Committees.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4574;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In undernourished populations, nutrition education on increasing daily energy and protein intake is recommended for pregnant women to reduce the risk of low birth- weight neonates.";"(Context-specific recommendation) Remarks ? Undernourishment is usually defined by a low BMI (i.e. being underweight). For adults, a 20?39% prevalence of underweight women is considered a high prevalence of underweight and 40% or higher is considered a very high prevalence. Mid-upper arm circumference (MUAC) may also be useful to identify protein?energy malnutrition in individual pregnant women and to determine its prevalence in this population. However, the optimal cut-off points may need to be determined for individual countries based on context-specific cost?benefit analyses. ? Anthropometric characteristics of the general population are changing, and this needs to be taken into account by regularly reassessing the prevalence of undernutrition to ensure that the intervention remains relevant. ? The GDG noted that a strong training package is needed for practitioners, including standardized guidance on nutrition. This guidance should be evidence-based, sustainable, reproducible, accessible and adaptable to different cultural settings. ? Stakeholders might wish to consider alternative delivery platforms (e.g. peer counsellors, media reminders) and task shifting for delivery of this intervention. ? Areas that are highly food insecure or those with little access to a variety of foods may wish to consider additional complementary interventions, such as distribution of balanced protein and energy supplements.";2019;;;"High value";"Dietary interventions";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4830;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to prescribe testosterone to men with erectile dysfunction who have normal testosterone levels";"While testosterone treatment is shown to increase sexual interest, there appears to be no significant influence on erectile function, at least not in men with normal testosterone levels. The information available in studies to date is insufficient to fully evaluate testosterone?s efficacy in the treatment of men with erectile dysfunction who have normal testosterone levels.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5086;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for the prevention and treatment of the surgical bed for patients and caregivers. ";"Offer patients and carers information and advice on how to care for their wound after discharge. Offer patients and carers information and advice about how to recognise a surgical site infection and who to contact if they are concerned. Use an integrated care pathway for healthcare-associated infections to help communicate this information to both patients and all those involved in their care after discharge. Always inform patients after their operation if they have been given antibiotics.";2019;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5854;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia de COVID-";Spanish;"It is recommended mobile phone text messaging and app?based interventions for smoking cessation";"There is moderate?certainty evidence that automated text message?based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate?certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.";2019;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4575;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In undernourished populations, balanced energy and protein dietary supplementation is recommended for pregnant women to reduce the risk of stillbirths and small for- gestational-age neonates.";"(Context-specific recommendation) ? The GDG stressed that this recommendation is for populations or settings with a high prevalence of undernourished pregnant women, and not for individual pregnant women identified as being undernourished. ? Undernourishment is usually defined by a low BMI (i.e. being underweight). For adults, a 20?39% prevalence of underweight women is considered a high prevalence of underweight and 40% or higher is considered a very high prevalence. MUAC may also be useful to identify protein?energy malnutrition in individual pregnant women and to determine its prevalence in this population (31). However, the optimal cut-off points may need to be determined for individual countries based on context-specific cost? benefit analyses. ? Establishment of a quality assurance process is important to guarantee that balanced energy and protein food supplements are manufactured, packaged and stored in a controlled and uncontaminated environment. The cost and logistical implications associated with balanced energy and protein supplements might be mitigated by local production of supplements, provided that a quality assurance process is established. ? A continual, adequate supply of supplements is required for programme success. This requires a clear understanding and investment in procurement and supply chain management. ? Programmes should be designed and continually improved based on locally generated data and experiences. Examples relevant to this guideline include: ?? Improving delivery, acceptability and utilization of this intervention by pregnant women (i.e. overcoming supply and utilization barriers). ?? Distribution of balanced energy and protein supplements may not be feasible only through the local schedule of ANC visits; additional visits may need to be scheduled. The costs related to these additional visits should be considered. In the absence of antenatal visits, too few visits, or when the first visit comes too late, consideration should be given to alternative platforms for delivery (e.g. community health workers, task shifting in specific settings). ?? Values and preferences related to the types and amounts of balanced energy and protein supplements may vary. ? Monitoring and evaluation should include evaluation of household-level storage facilities, spoilage, wastage, retailing, sharing and other issues related to food distribution. ? Each country will need to understand the context-specific etiology of undernutrition at the national and sub-national levels. For instance, where seasonality is a predictor of food availability, the programme should consider this and adapt to the conditions as needed (e.g. provision of more or less food of different types in different seasons). In addition, a better understanding is needed of whether alternatives to energy and protein supplements ? such as cash or vouchers, or improved local and national food production and distribution ? can lead to better or equivalent results. ? Anthropometric characteristics of the general population are changing, and this needs to be taken into account to ensure that only those women who are likely to benefit (i.e. only undernourished women) are included. ? The GDG noted that it is not known whether there are risks associated with providing this intervention to women with a high BMI.";2019;;;"High value";"Dietary interventions";"https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/anc-positive-pregnancy-experience/en/" 4576;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In undernourished populations, high-protein supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes. ";"(Not recommended) Remarks ? The GDG noted that there is insufficient evidence on the benefits, if any, of high-protein supplementation. ? Further research on the effects of high-protein supplements in undernourished populations is not considered a research priority.";2019;;;"Low value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4832;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to order creatinine or upper-tract imaging for patients with benign prostatic hyperplasia (BPH).";"When an initial evaluation shows only the presence of lower urinary tract symptoms (LUTS), if the symptoms are not significantly bothersome to the patient or if the patient doesn?t desire treatment, no further evaluation is recommended. Such patients are unlikely to experience significant health problems in the future due to their condition and can be seen again if necessary. [While the patient can often tell the provider if the symptoms are bothersome enough that he desires additional therapy, another possible option is to use a validated questionnaire to assess symptoms. For example, if the patient completes the International Prostate Symptom Scale (IPSS) and has a symptom score of 8 or greater, this is considered to be ?clinically? bothersome.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5088;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Abemaciclib with an aromatase inhibitor is recommended, within its marketing authorisation, as an option for treating locally advanced or metastatic, hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer as first endocrine-based therapy in adults. Abemaciclib is recommended only if the company provides it according to the commercial arrangement. ";" Palbociclib or ribociclib, taken with an aromatase inhibitor, are usually the first treatments for locally advanced or metastatic, hormone receptor-positive, HER2-negative breast cancer. They are cyclin-dependent kinase 4 and 6 (CDK 4/6) inhibitors, as is abemaciclib. Clinical trial evidence shows that abemaciclib with an aromatase inhibitor increases how long people live without their disease getting worse, compared with an aromatase inhibitor alone. It is not known whether abemaciclib increases the length of time people live, because the final trial results are not available yet. Abemaciclib, palbociclib and ribociclib have different side effects, but they all appear to work as well as each other. Taking into account the commercial arrangements for all the CDK 4/6 inhibitors, abemaciclib is a cost-effective use of NHS resources and it can be recommended.";2019;;;"High value";"Breast Cancer";"https://www.nice.org.uk/guidance/ta563" 5856;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"It is recommended print?based self?help interventions for smoking cessation";"When no other support is available, written self?help materials help more people to stop smoking compared with getting no help at all. People were more likely to make successful quit attempts when they were also given face?to?face support or nicotine replacement therapy, but printed self?help did not make these people more likely to quit. Self?help materials that were tailored to help individual people are more effective than no help at all. However, tailoring these materials often involves more contact with the research team, and when we compared tailored self?help with regular self?help that involved the same amount of contact, we did not find a difference in quit rates. The studies we found looked at self?help given to people in high?income countries, where more intensive support is often available. More research is needed to find out how well self?help works for people in low? and middle?income countries, where more intensive support is less available.";2019;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6624;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Servicio Navarro de Salud - Osasunbidea ";Spanish;"Vitamin D screening would only be justified for the diagnosis of parathyroid, calcium, and phosphorus disorders; malabsorption syndrome; and in people over 65 years of age institutionalized, homebound, or hospitalized for >2 months.";"Vitamin D screening is recommended in the following situations: a) Differential diagnosis of primary/secondary hyperparathyroidism; b) Possible hypoparathyroidism, hypo/hypercalcemia or hypo/hyperphosphatemia; c) malabsorption syndrome; and d) Patients over 65 years of age who meet at least one of these criteria: being in an institutionalization regime, being confined to their home or being in a prolonged hospital admission regime (>2 months). Vitamin D screening is not recommended in the following situations: a) Asymptomatic general population without risk factors; b) Non-institutionalized elderly population; c) Renal failure without severe or progressive parathyroid abnormalities; d) Hepatic failure; e) Osteoporosis, osteopenia or osteomalacia; f) Elevation of alkaline phosphatase; g) Pregnancy in women without risk factors; h) Administration of antiepileptics, cholestyramine, colestipol or thiazide diuretics; i) Childhood obesity; j) People with fertility problems; k) Nutritional assessment in people without risk factors for vitamin D deficiency.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4577;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Daily oral supplementation with 30 mg to 60 mg of elemental iron and 400 ?g (0.4 mg) folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.";"(Recommended) Remarks ? This recommendation supersedes the 2012 WHO Guideline: daily iron and folic acid supplementation in pregnant women and should be considered alongside Recommendation A.2.2 on intermittent iron. ? In settings where anaemia in pregnant women is a severe public health problem (i.e. where at least 40% of pregnant women have a blood haemoglobin [Hb] concentration < 110 g/L), a daily dose of 60 mg of elemental iron is preferred over a lower dose. ? In the first and third trimesters, the Hb threshold for diagnosing anaemia is 110 g/L; in the second trimester, the threshold is 105 g/L (50). ? If a woman is diagnosed with anaemia during pregnancy, her daily elemental iron should be increased to 120 mg until her Hb concentration rises to normal (Hb 110 g/L or higher) (34, 51). Thereafter, she can resume the standard daily antenatal iron dose to prevent recurrence of anaemia. ? Effective communication with pregnant women about diet and healthy eating ? including providing information about food sources of vitamins and minerals, and dietary diversity ? is an integral part of preventing anaemia and providing quality ANC. ? Effective communication strategies are vital for improving the acceptability of, and adherence to supplementation schemes. ? Stakeholders may need to consider ways of reminding pregnant women to take their supplements and of assisting them to manage associated side-effects. ? In areas with endemic infections that may cause anaemia through blood loss, increased red cell destruction or decreased red cell production, such as malaria and hookworm, measures to prevent, diagnose and treat these infections should be implemented. ? Oral supplements are available as capsules or tablets (including soluble tablets, and dissolvable and modified-release tablets). Establishment of a quality assurance process is important to guarantee that supplements are manufactured, packaged and stored in a controlled and uncontaminated environment. ? A better understanding of the etiology of anaemia (e.g. malaria endemnicity, haemoglobinopathies) and the prevalence of risk factors is needed at the country level, to inform context-specific adaptations of this recommendation. ? Standardized definitions of side-effects are needed to facilitate monitoring and evaluation. ? Development and improvement of integrated surveillance systems are needed to link the assessment of anaemia and iron status at the country level to national and global surveillance systems. ? To reach the most vulnerable populations and ensure a timely and continuous supply of supplements, stakeholders may wish to consider task shifting the provision of iron supplementation in community settings with poor access to health-care professionals. ";2019;;;"High value";"Dietary interventions";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5089;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"NICE is unable to make a recommendation about the use in the NHS of pembrolizumab (Keytruda) for treating recurrent or metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy because no evidence submission was received from Merck Sharp & Dohme. We will review this decision if the company decides to make a submission.";"NICE is unable to make a recommendation about the use in the NHS of pembrolizumab (Keytruda) for treating recurrent or metastatic squamous cell carcinoma of the head and neck after platinum-based chemotherapy because no evidence submission was received from Merck Sharp & Dohme. We will review this decision if the company decides to make a submission.";2019;;;"Low value";"Head and neck cancers ";"https://www.nice.org.uk/guidance/ta570" 5857;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"There is uncertainty about the effectiveness of smoking reduction interventions for smoking cessation";"There is moderate?certainty evidence that neither reduction?to?quit nor abrupt quitting interventions result in superior long?term quit rates when compared with one another. Evidence comparing the efficacy of reduction?to?quit interventions with no treatment was inconclusive and of low certainty. There is also low?certainty evidence to suggest that reduction?to?quit interventions may be more effective when pharmacotherapy is used as an aid, particularly fast?acting NRT or varenicline (moderate?certainty evidence). Evidence for any adverse effects of reduction?to?quit interventions was sparse, but available data suggested no excess of pre?quit SAEs or withdrawal symptoms. We downgraded the evidence across comparisons due to risk of bias, inconsistency and imprecision. Future research should aim to match any additional components of multicomponent reduction?to?quit interventions across study arms, so that the effect of reduction can be isolated. In particular, well?conducted, adequately?powered studies should focus on investigating the most effective features of reduction?to?quit interventions to maximise cessation rates.";2019;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4578;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Intermittent oral supplementation with 120 mg of elemental iron and 2800 ?g (2.8 mg) of folic acid once weekly is recommended for pregnant women to improve maternal and neonatal outcomes";"If it's daily iron, it's not acceptable due to sideeffects, and in populations with an anaemia prevalence among pregnant women of less than 20%. (Context-specific recommendation). Remarks ? This recommendation supersedes the previous WHO recommendation in the 2012 Guideline: intermittent iron and folic acid supplementation in non-anaemic pregnant women. ? In general, anaemia prevalence of less than 20% is classified as a mild public health problem. ? Before commencing intermittent iron supplementation, accurate measurement of maternal blood Hb concentrations is needed to confirm the absence of anaemia. Therefore, this recommendation may require a strong health system to facilitate accurate Hb measurement and to monitor anaemia status throughout pregnancy. ? If a woman is diagnosed with anaemia (Hb < 110 g/L) during ANC, she should be given 120 mg of elemental iron and 400 ?g (0.4 mg) of folic acid daily until her Hb concentration rises to normal (Hb 110 g/L or higher). Thereafter, she can continue with the standard daily antenatal iron and folic acid dose (or the intermittent regimen if daily iron is not acceptable due to side-effects) to prevent recurrence of anaemia. ? Stakeholders may need to consider ways of reminding pregnant women to take their supplements on an intermittent basis and of assisting them to manage associated side-effects.";2019;;;"High value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4834;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to treat an elevated PSA with antibiotics for patients not experiencing other symptoms. ";"It had previously been suggested that a course of antibiotics might lead to a decrease in an initially raised PSA and reduce the need for prostate biopsy; however, there is a lack of clinical studies to show that antibiotics actually decrease PSA levels. It should also be noted that a decrease in PSA does not indicate an absence of prostate cancer. There is no information available on the implications of deferring a biopsy following a decrease in PSA.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5090;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for the use of antibiotics in the management of acute cough. ";"Be aware that an acute cough: is usually self-limiting and gets better within 3 to 4 weeks without antibiotics.Iis most commonly caused by a viral upper respiratory tract infection, such as a cold or flu.Can also be caused by acute bronchitis, a lower respiratory tract infection, which is usually a viral infection but can be bacterial can also have other infective or non-infective causes. For children under 5 with an acute cough and fever, follow the NICE guideline on fever in under 5s: assessment and initial management. For adults with an acute cough and suspected pneumonia, follow the NICE guideline on pneumonia in adults: diagnosis and management.";2019;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5858;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - optimizando la salud en el espacio de trabajo en casa";Spanish;"There is uncertainty if workplace interventions for increasing standing or walking can decrease musculoskeletal symptoms in sedentary workers";"Currently available limited evidence does not show that interventions to increase standing or walking in the workplace reduced musculoskeletal symptoms among sedentary workers at short?, medium?, or long?term follow up. The quality of evidence is low or very low, largely due to study design and small sample sizes. Although the results of this review are not statistically significant, some interventions targeting the physical work environment are suggestive of an intervention effect. Therefore, in the future, larger cluster?RCTs recruiting participants with baseline musculoskeletal symptoms and long?term outcomes are needed to determine whether interventions to increase standing or walking can reduce musculoskeletal symptoms among sedentary workers and can be sustained over time.";2019;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4579;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In populations with low dietary calcium intake, daily calcium supplementation (1.5?2.0 g oral elemental calcium) is recommended for pregnant women to reduce the risk of pre-eclampsia.";"(Context-specific recommendation) Remarks ? This recommendation is consistent with the 2011 WHO recommendations for prevention and treatment of pre-eclampsia and eclampsia (strong recommendation, moderate-quality evidence) and supersedes the WHO recommendation found in the 2013 Guideline: calcium supplementation in pregnant women. ? Dietary counselling of pregnant women should promote adequate calcium intake through locally available, calcium-rich foods. ? Dividing the dose of calcium may improve acceptability. The suggested scheme for calcium supplementation is 1.5?2 g daily, with the total dose divided into three doses, preferably taken at mealtimes. ? Negative interactions between iron and calcium supplements may occur. Therefore, the two nutrients should preferably be administered several hours apart rather than concomitantly. ? As there is no clear evidence on the timing of initiation of calcium supplementation, stakeholders may wish to commence supplementation at the first ANC visit, given the possibility of compliance issues. ? To reach the most vulnerable populations and ensure a timely and continuous supply of supplements, stakeholders may wish to consider task shifting the provision of calcium supplementation in community settings with poor access to health-care professionals. ? The implementation and impact of this recommendation should be monitored at the health service, regional and country levels, based on clearly defined criteria and indicators associated with locally agreed targets. Successes and failures should be evaluated to inform integration of this recommendation into the ANC package. ? Further WHO guidance on prevention and treatment of pre-eclampsia and eclampsia is available in the 2011 WHO recommendations.";2019;;;"High value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5091;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"tezolizumab plus bevacizumab, carboplatin and paclitaxel is recommended as an option for metastatic non-squamous non-small-cell lung cancer (NSCLC) in adult";"Pemetrexed plus carboplatin or cisplatin, with or without pemetrexed maintenance, is the current treatment for: untreated metastatic non-squamous NSCLC (with no EGFR- or ALK?positive mutations) with a PD?L1 tumour proportion score between 0% and 49% and metastatic non-squamous EGFR- or ALK-positive NSCLC when targeted therapy is either not an option or has failed. Pembrolizumab monotherapy is the current treatment for untreated metastatic non-squamous NSCLC with a PD?L1 tumour proportion score of at least 50%. An indirect comparison of studies suggests that people having atezolizumab plus bevacizumab, carboplatin and paclitaxel live longer than those having pemetrexed plus carboplatin or cisplatin, with or without pemetrexed maintenance. This comparison also suggests that they live for longer before their condition worsens. Atezolizumab plus bevacizumab, carboplatin and paclitaxel meets NICE's criteria to be considered a life-extending treatment at the end of life. There is uncertainty about the company's long-term survival estimates, especially for people with EGFR- or ALK?positive NSCLC. But including the most plausible assumptions and the commercial arrangements, the cost-effectiveness estimates are within what NICE normally considers acceptable for an end-of-life treatment. Therefore, atezolizumab plus bevacizumab, carboplatin and paclitaxel is recommended for metastatic non-squamous NSCLC that is untreated (with no EGFR- or ALK?positive mutations) and when the PD?L1 tumour proportion score is between 0% and 49%, or that is EGFR- or ALK?positive and for which targeted therapy has failed. Atezolizumab and bevacizumab are stopped at 2 years of uninterrupted treatment, or earlier if there is loss of clinical benefit (for atezolizumab) or if the disease progresses (for bevacizumab). This is because the cost-effectiveness evidence was primarily based on 2 years of treatment and the best duration of treatment is unknown. No recommendation can be made for atezolizumab plus bevacizumab, carboplatin and paclitaxel for treating untreated PD?L1?positive metastatic NSCLC in people whose PD?L1 tumour proportion score is at least 50% because no cost-effectiveness analyses comparing atezolizumab plus bevacizumab, carboplatin and paclitaxel with pembrolizumab monotherapy were provided.";2019;;;"High value";" Lung cancer ";"https://www.nice.org.uk/guidance/ta584" 5347;35;"Evidencias COVID-19";" Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"Evidence was found that the alpha2 agonist dexmedetomidine may shorten the duration of delirium, although this small effect (compared to placebo) ";"Thise was observed in pairwise analysis based on a single study and was not observed in the results of the network meta-analysis. - Alpha2 agonists were also better classified for the duration of mechanical respiratory support and the length of the ICU stay, while the CHE inhibitor rivastigmine was associated with a longer ICU stay. - No evidence was found of a difference between placebo and any drug in terms of delusion-free and coma-free days, coma days, use of physical restraint, length of stay, long-term cognitive outcomes or mortality. - No study reported relapse of delirium, resolution of symptoms, or quality of life. - The ten studies in progress and the six studies awaiting classification that were identified, once published and evaluated, may alter the conclusions of the review.";2019;;;Uncertain;Treatment-Covid19;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4580;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Vitamin A supplementation is only recommended for pregnant women in areas where vitamin A deficiency is a severe public health problem, to prevent night blindness. ";"(Context-specific recommendation) Remarks ? This recommendation supersedes the previous WHO recommendation found in the 2011 Guideline: vitamin A supplementation in pregnant women. ? Vitamin A is not recommended to improve maternal and perinatal outcomes. ? Vitamin A deficiency is a severe public health problem if 5% or more of women in a population have a history of night blindness in their most recent pregnancy in the previous 3?5 years that ended in a live birth, or if 20% or more of pregnant women have a serum retinol level below 0.70 ?mol/L . Determination of vitamin A deficiency as a public health problem involves estimating the prevalence of deficiency in a population by using specific biochemical and clinical indicators of vitamin A status. ? Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet, and to refer to WHO guidance on healthy eating. ? In areas where supplementation is indicated for vitamin A deficiency, it can be given daily or weekly. Existing WHO guidance suggests a dose of up to 10 000 IU vitamin A per day, or a weekly dose of up to 25 000 IU. ? A single dose of a vitamin A supplement greater than 25 000 IU is not recommended as its safety is uncertain. Furthermore, a single dose of a vitamin A supplement greater than 25 000 IU might be teratogenic if consumed between day 15 and day 60 from conception. ? There is no demonstrated benefit from taking vitamin A supplements in populations where habitual daily vitamin A intakes exceed 8000 IU or 2400 ?g, and the potential risk of adverse events increases with higher intakes (above 10 000 IU) if supplements are routinely taken by people in these populations.";2019;;;"High value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4836;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to perform routinely ultrasound on boys with cryptorchidism.";"Ultrasound has been found to have poor diagnostic performance in the localization of testes that cannot be felt through physical examination. Studies have shown that the probability of locating testes was small when using ultrasound, and there was still a significant chance that testes were present even after a negative ultrasound result. Additionally, ultrasound results are complicated by the presence of surrounding tissue and bowel gas present in the abdomen.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5092;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cemiplimab is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced or metastatic cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy is not appropriate. It is recommended only if the conditions in the managed access agreement are followed.";"Living with advanced unresectable cutaneous squamous cell carcinoma is physically and emotionally challenging, and there is a high unmet need for new treatments. Cemiplimab trial data are promising but uncertain. The cost-effectiveness estimates for cemiplimab are above what is normally considered a cost-effective use of NHS resources. The evidence on life expectancy with current treatments and how long life might be prolonged with cemiplimab is very uncertain. Because of this it is not known for certain whether the end-of-life criteria apply. So cemiplimab cannot be recommended for routine use in the NHS. However, if more mature data become available from an ongoing trial of cemiplimab, and more data on life expectancy with current treatments are obtained, this could confirm the expectation that the end-of-life criteria apply. If this is the case, there is plausible potential for cemiplimab to be a cost-effective treatment. Therefore, cemiplimab is recommended for use within the Cancer Drugs Fund.";2019;;;"High value";Metastases;"https://www.nice.org.uk/guidance/ta592" 4581;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Zinc supplementation for pregnant women is only recommended in the context of rigorous research. ";"(Context-specific recommendation ? research) Remarks ? Many of the included studies were at risk of bias, which influenced the certainty of the review evidence on the effects of zinc supplementation. ? The low-certainty evidence that zinc supplementation may reduce preterm birth warrants further investigation, as do the other outcomes for which the evidence is very uncertain (e.g. perinatal mortality, neonatal sepsis), particularly in zinc-deficient populations with no food fortification strategy in place. Further research should aim to clarify to what extent zinc supplementation competes with iron and/or calcium antenatal supplements for absorption. The GDG considered that food fortification may be a more cost?effective strategy and that more evidence is needed on the cost?effectiveness of food fortification strategies.";2019;;;"High value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4837;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to prescribe antimicrobials to patients using indwelling or intermittent catheterization of the bladder unless there are signs and symptoms of urinary tract infection. ";"Antibiotics in the absence of signs and symptoms (which may include fever; altered mental status or malaise with no other cause; flank or pelvic pain; flank or suprapubic tenderness; hematuria; dysuria, urinary urgency or frequency; and, in spinal cord injury patients, increased spasticity, autonomic dysreflexia or sense of unease) is not efficacious and risks inducing resistance to antimicrobials. This applies to both indwelling and intermittent catheterization of the bladder. The major exception is patients needing periprocedural antimicrobials. Additionally, initial placement of a suprapubic tube requires a skin puncture or incision and therefore antibiotics should be considered.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5093;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;" Pembrolizumab, with carboplatin and paclitaxel, is recommended for use within the Cancer Drugs Fund as an option for untreated metastatic squamous non-small-cell lung cancer (NSCLC) in adults";"Current treatment for untreated metastatic squamous NSCLC is usually platinum-based combination chemotherapy (standard chemotherapy) for people whose tumours express PD?L1 with a tumour proportion score of lower than 50%, or pembrolizumab monotherapy for people whose tumours express PD?L1 with a tumour proportion score of 50% or higher. The main clinical evidence for pembrolizumab with carboplatin and paclitaxel (pembrolizumab combination therapy) comes from an ongoing randomised controlled trial (KEYNOTE?407). This suggests that people who have pembrolizumab combination therapy live longer than those who have standard chemotherapy. Pembrolizumab combination therapy has only been indirectly compared with pembrolizumab monotherapy in people whose tumours express PD?L1 with a tumour proportion score of 50% or higher. Because the clinical evidence is immature, the cost-effectiveness estimates for pembrolizumab combination therapy are very uncertain. It may meet NICE's criteria to be considered a life-extending treatment at the end of life when compared with standard chemotherapy, but there is uncertainty about this. It does not meet the end-of-life criteria when compared with pembrolizumab monotherapy for people whose tumours express PD?L1 with a tumour proportion score of 50% or higher. Pembrolizumab should be stopped at 2 years of uninterrupted treatment or earlier if disease progresses because the clinical- and cost-effectiveness evidence is limited to 2 years of treatment and the best treatment duration is unknown. Pembrolizumab combination therapy has the potential to be cost effective, but more evidence is needed to address the clinical uncertainties. Therefore, it is recommended for use in the Cancer Drugs Fund for untreated metastatic squamous NSCLC in adults.";2019;;;"High value";"Lung cancer ";"https://www.nice.org.uk/guidance/ta600" 4582;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Multiple micronutrient supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.";"(Not recommended) Remarks ? There is some evidence of additional benefit of MMN supplements containing 13?15 different micronutrients (including iron and folic acid) over iron and folic acid supplements alone, but there is also some evidence of risk, and some important gaps in the evidence. Although the GDG agreed that overall there was insufficient evidence to warrant a recommendation, the group agreed that policymakers in populations with a high prevalence of nutritional deficiencies might consider the benefits of MMN supplements on maternal health to outweigh the disadvantages, and may choose to give MMN supplements that include iron and folic acid. ? More research is needed to determine which micronutrients improve maternal and perinatal outcomes, and how these can be optimally combined into a single supplement.";2019;;;"Low value";"Dietary interventions";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4583;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Vitamin B6 (pyridoxine) supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.";"(Not recommended) Remarks ? Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet, and to refer to guidelines on healthy eating. ? The GDG agreed that there is insufficient evidence on the benefits and harms, if any, of routine vitamin B6 supplementation in pregnancy. However, research on the effects of routine vitamin B6 supplementation for pregnant women on maternal and perinatal outcomes is not considered a research priority.";2019;;;"Low value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4839;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend obtain computed tomography scan of the pelvis for asymptomatic men with low-risk or very low-risk clinically localized prostate cancer.";"Computed tomography scan of the pelvis is very unlikely to provide actionable information in men with low-risk prostate cancer (one commonly accepted definition of low-risk prostate cancer is Gleason score less than 7, PSA less than 20.0 ng/mL, and tumor stage of T2 or less and very low-risk is Gleason score less than 7, PSA less than 10 ng/ml and tumor stage T1-T2a, less than 34 percent of biopsy cores positive and no core with more than 50 percent involved, and PSA density of less than .15 ng/ml/cc). Magnetic resonance imaging of the pelvis may be useful in some men considering active surveillance.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4584;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Vitamin E and C supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.";"(Not recommended) Remarks ? The GDG noted that vitamin E and C combined supplements were evaluated mainly in the context of preventing pre-eclampsia. Vitamin C is important for improving the bioavailability of oral iron, but this was not considered within the context of the Cochrane reviews. In addition, low-certainty evidence on vitamin C alone suggests that it may prevent prelabour rupture of membranes (PROM). Therefore, the GDG agreed that future research should consider vitamin C supplements separately from vitamin E and C supplements. ? Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet, and to refer to guidelines on healthy eating. It is relatively easy to consume sufficient quantities of vitamin C from food sources.";2019;;;"Low value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4840;2;"Choosing Wisely�";"American Urological Association";English;"Do not recommend to remove synthetic vaginal mesh in asymptomatic patients. ";"There is no clear benefit to mesh removal in the absence of symptoms, and mesh removal in this circumstance exposes the patient to potential complications such as bladder injury, rectal injury and fistula formation. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4585;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Vitamin D supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes.";"(Not recommended) Remarks ? This recommendation supersedes the previous WHO recommendation found in the 2012 Guideline: vitamin D supplementation in pregnant women. ? Pregnant women should be advised that sunlight is the most important source of vitamin D. The amount of time needed in the sun is not known and depends on many variables, such as the amount of skin exposed, the time of day, latitude and season, skin pigmentation (darker skin pigments synthesize less vitamin D than lighter pigments) and sunscreen use. ? Pregnant women should be encouraged to receive adequate nutrition, which is best achieved through consumption of a healthy, balanced diet, and to refer to guidelines on healthy eating. ? For pregnant women with documented vitamin D deficiency, vitamin D supplements may be given at the current recommended nutrient intake (RNI) of 200 IU (5 ?g) per day. ? According to the Cochrane review, there are 23 ongoing or unpublished studies on vitamin D supplementation in pregnancy. Evidence from these trials should help to clarify the current uncertainties regarding vitamin D effects, particularly the effect on preterm birth, and any other associated benefits or harms of vitamin D when combined with other vitamins and minerals, particularly calcium.";2019;;;"Low value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4586;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"For pregnant women with high daily caffeine intake (more than 300 mg per day), lowering daily caffeine intake during pregnancy is recommended to reduce the risk of pregnancy loss and low-birth-weight neonates.";"(Context-specific recommendation) Remarks ? Pregnant women should be informed that a high daily caffeine intake (> 300 mg per day) is probably associated with a higher risk of pregnancy loss and low birth weight. ? Caffeine is a stimulant found in tea, coffee, soft-drinks, chocolate, kola nuts and some over-the-counter medicines. Coffee is probably the most common source of high caffeine intake. A cup of instant coffee can contain about 60 mg of caffeine; however, some commercially brewed coffee brands contain more than 150 mg of caffeine per serving. ? Caffeine-containing teas (black tea and green tea) and soft drinks (colas and iced tea) usually contain less than 50 mg per 250 mL serving.";2019;;;"High value";"Dietary interventions ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4842;2;"Choosing Wisely�";"American Urological Association";English;"Recommend PSA screening for detecting prostate cancer only after engaging in shared decision making. ";"Shared decision making (between health care provider and patient and, in some cases, family members) is an excellent strategy for making health care decisions when there is more than one medically reasonable option. Since both screening and not screening may be reasonable options, depending on the particular situation, shared decision making is recommended.";2019;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4587;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Full blood count testing is the recommended method for diagnosing anaemia during pregnancy. In settings where full blood count testing is not available, onsite haemoglobin testing with a haemoglobinometer is recommended over the use of the haemoglobin colour scale as the method for diagnosing anaemia in pregnancy.";"(Context-specific recommendation) Remarks ? The GDG agreed that the high recurrent costs of Hb testing with haemoglobinometers might reduce the feasibility of this method in some low-resource settings, in which case the WHO haemoglobin colour scale method may be used. ? Other low-technology on-site methods for detecting anaemia need development and/or investigation.";2019;;;"High value";"Maternal and fetal assessment";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4588;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy. In settings where urine culture is not available, on-site midstream urine Gram-staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy.";"(Context-specific recommendation) Remarks ? The GDG agreed that the higher resource costs associated with Gram stain testing might reduce the feasibility of this method in low-resource settings, in which case, dipstick tests may be used. ? The GDG agreed that ASB is a priority research topic, given its association with preterm birth and the uncertainty around urine testing and treatment in settings with different levels of ASB prevalence. Specifically, studies are needed that compare on-site testing and treatment versus testing plus confirmation of test with treatment on confirmatory culture, to explore health and other relevant outcomes, including acceptability, feasibility and antimicrobial resistance. In addition, better on-site tests need to be developed to improve accuracy and feasibility of testing and to reduce overtreatment of ASB. Research is also needed to determine the prevalence of ASB at which targeted testing and treatment rather than universal testing and treatment might be effective.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4589;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Clinical enquiry about the possibility of intimate partner violence (IPV) should be strongly considered at antenatal care visits when assessing conditions that may be caused or complicated by IPV in order to improve clinical diagnosis and subsequent care, where there is the capacity to provide a supportive response.";"(Context-specific recommendation) Remarks ? This recommendation is consistent with the 2013 publication Responding to intimate partner violence and sexual violence against women: WHO clinical and policy guidelines (86). The evidence on clinical enquiry was indirect (strong recommendation) and the evidence on universal screening was judged as being of low to moderate quality (conditional recommendation). ? ?Universal screening? or ?routine enquiry? (i.e. asking all women at all health-care encounters) about IPV is not recommended. However, the WHO guidelines identify ANC as a setting where routine enquiry could be implemented if providers are well trained on a first-line response and minimum requirements are met. ? Examples of conditions during pregnancy that may be caused or complicated by IPV include: ?? traumatic injury, particularly if repeated and with vague or implausible explanations; ?? intrusive partner or husband present at consultations; ?? adverse reproductive outcomes, including multiple unintended pregnancies and/or terminations, delay in seeking ANC, adverse birth outcomes, repeated STIs; ?? unexplained or repeated genitourinary symptoms; ?? symptoms of depression and anxiety; ?? alcohol and other substance use; ?? self-harm, suicidality, symptoms of depression and anxiety. ? The GDG agreed that, despite a paucity of evidence, it was important to make a recommendation due to the high prevalence and importance of IPV. ANC provides an opportunity to enquire about IPV among women for whom barriers to accessing health care may exist, and also allows for the possibility for follow-up during ANC with appropriate supportive interventions, such as counselling and empowerment interventions. However, the evidence on benefits and potential harms of clinical enquiry and subsequent interventions is lacking or uncertain. ? A minimum condition for health-care providers to ask women about violence is that it must be safe to do so (i.e. the partner is not present) and that identification of IPV is followed by an appropriate response. In addition, providers must be trained to ask questions in the correct way and to respond appropriately to women who disclose violence (86). ? Research on IPV is needed to answer the following questions: ?? Which are the most effective strategies for identifying, preventing and managing IPV in pregnancy? ?? Does asking routinely about violence impact on ANC attendance? ?? Can interventions targeted at partners of pregnant women prevent IPV?";2019;;;"Low value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4590;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Hyperglycaemia first detected at any time during pregnancy should be classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy";"(Recommended) Remarks ? This recommendation has been integrated from the 2013 WHO publication Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy (the strength of the recommendation and the quality of the evidence were not stated). ? WHO currently does not have a recommendation on whether or how to screen for GDM, and screening strategies for GDM are considered a priority area for research, particularly in LMICs. ? Diabetes mellitus in pregnancy differs from GDM in that the hyperglycaemia is more severe and does not resolve after pregnancy as it does with GDM. ? A systematic review of cohort studies shows that women with hyperglycaemia (diabetes mellitus and GDM) detected during pregnancy are at greater risk of adverse pregnancy outcomes, including macrosomia, pre-eclampsia/hypertensive disorders in pregnancy, and shoulder dystocia. Treatment of GDM, which usually involves a stepped approach of lifestyle changes (nutritional counselling and exercise) followed by oral blood-glucose-lowering agents or insulin if necessary, is effective in reducing these poor outcomes. ? There are many uncertainties about the cost?effectiveness of different screening strategies, the prevalence of GDM and diabetes mellitus according to the 2013 criteria in diverse populations, and the impact of earlier diagnosis on pregnancy outcomes (see Chapter 5: Research implications). ? The usual window for diagnosing GDM is between 24 and 28 weeks of gestation. Risk factor screening is used in some settings as a strategy to determine the need for a 2-hour 75 g oral glucose tolerance test (OGTT). These include a BMI of greater than 30 kg/m2, previous GDM, previous macrosomia, family history of diabetes mellitus, and ethnicity with a high prevalence of diabetes mellitus. In addition, glycosuria on dipstick testing (2+ or above on one occasion, or 1+ on two or more occasions) may indicate undiagnosed GDM and, if this is observed, performing an OGTT could be considered. ? The management approach for women classified with diabetes mellitus in pregnancy (i.e. severe hyperglycaemia first detected in pregnancy) usually differs from the approach for women with GDM, particularly when diagnosed early in pregnancy; however, the principles of management are similar and both require referral and increased monitoring.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4591;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Health-care providers should ask all pregnant women about their tobacco use (past and present) and exposure to second-hand smoke as early as possible in pregnancy and at every antenatal care visit. ";"(Recommended) Remarks ? This strong recommendation based on low-quality evidence has been integrated from the 2013 WHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy. Related recommendations from this guideline include the following: ?? Health-care providers should routinely offer advice and psychosocial interventions for tobacco cessation to all pregnant women who are either current tobacco users or recent tobacco quitters (strong recommendation based on moderate quality evidence). ?? All health-care facilities should be smoke-free to protect the health of all staff, patients and visitors, including pregnant women (strong recommendation based on low-quality evidence). ?? Health-care providers should provide pregnant women, their partners and other household members with advice and information about the risks of second-hand smoke (SHS) exposure from all forms of smoked tobacco, as well as strategies to reduce SHS in the home (strong recommendation based on low quality evidence). ?? Health-care providers should, wherever possible, engage directly with partners and other household members to inform them of all the risks of SHS exposure to pregnant women from all forms of tobacco, and to promote reduction of exposure and offer smoking cessation support (strong recommendation based on low-quality evidence).";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5615;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento de la hipoxemia)";Spanish;"It is not recommended inspired oxygen fraction and higher versus lower arterial oxygenation targets in adults admitted to the intensive care unit";"The effects of an inspired oxygen fraction or a major versus minor arterial oxygenation target for ICU adults on all-cause mortality, serious adverse events, and lung injury at the time closest to 3 are unknown. months due to evidence of very low certainty. The results indicate that the administration of oxygen with higher or lower fractions or oxygenation targets can increase mortality. None of the trials reported the proportion of participants with one or more serious adverse events according to the ICH ? GCP criteria, however, we found that the trials reported an increase in the number of serious adverse events with fractions or older oxygenation. Effects on quality of life, acute myocardial infarction, stroke, and sepsis are not known due to insufficient data.";2019;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4592;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal care visit. ";"Recommended Remarks ? This strong recommendation based on low-quality evidence has been integrated from the 2014 WHO Guidelines for the identification and management of substance use and substance use disorders in pregnancy. The overarching principles of this guideline aimed to prioritize prevention, ensure access to prevention and treatment services, respect women?s autonomy, provide comprehensive care, and safeguard against discrimination and stigmatization. ? The GDG responsible for the recommendation noted that asking women at every ANC visit is important as some women are more likely to report sensitive information only after a trusting relationship has been established. ? Pregnant women should be advised of the potential health risks to themselves and to their babies posed by alcohol and drug use. ? Validated screening instruments for alcohol and other substance use and substance use disorders are available (refer to Annex 3 of the 2014 guidelines). ? Health-care providers should be prepared to intervene or refer all pregnant women who are identified as using alcohol and/or drugs (past and present). ? For women identified as being dependent on alcohol or drugs, further recommendations from the guideline include the following: ?? Health-care providers should at the earliest opportunity advise pregnant women dependent on alcohol or drugs to cease their alcohol or drug use and offer, or refer them to, detoxification services under medical supervision, where necessary and applicable (strong recommendation based on very low-quality evidence). ?? Health-care providers should offer a brief intervention to all pregnant women using alcohol or drugs (strong recommendation based on low-quality evidence). ? It was decided that despite the low-quality evidence on effects of brief psychosocial interventions, the benefit (potential reduction of alcohol and substance use) outweighed any potential harms, which were considered to be minimal. ? A brief intervention is a structured therapy of short duration (typically 5?30 minutes) offered with the aim of assisting an individual to cease or reduce use of a psychoactive substance.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4593;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In high-prevalence settings,a provider-initiated testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnancy women in all antenatal care settings.";"In low-prevalence settings, PITC can be considered for pregnant women in antenatal care settings as a key component of the effort to eliminate mother-to-child transmission of HIV, and to integrate HIV testing with syphilis, viral or other key tests, as relevant to the setting, and to strengthen the underlying maternal and child health systems. (Recommended) Remarks ? This recommendation has been integrated from the 2015 WHO Consolidated guidelines on HIV testing services (the strength of the recommendation and the quality of the evidence were not stated). ? PITC denotes an HIV testing service that is routinely offered in a health-care facility and includes providing pre-test information and obtaining consent, with the option for individuals to decline testing. PITC has proved highly acceptable and has increased the uptake of HIV testing in LMICs. ? The availability of HIV testing at ANC services is responsible for the high level of knowledge of HIV status among women in many countries, which has allowed women and infants to benefit from ART. ? WHO recommends that ART should be initiated in all pregnant women diagnosed with HIV at any CD4 count and continued lifelong. This recommendation is based on evidence that shows that providing ART to all pregnant and breastfeeding women living with HIV improves individual health outcomes, prevents mother-to-child transmission of HIV, and prevents horizontal transmission of HIV from the mother to an uninfected sexual partner. ? Other recommendations relevant to ANC services from the Consolidated guidelines on HIV testing services include the following: ?? On disclosure: Initiatives should be put in place to enforce privacy protection and institute policy, laws and norms that prevent discrimination and promote tolerance and acceptance of people living with HIV. This can help create environments where disclosure of HIV status is easier (strong recommendation, low-quality evidence). ?? On retesting: In settings with a generalized HIV epidemic:b Retest all HIV-negative pregnant women in the third trimester, during labour or postpartum because of the high risk of acquiring HIV infection during pregnancy (strength of recommendation and quality of evidence not stated). ?? On retesting: In settings with a concentrated HIV epidemic:c Retest HIV-negative pregnant women who are in a serodiscordant couple or from a key population groupd (strength of recommendation and quality of evidence not stated). ?? On retesting before ART initiation: National programmes should retest all people newly and previously diagnosed with HIV before they enrol in care and initiate ART (strength of recommendation and quality of evidence not stated). ?? On testing strategies: In settings with greater than 5% HIV prevalence in the population being tested, a diagnosis of HIV-positive should be issued to people with two sequential reactive tests. In settings with less than 5% HIV prevalence in the population being tested, a diagnosis of HIV-positive should be issued to people with three sequential reactive tests (strength of recommendation and quality of evidence not stated). ?? On task shifting: Lay providers who are trained and supervised can independently conduct safe and effective HIV testing using rapid diagnostic tests (strong recommendation, moderate-quality evidence).";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4594;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In settings where the tuberculosis (TB) prevalence in the general population is 100/100 000 population or higher, systematic screening for active TB should be considered for pregnant women as part of antenatal care.";"Context-specific recommendation Remarks ? This recommendation has been adapted and integrated from the 2013 WHO publication Systematic screening for active tuberculosis: principles and recommendations, where it was considered a conditiona recommendation based on very low-quality evidence. ? Systematic screening is defined as the systematic identification of people with suspected active TB in a predetermined target group, using tests, examinations or other procedures that can be applied rapidly. Options for initial screening include screening for symptoms (either for cough lasting longer than two weeks, or any symptoms compatible with TB, including a cough of any duration, haemoptysis, weight loss, fever or night sweats) or screening with chest radiography. The use of chest radiography in pregnant women poses no significant risk but the national guidelines for the use of radiography during pregnancy should be followed. ? Before screening is initiated, high-quality TB diagnosis, treatment, care, management and support should be in place, and there should be the capacity to scale these up further to match the anticipated rise in case detection that may occur as a result of screening. ? The panel responsible for making this recommendation noted that it may not be possible to implement it in resource-constrained settings. ? Other recommendations relevant to ANC services from the same publication include the following: ?? Household contacts and other close contacts should be systematically screened for TB (strong recommendation, very low-quality evidence). ?? People living with HIV should be systematically screened for active TB at each visit to a health-care facility (strong recommendation, very low-quality evidence). ?? Systematic screening for active TB may be considered also for other subpopulations that have very poor access to health care, such as people living in urban slums, homeless people, people living in remote areas with poor access to health care, and other vulnerable or marginalized groups including some indigenous populations, migrants and refugees (conditional recommendation, very low-quality evidence). ? TB increases the risk of preterm birth, perinatal death and other pregnancy complications. Initiating TB treatment early is associated with better maternal and infant outcomes than late initiation. ? To better understand the local burden of TB in pregnancy, health systems may benefit from capturing pregnancy status in registers that track TB screening and treatment.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5106;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to adopting UrgoStart dressings to treat diabetic foot ulcers and venous leg ulcers in the NHS, because they are associated with increased wound healing compared with non-interactive dressings.";"UrgoStart dressings should therefore be considered as an option for people with diabetic foot ulcers or venous leg ulcers after any modifiable factors such as infection have been treated. Cost modelling shows that, compared with standard care, using UrgoStart dressings to treat diabetic foot ulcers is associated with a cost saving of �342 per patient after 1 year. It also shows that UrgoStart is likely to be cost saving for treating venous leg ulcers, but the robustness of this conclusion is less certain from the evidence available. For both types of ulcers, potential cost savings mainly come from better healing with UrgoStart dressings. If 25% of people having treatment for diabetic foot ulcers use UrgoStart instead of a non-interactive dressing, the NHS may save up to �5.4 million each year. For more details, see the NICE resource impact report. For people with non-venous leg ulcers, there is insufficient evidence to support routine adoption.";2019;;;"High value";"Injuries, accidents and wounds";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5362;35;"Evidencias COVID-19";" Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"It cannot be determined whether the administration of omega 3 fatty acids and antioxidants as part of nutritional intake in patients with ARDS improves long-term survival.";"Omega 3 fatty acids (known as DHA and EPA) are found in fish oils and can have an anti-inflammatory effect. The review authors examined the reported results and effects of nutritional changes in studies of adult patients with ARDS. It cannot be determined whether omega 3 fatty acids and antioxidants reduce the length of stay in the ICU and the number of days on a respirator, or whether they improve oxygenation. It is also unclear whether this type of nutrition results in more harm. The results of this review are limited by the lack of standardization of included studies in terms of methods, types of nutritional supplements administered and reporting of outcome measures. The quality of the evidence was considered low to very low. ";2019;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4595;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Daily fetal movement counting, such as with ?count-to-ten? kick charts, is only recommended in the context of rigorous research.";"(Context-specific recommendation ? research) Remarks ? Fetal movement counting is when a pregnant woman counts and records her baby?s movements in order to monitor the baby?s health. Various methods have been described, with further monitoring variously indicated depending on the method used, for example, if fewer than six distinct movements are felt within 2 hours or fewer than 10 distinct movements are felt within 12 hours (the Cardiff ?count to ten? method). ? While daily fetal movement counting is not recommended, healthy pregnant women should be made aware of the importance of fetal movements in the third trimester and of reporting reduced fetal movements. ? Clinical enquiry by ANC providers at each ANC visit about maternal perception of fetal movements is recommended as part of good clinical practice. Women who perceive poor or reduced fetal movements require further monitoring (e.g. with daily fetal movement counting) and investigation, if indicated. ? The GDG agreed that more research is needed on the effects of daily fetal movement counting in the third trimester of pregnancy, particularly in LMIC settings with a high prevalence of unexplained stillbirths.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5107;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended adopting the Debrisoft monofilament debridement pad as part of the management of acute or chronic wounds in the community.";"La evidencia disponible es limitada, pero los beneficios probables de usar la almohadilla Debrisoft en las heridas apropiadas son que se desbridar�n por completo m�s r�pidamente, con menos visitas de enfermer�a necesarias, en comparaci�n con otros m�todos de desbridamiento. Adem�s, la almohadilla Debrisoft es conveniente y f�cil de usar, y los pacientes la toleran bien. El desbridamiento es un componente importante del manejo est�ndar del cuidado de heridas como se describe en las gu�as NICE sobre �lceras por presi�n y problemas del pie diab�tico. La almohadilla Debrisoft est� indicada para adultos y ni�os con heridas agudas o cr�nicas. La evidencia disponible es principalmente en adultos con heridas cr�nicas que necesitan desbridamiento en la comunidad. Los datos muestran que el dispositivo es particularmente eficaz para las heridas cr�nicas mucosas y la piel hiperquerat�tica alrededor de heridas agudas o cr�nicas.";2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4596;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Replacing abdominal palpation with symphysis-fundal height (SFH) measurement for the assessment of fetal growth is not recommended to improve perinatal outcomes. A change from what is usually practiced (abdominal palpation or SFH measurement) in a particular setting is not recommended. ";"Context-specific recommendation Remarks ? SFH measurement is routinely practiced in many ANC settings. Due to a lack of clear evidence of accuracy or superiority of either SFH measurement or clinical palpation to assess fetal growth, the GDG does not recommend a change of practice. ? The GDG agreed that there is a lack of evidence on SFH, rather than a lack of effectiveness, particularly in LMIC settings. ? Apart from false reassurance, which might occur with both SFH measurement and clinical palpation, there is no evidence of harm with SFH measurement. ? Research is needed to determine the role of SFH measurement in detecting abnormal fetal growth and other risk factors for perinatal morbidity (e.g. multiple pregnancy, polyhydramnios) in settings where antenatal ultrasound is not available.";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5108;1;"NICE ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina";English;"I is not recommended to adopted the routine use of Mepilex Border Heel and Sacrum to prevent pressure ulcers in people considered to be at risk in acute care settings.";"Mepilex Border Heel and Sacrum dressings show promise for preventing pressure ulcers in people who are considered to be at risk in acute care settings. However, there is currently insufficient evidence to support the case for routine adoption in the NHS. Research is recommended to address uncertainties about the claimed benefits of using Mepilex Border Heel and Sacrum dressings. This research should also explore issues such as: the incidence of heel and sacrum pressure ulcers in NHS acute care settings criteria for patient selection to reduce pressure ulcer incidence with Mepilex Border Heel and Sacrum dressings in addition to standard care. NICE will consider reviewing this guidance when substantive new evidence becomes available.";2019;;;"Low value";"Pressure ulcers";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4597;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Routine antenatal cardiotocography is not recommended for pregnant women to improve maternal and perinatal outcomes.";"(Not recommended) Remarks ? CTG is the continuous recording of the fetal heart rate and uterine contractions obtained via an ultrasound transducer placed on the mother?s abdomen. ? There is currently no evidence on effects or other considerations that supports the use of antenatal (prelabour) CTG as part of routine ANC. ? A lack of evidence of benefits associated with CTG in high-risk pregnancies suggests that the evaluation of antenatal CTG in healthy pregnant women is not a research priority.";2019;;;"Low value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5109;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations to identify acute kidney injury in people with acute illness.";"Investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in adults with acute illness. Investigate for acute kidney injury, by measuring serum creatinine and comparing with baseline, in children and young people with acute illness. Be aware that in adults, children and young people with chronic kidney disease and no obvious acute illness, a rise in serum creatinine may indicate acute kidney injury rather than a worsening of their chronic disease. Ensure that acute kidney injury is considered when an adult, child or young person presents with an illness with no clear acute component";2019;;;"High value";"Infections, Covid 19";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4598;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"One ultrasound scan before 24 weeks of gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman?s pregnancy experience.";"(Recommended) Remarks ? The benefits of an early ultrasound scan are not improved upon and cannot be replicated with a late ultrasound scan where there has not been an early ultrasound scan. Therefore, an ultrasound scan after 24 weeks of gestation (late ultrasound) is not recommended for pregnant women who have had an early ultrasound scan. However, stakeholders should consider offering a late ultrasound scan to pregnant women who have not had an early ultrasound scan, for the purposes of identifying the number of fetuses, presentation and placental location. ? The GDG noted that the effects of introducing antenatal ultrasound on population health outcomes and health systems in rural, low-resource settings are unproven. However, the introduction of ultrasound to detect pregnancy complications and confirm fetal viability to the woman and her family in these settings could plausibly increase ANC service utilization and reduce morbidity and mortality, when accompanied by appropriate gestational age estimation, diagnosis, referral and management. ? The ongoing multicountry trial that is under way should contribute further evidence on health effects, health care utilization and implementation-related information on ultrasound in rural, low-resource settings. ? The GDG acknowledged that the use of early pregnancy ultrasound has not been shown to reduce perinatal mortality. The GDG put emphasis on other benefits of ultrasound (mentioned in points above) and the increased accuracy of gestational age assessment, which would assist management in case of suspected preterm birth and reduce labour induction for post-term pregnancies. ? The GDG acknowledges that implementing and scaling up this recommendation in low-resource settings will be associated with a variety of challenges that may include political (budgeting for fees and tariffs), logistical (equipment maintenance, supplies, technical support), infrastructural (ensuring a reliable power supply and secure storage) and resources. ? The GDG noted that antenatal ultrasound is an intervention that can potentially be task shifted from trained sonographers and doctors to trained nurses, midwives and clinical officers, provided that ongoing training, staff retention, quality improvement activities and supervision are ensured. ? Stakeholders might be able to offset/reduce the cost of antenatal ultrasound if the ultrasound equipment is also used for other indications (e.g. obstetric emergencies) or by other medical departments. ? The implementation and impact of this recommendation on health outcomes, facility utilization and equity should be monitored at the health service, regional and country levels, based on clearly defined criteria and indicators associated with locally agreed targets";2019;;;"High value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4599;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Routine Doppler ultrasound examination is not recommended for pregnant women to improve maternal and perinatal outcomes. ";"(Not recommended) Remarks ? The GDG noted that the evidence base for the use of Doppler ultrasound of fetal blood vessels in high risk pregnancy is already established. ? The GDG agreed that the value of a single Doppler ultrasound examination of fetal blood vessels for all pregnant women in the third trimester needs rigorous evaluation, particularly in LMIC settings. Future trials should be designed to evaluate the effect of a single Doppler ultrasound on preventable perinatal deaths.";2019;;;"Low value";"Maternal and fetal assessment ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5111;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for use of thermometers and the detection of fever.";"Do not routinely use the oral and rectal routes to measure the body temperature of children aged 0?5 years. In infants under the age of 4 weeks, measure body temperature with an electronic thermometer in the axilla. In children aged 4 weeks to 5 years, measure body temperature by one of the following methods: - electronic thermometer in the axilla. - chemical dot thermometer in the axilla. - infra-red tympanic thermometer. Healthcare professionals who routinely use disposable chemical dot thermometers should consider using an alternative type of thermometer when multiple temperature measurements are required. Forehead chemical thermometers are unreliable and should not be used by healthcare professionals. Reported parental perception of a fever should be considered valid and taken seriously by healthcare professionals.";2019;;;"High value";"Feverish illness";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4600;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"A seven-day antibiotic regimen is recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight.";"Recommended Remarks ? This recommendation should be considered alongside the recommendation on ASB diagnosis. ? Stakeholders may wish to consider context-specific ASB screening and treatment based on ASB and preterm birth prevalence, as it may not be appropriate in settings with low prevalence. ? Evidence on preterm birth is of low certainty and large multicentre trials are needed to confirm whether screening and antibiotic treatment reduces preterm birth and perinatal mortality in LMICs. Such trials should also aim to evaluate the effects of group B streptococcus (GBS) screening and treatment. ? Studies have shown that GBS bacteriuria is a sign of heavy GBS colonization, which may not be eradicated by antibiotic treatment. GBS bacteriuria is a risk factor for having an infant with early onset GBS disease. WHO recommends that pregnant women with GBS colonization receive intrapartum antibiotic administration to prevent early neonatal GBS infection. ? Preterm birth indicators should be monitored with this intervention, as should changes in antimicrobial resistance.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4601;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Antibiotic prophylaxis is only recommended to prevent recurrent urinary tract infections in pregnant women in the context of rigorous research.";"(Context-specific recommendation ? research) Remarks ? Further research is needed to determine the best strategies for preventing RUTI in pregnancy, including the effects of antibiotic prophylaxis on pregnancy-related outcomes and changes in antimicrobial resistance.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4857;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t recommend diagnostic testing following sonographic identification of an isolated echogenic intracardiac focus (EIF) or choroid plexus cyst (CPC) in women with low-risk aneuploidy screening results.";"The concept of using ultrasonographic soft markers for aneuploidy, such as EIF and CPC, was introduced in an era that predated screening for Down syndrome based on factors other than maternal age. Because the sensitivity of cell free (cfDNA) screening for Down syndrome approaches 99%, the residual risk for Down syndrome is very low in patients who have a negative cfDNA screening test result. Given the low a priori risk, the presence of an isolated EIF or CPC is unlikely to increase the detection rate for aneuploidy to any measurable degree. In addition, for a woman with an isolated EIF or CPC on a second-trimester ultrasound in the setting of any negative first- or second-trimester aneuploidy screening test result, a reasonable approach is to consider the presence of the isolated finding as a normal variant. Recent guidelines from the Society for Maternal-Fetal Medicine state that diagnostic testing should not be recommended to patients solely for the indication of an isolated EIF or CPC in the setting of a negative cfDNA screening test result or a negative first- or second-trimester screening test result.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4602;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Antenatal prophylaxis with anti-D immunoglobulin in non-sensitized Rh-negative pregnant women at 28 and 34 weeks of gestation to prevent RhD alloimmunization is recommended only in the context of rigorous research.";"(Context-specific recommendation ? research) Remarks ? This context-specific recommendation relates to anti-D prophylaxis during pregnancy and not the practice of giving anti-D after childbirth, for which there is high-certainty evidence of its effect of reducing RhD alloimmunization in subsequent pregnancies (129). Anti-D should still be given postnatally when indicated. ? Determining the prevalence of RhD alloimmunization and associated poor outcomes among women in LMIC settings, as well as developing strategies to manage this condition, is considered a research priority";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4858;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Do not recommend to perform serial cervical length measurement following cerclage placement.";"Although progressive cervical shortening after cerclage placement increases the risk of preterm birth, neither overall cervical length nor the length below the stitch correlates well with outcomes. Most importantly, there are currently no additional treatment options for a short cervix after cerclage (e.g., reinforcement suture does not improve outcomes). Although there may be theoretical psychological benefits to the patient and provider to visualize the stitch, there are insufficient data to suggest a clinical benefit of routine post-cerclage serial cervical length measurement.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5114;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for reduced catheter?related bloodstream infections and local site infections compared with semipermeable transparent (standard) dressings";"The 3M Tegaderm CHG IV securement dressing should be considered for use in critically ill adults who need a central venous or arterial catheter in intensive care or high dependency units. The estimated cost saving from using a 3M Tegaderm CHG IV securement dressing (Tegaderm CHG) instead of a standard transparent semipermeable dressing is �93 per patient. This estimate is based on a baseline catheter?related bloodstream infection rate of 1.48 per 1,000 catheter days. Tegaderm CHG is estimated to be cost neutral when the baseline catheter?related bloodstream infection rate is 0.18 per 1,000 catheter days, and cost incurring when the baseline rate falls below that figure.";2019;;;"High value";"Healthcare-associated infections.";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4603;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In endemic areas, preventive anthelminthic treatment is recommended for pregnant women after the first trimester as part of worm infection reduction programmes.";"(Context-specific recommendation) Remarks ? This recommendation is consistent with the WHO Guideline: preventive chemotherapy to control soiltransmitted helminth infections in high-risk groups (140), which states that: ?Preventive chemotherapy (deworming), using single-dose albendazole (400 mg) or mebendazole (500 mg) is recommended as a public health intervention for pregnant women, after the first trimester, living in areas where both: (1) the baseline prevalence of hookworm and/or T. trichiura infection is 20% or more and (2) where anaemia is a severe public health problem, with prevalence of 40% or higher among pregnant women, in order to reduce the burden of hookworm and T. trichiura infection (conditional recommendation, moderate quality of evidence).? ? Endemic areas are areas where the prevalence of hookworm and/or whipworm infection is 20% or more. Anaemia is considered a severe public health problem when the prevalence among pregnant women is 40% or higher. ? Infected pregnant women in non-endemic areas should receive anthelminthic treatment in the second or third trimester on a case-by-case basis. A single dose of albendazole (400 mg) or mebendazole (500 mg) should be used. ? The safety of these drugs in pregnancy has not been unequivocally established; however, the benefits are considered to outweigh the disadvantages. ? WHO recommends a treatment strategy comprising two treatments per year in high-risk settings with a prevalence of 50% for soil-transmitted helminthiasis, and once per year in areas with a 20?50% prevalence.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4859;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Do not recommend test women for MTHFR mutations.";"MTHFR is responsible for the conversion of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate. Genetic variant C677T and A1286C have been associated with a mild decrease in enzymatic activity, which in the setting of reduced folate levels has been found to be a risk factor for hyperhomocysteinemia. Although hyperhomocysteinemia is a risk factor for cardiovascular disease and venous thrombosis, its cause is multifactorial and independent of the MTHFR genotype, even in homozygotic individuals. Despite earlier (mostly case control) studies that found an association between the MTHFR genotype and adverse outcomes, recent studies of more robust design have not replicated these findings. Due to the lack of evidence associating genotype independently with thrombosis, recurrent pregnancy loss, or other adverse pregnancy outcomes, MTHFR genotyping should not be ordered as part of a workup for thrombophilia.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5115;1;"NICE ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina";Spanish;"It is recommended to start antibiotic treatment for people with suspected diabetic foot infection as soon as possible and take samples for microbiological testing before, or as close as possible to, the start of antibiotic treatment.";.;2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4604;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus. ";"(Recommended) Remarks ? This recommendation is consistent with recommendations from the 2006 WHO guideline on Maternal immunization against tetanus. The GDG endorses the 2006 guideline approach, which recommends the following: ?? If a pregnant woman has not previously been vaccinated, or if her immunization status is unknown, she should receive two doses of a tetanus toxoid-containing vaccine (TT-CV) one month apart with the second dose given at least two weeks before delivery. Two doses protect against tetanus infection for 1?3 years in most people. A third dose is recommended six months after the second dose, which should extend protection to at least five years. ?? Two further doses for women who are first vaccinated against tetanus during pregnancy should be given after the third dose, in the two subsequent years or during two subsequent pregnancies. ?? If a woman has had 1?4 doses of a TT-CV in the past, she should receive one dose of a TT-CV during each subsequent pregnancy to a total of five doses (five doses protects throughout the childbearing years). ? Tetanus vaccination and clean delivery practices are major components of the strategy to eradicate maternal and neonatal tetanus globally. ? Effective surveillance is critical for identifying areas or populations at high risk of neonatal tetanus and for monitoring the impact of interventions. ? A monitoring system should include an immunization register, personal vaccination cards and maternal health records, which should be held by the woman. ? For effective implementation, ANC health-care providers need to be trained in tetanus vaccination and the vaccine, equipment and supplies (refrigerator, needles and syringes) need to be readily available at ANC services. ? Policy-makers in low prevalence/high-income settings may choose not to include tetanus vaccination among ANC interventions if effective tetanus immunization programmes and good post-exposure prophylaxis exist outside of pregnancy. ? ANC contacts should be used to verify the vaccination status of pregnant women, and administer any vaccines that are recommended in the national immunization schedule. ANC contacts are also opportunities to explain the importance of infant vaccination and communicate the infant/child vaccination schedule to pregnant women.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4860;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t screen asymptomatic pregnant women for subclinical hypothyroidism. ";"Subclinical hypothyroidism (SCH) is defined as an elevated serum TSH level in the presence of a normal free T4 level and is found in 2% to 5% of otherwise healthy pregnant women. SCH is unlikely to progress to overt hypothyroidism during pregnancy. While some authorities and organizations have recommended routine screening for all pregnant women and subsequent treatment with levothyroxine, two recent, large (>100,000 women) prospective randomized clinical trials of screening and treatment for SCH demonstrated no effect of treatment on offspring IQ at age 5 years. Because treatment for SCH has not resulted in a beneficial effect on outcomes, routine screening for SCH is not currently recommended. Targeted screening for women at risk for overt hypothyroidism is still appropriate.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5116;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"It is recommended to the severity of diabetic foot infection, the risk of developing complications, previous microbiological results, previous antibiotic use and patient preferences when choosing an antibiotic for people with a suspected diabetic foot infection. ";.;2019;;;"High value";diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4605;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"In malaria-endemic areas in Africa, intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) is recommended for all pregnant women. Dosing should start in the second trimester, and doses should be given at least one month apart, with the objective of ensuring that at least three doses are received.";"(Context-specific recommendation) Remarks ? This recommendation has been integrated from the WHO Guidelines for the treatment of malaria (2015), where it is considered to be a strong recommendation based on high-quality evidence. ? Malaria infection during pregnancy is a major public health problem, with substantial risks for the mother, her fetus and the newborn. WHO recommends a package of interventions for preventing and controlling malaria during pregnancy, which includes promotion and use of insecticide-treated nets, appropriate case management with prompt, effective treatment, and, in areas with moderate to high transmission of Plasmodium falciparum, administration of IPTp-SP. ? The high-quality evidence supporting this recommendation was derived from a systematic review of seven RCTs conducted in malaria-endemic countries, which shows that three or more doses of sulfadoxine-pyrimethamine (SP) is associated with reduced maternal parasitaemia, fewer low-birthweight infants and increased mean birth weight compared with two doses only. ? The malaria GDG noted that most evidence was derived from women in their first and second pregnancies; however, the limited evidence on IPTp-SP from women in their third and subsequent pregnancies was consistent with benefit. ? To ensure that pregnant women in endemic areas start IPTp-SP as early as possible in the second trimester, policy-makers should ensure health system contact with women at 13 weeks of gestation. Policy-makers could also consider supplying women with their first SP dose at the first ANC visit with instructions about the date (corresponding to 13 weeks of gestation) on which the medicine should be taken. ? SP acts by interfering with folic acid synthesis in the malaria parasite, thereby inhibiting its life-cycle. There is some evidence that high doses of supplemented folic acid (i.e. 5 mg daily or more) may interfere with the efficacy of SP in pregnancy (155). Countries should ensure that they procure and distribute folic acid supplements for antenatal use at the recommended antenatal dosage (i.e. 0.4 mg daily). ? The malaria GDG noted that there is insufficient evidence on the safety, efficacy and pharmacokinetics of most antimalarial agents in pregnancy, particularly during the first trimester.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4861;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Do not recommend to use amniotic fluid index to make a diagnosis of oligohydramnios (in the third trimester).";"Amniotic fluid volume can be measured using either the amniotic fluid index (AFI) or the deepest vertical pocket (DVP). Diagnosis of oligohydramnios based on an AFI of <5 cm has been found to lead to a greater number of obstetric interventions without a significant benefit in improving perinatal outcomes when compared to use of a DVP of <2 cm for diagnosis.";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4606;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) should be offered as an additional prevention choice for pregnant women at substantial risk of HIV infection as part of combination prevention approaches.";"(Context-specific recommendation) Remarks ? This recommendation has been integrated from the WHO guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV (2015), where it is considered to be a strong recommendation based on high-quality evidence. The evidence and further guidance related to the recommendation can be found in this guideline. ? ?Substantial risk? is provisionally defined as HIV incidence greater than 3 per 100 person-years in the absence of PrEP, but individual risk varies within this group depending on individual behaviour and the characteristics of sexual partners. Local epidemiological evidence concerning risk factors and HIV incidence should be used to inform implementation. ? Thresholds for offering PrEP may vary depending on a variety of considerations, including resources, feasibility and demand. ? The level of protection is strongly correlated with adherence.";2019;;;"High value";"Preventive measures ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4862;14;"Prescrire bilan. Towards better patient care: drugs to avoid";-;English;"Do not recommend Bupropion for smoking cessation.";"Bupropion, an amphetamine authorised for smoking cessation, is no more effective than nicotine but can cause neuropsychiatric disorders (including aggressiveness, depression and suicidal ideation), potentially severe allergic reactions (including angioedema and Stevens-Johnson syndrome), addiction, and congenital heart defects in children exposed to the drug in utero. ";2019;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5118;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence supports the case for adopting Endocuff Vision in the NHS because it improves the adenoma detection rate during colonoscopy, particularly for people having a colonoscopy as part of bowel cancer screening.";"Endocuff Vision debe considerarse como una opci�n para las personas que se someten a una colonoscopia como parte de la detecci�n del c�ncer de intestino despu�s de una prueba de heces positiva. Hay evidencia limitada de los beneficios de Endocuff Vision en una poblaci�n que no realiza pruebas de detecci�n. El modelado de costos muestra que para las personas que se someten a una colonoscopia como parte de la detecci�n del c�ncer de intestino, el uso de Endocuff Vision es un ahorro de costos. El programa de detecci�n de c�ncer de intestino es un servicio del NHS que ofrece pruebas (incluida la colonoscopia) a las personas con riesgo de c�ncer de intestino. La colonoscopia se usa para detectar el c�ncer de intestino, pero tambi�n para identificar y eliminar adenomas que podr�an convertirse en lesiones cancerosas si no se tratan. Endocuff Vision is a disposable sleeve that fits over the end of most colonoscopes. It is designed to improve visualisation of the bowel during colonoscopy. Clinical evidence shows that for people having a colonoscopy as part of bowel cancer screening, using Endocuff Vision improves the adenoma detection rate without increasing how long the procedure takes. Better detection of adenomas is likely to reduce the incidence of subsequent cancers. Cost analyses in this population also suggest that Endocuff Vision is cost saving if the adenoma detection rate is improved by more than 3%.";2019;;;"High value";"Colorectal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4607;34;"WHO recommendations";"WHO recommendations on antenatal care for a positive pregnancy experience";English;"Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for the relief of nausea in early pregnancy, based on a woman?s preferences and available options.";"(Recommended) Remarks ? In the absence of stronger evidence, the GDG agreed that these non-pharmacological options are unlikely to have harmful effects on mother and baby. ? Women should be informed that symptoms of nausea and vomiting usually resolve in the second half of pregnancy. ? Pharmacological treatments for nausea and vomiting, such as doxylamine and metoclopramide, should be reserved for those pregnant women experiencing distressing symptoms that are not relieved by non-pharmacological options, under the supervision of a medical doctor.";2019;;;"High value";"Interventions for common physiological symptoms ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5119;1;"NICE ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina";Spanish;"It is recommended when prescribing antibiotics for a suspected diabetic foot infection in adults aged 18 years and over, follow table 1 for a mild infection or table 2 for a moderate or severe infection.";"Go to the recommendation website to see the tables.";2019;;;"High value";Diabetes;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4352;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t routinely suggest antimicrobial treatment for older persons unless they are consistent with their goals of care. ";"While antimicrobial treatments can be lifesaving, they are not without side-effects, particularly for an older person. Antimicrobial use is only appropriate if it aligns with the older person?s wishes and goals of care. Life-prolonging use of antimicrobials may be inconsistent with a patient?s wishes or a palliative approach to care. Talk with the older person and their family to ensure they understand the impact of antimicrobial treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4864;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Rimmer A. BMJ 2018;360:k847";English;"Antidepressants are more effective than placebo for short term treatment of acute depression in adults.";"A meta-analysis found that all antidepressants were more effective than placebo. The limitations that we can?t predict which antidepressant would be best for an individual, but knowing which antidepressants are better than others can help the decision making. For further information please visit the website of the initiative (link below)";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4353;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t routinely use intravenous antimicrobials for older persons who can take and absorb oral medications. ";"When antimicrobials are indicated and consistent with an older person?s plan of care, intravenous formulations should not be the first choice unless there is no other safe and effective route of administration. Many antimicrobials have excellent bioavailability and only in rare instances need to be administered intravenously. Use of oral formulations of these medications reduces the need for placement and maintenance of venous access devices and their associated complications. In addition, reduced need for venous access can prevent transfer of an older person away from their current setting to accommodate a higher level of care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5121;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for adopting Peristeen for transanal irrigation in people with bowel dysfunction is supported by the evidence. Peristeen can reduce the severity of constipation and incontinence, improve quality of life and promote dignity and independence.";"Peristeen may not be suitable for all people with bowel dysfunction. It may take several weeks before a person is comfortable with using Peristeen, and some people may choose to stop using it. Peristeen is therefore most effective when it is offered with specialist training for users, carers and NHS staff, and structured patient support. Cost modelling for Peristeen is uncertain, but it is likely that Peristeen provides additional clinical benefits without costing more than standard bowel care.";2018;;;"High value";Constipation;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4354;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t send frail older persons to the hospital unless their urgent needs and goals of care cannot be met in their current setting. ";"Transfers to hospital for assessment and treatment of a change in condition have become customary. However, harms can outweigh benefit and may result in increased morbidity. In one Canadian study, approximately half of hospitalizations were considered avoidable. Transfer often results in long periods in an unfamiliar and stressful environment for the older person. Other hazards include delirium, hospital-acquired infections, medication side effects, lack of sleep, and rapid loss of muscle strength while bedridden. Frail older persons assessed and treated in their current settings have the opportunity to receive more individualized care and better comfort and end-of-life care. If a transfer is unavoidable, a person-centred collaborative approach is necessary to communicate the older person?s functionality and plan of care to ensure their needs are met. Much consideration should be given to the older person?s goals of care, including integrating a palliative approach to care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4866;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2018;360:k774";English;"Hydroxychloroquine is no more effective than placebo in reducing the symptoms of hand osteoarthritis";"A study published in the Annals of Internal Medicine realized in UK has found that no significant treatment difference was found in grip strength, function, or quality of life. For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5122;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for adopting Peristeen for transanal irrigation in people with bowel dysfunction is supported by the evidence. Peristeen can reduce the severity of constipation and incontinence, improve quality of life and promote dignity and independence.";"Peristeen may not be suitable for all people with bowel dysfunction. It may take several weeks before a person is comfortable with using Peristeen, and some people may choose to stop using it. Peristeen is therefore most effective when it is offered with specialist training for users, carers and NHS staff, and structured patient support. Cost modelling for Peristeen is uncertain, but it is likely that Peristeen provides additional clinical benefits without costing more than standard bowel care.";2018;;;"High value";"Faecal incontinence";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4355;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t encourage bed rest for older persons during a hospital stay unless medically indicated. ";"Continuous bed rest or limited ambulation during a hospital stay causes deconditioning and loss of muscle mass and is one of the primary factors for loss of walking independence in hospitalized older adults. Up to 65% of older persons who can walk independently will lose this ability during a hospital stay. Walking during the hospital stay is critical for maintaining this functional ability. Loss of walking independence increases the length of hospital stay, the need for rehabilitation services, the possibility of placement in a nursing home, and the risk for falls both during and after discharge from the hospital. It also places higher demands on caregivers and increases the risk of death. Compared with older persons who don?t walk during their hospital stay, those that do are able to walk farther by discharge, are discharged from the hospital sooner, have improved ability to perform basic daily living tasks independently, and have a faster recovery rate after surgery.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5123;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tofacitinib, with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults.";"Only if: it is used as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (recommendations 1.1 and 1.2) or the person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after 12 weeks or TNF?alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis). Tofacitinib is only recommended if the company provides it according to the commercial arrangement. Assess the response to tofacitinib after 12 weeks of treatment. Only continue treatment if there is clear evidence of response, defined as an improvement in at least 2 of the 4 Psoriatic Arthritis Response Criteria (PsARC), 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria. People whose disease has a Psoriasis Area and Severity Index (PASI) 75 response but whose PsARC response does not justify continuing treatment should be assessed by a dermatologist, to determine whether continuing treatment is appropriate based on skin response (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis, recommendation 1.3). When using the PsARC healthcare professionals should take into account any physical, sensory or learning disabilities or communication difficulties that could affect a person's responses to components of the PsARC and make any adjustments they consider appropriate. When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate. These recommendations are not intended to affect treatment with tofacitinib that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. NICE recommends several treatments for treating psoriatic arthritis. Tofacitinib is the first of a new class of drugs for treating psoriatic arthritis (Janus kinase inhibitors). Clinical trial evidence shows that tofacitinib is more effective than placebo at treating joint and skin symptoms. An indirect comparison suggests that tofacitinib is likely to improve symptoms about as well as some of the current treatments used in the NHS for psoriatic arthritis.";2018;;;"High value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4356;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t use restraints with older persons unless all other alternatives have been explored.";"Restraints are most often applied when an older person is distressed or has a change in medical status. These situations require immediate assessment and attention, not restraint. Restraints can be mechanical, physical, chemical or environmental in nature ? for example, devices or medications that can be used to restrict a person?s movement. Perceived benefits of restraints are often outweighed by their significant potential for harm, including serious complications and even death. Safe, quality care can be achieved using a least-restraint approach.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4357;19;"Choosing Wisely Canada";"Canadian Nurses Association & Canadian Gerontological Nursing Association";English;"Don?t use a q2h turning routine unless it meets the older person?s plan of care. ";"Individualized turning plans should be developed to align with the older person?s care needs. Turning an older person q2h is often considered the gold standard implemented in many areas of health care to aid in the avoidance of skin breakdown and pressure injuries. However, there is little evidence to support this particular frequency of repositioning. In some cases, it is far too frequent; in others, it is not frequent enough. For older persons at low risk for skin breakdown, this practice may severely impact their quality of life due to sleep deprivation and disruption, leading to delirium, depression and other psychiatric impairments. Excessive repositioning of an older adult may also result in shearing forces that can lead to pressure injuries. Conversely, q2h turning may be inadequate for persons at higher risk for skin breakdown, including those with decreased tissue tolerance and limited mobility. To facilitate an appropriate turning schedule for older adults of all risk levels, it is crucial to use a validated tool to assess each client?s risk for skin breakdown and develop an individualized turning plan.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4869;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Iacobucci G. BMJ 2018;360:k706";English;"It is important that Opioids are prescribed appropriately and in conjunction with established clinical guidelines.";"The number of opioid drugs prescribed in England is steadily rising despite a lack of effectiveness for treating chronic pain and their potentially serious side effects, a study has found. For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4358;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t use arthroscopic debridement as a primary treatment in the management of osteoarthritis of the knee. ";"Several recent meta-analyses have culminated in clinical practice guidelines recommending against the use of arthroscopic debridement for the treatment of degenerative knee arthritis and meniscal tears in patients over the age of 35, as it appears there is no maintained benefit of arthroscopic surgery over conservative management (exercise therapy, injections, and drugs). However, this does not preclude the judicious use of arthroscopic surgery when indicated to manage symptomatic co-existing pathology in the presence of osteoarthritis or degeneration.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4359;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t order a knee MRI when weight-bearing x-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment. ";"The diagnosis of knee osteoarthritis can be effectively made based upon the patient?s history, physical examination, and plain radiography consisting of weight-bearing posterior-anterior, lateral and skyline views. Ordering MRI scans incurs further waiting times for patients, can cause unnecessary anxiety while waiting.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4360;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t order a hip MRI when x-rays demonstrate osteoarthritis and symptoms are suggestive of osteoarthritis as the MRI rarely adds useful information to guide diagnosis or treatment. ";"The diagnosis of hip osteoarthritis can be effectively made based upon the patient?s history, physical examination and plain radiography. Ordering MRI scans incurs further waiting times for patients, can cause unnecessary anxiety while waiting for specialist consultation, and can delay MRI imaging for appropriate patients.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4872;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Murphy D. BMJ 2018;362:k3664";English;"It is not recommended to make repeated tests of thyroid function in previously euthyroid patients older than 65 years.";"Researchers from a UK study advised that routine thyroid function tests (TFT) investigations should cease in patients who have been euthyroid in the past five years without changing clinical circumstances. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative " 5128;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence for low-intensity pulsed ultrasound to promote healing of fresh fractures at low risk of non-healing raises no major safety concerns. However, current evidence does not show efficacy. Therefore, this procedure should not be used for this indication.";" ";2018;;;"Low value";Fractures;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4361;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t prescribe opioids for management of osteoarthritis before optimizing the use of nonopioid approaches to pain management. ";"The use of opioids in chronic non-cancer pain is associated with significant risks. Optimization of non-opioid pharmacotherapy and non-pharmacologic therapy is strongly recommended. Treatment with opioids is not superior to treatment with non-opioid medications in improving pain-related function over 12 months in patients with moderate to severe hip, knee or back pain due to osteoarthritis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4362;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t routinely request pathological examination of tissue from uncomplicated primary hip and knee replacement surgery undertaken for degenerative arthritis. ";"Several large reviews including thousands of patients have demonstrated that routine pathological examination of operative specimens from uncomplicated primary hip and knee arthroplasty surgeries does not alter patient management or outcome.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4363;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty. ";"Since ultrasound is not effective at diagnosing unsuspected deep vein thrombosis (DVT) and appropriate alternative screening tests do not exist, if there is no change in the patient?s clinical status, routine post-operative screening for DVT after hip or knee arthroplasty does not change outcomes or clinical management.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4875;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hopkins J. BMJ 2018;361:k2655";English;"It is recommended that in US states where there is a social movement of public health vaccine opposition, the non-medical exemption option is suspended and protect schoolchildren from vaccine preventable diseases.";"In 18 US states, parents can avoid having their children get the vaccinations required for school entry for personal religious or philosophical reasons rather than medical reasons. The result is a lower rate of MMR (measles, mumps, and rubella) immunization among kindergardens. The non-medical exemption option should be suspended and protect schoolchildren from vaccine preventable diseases.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 5131;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence for low-intensity pulsed ultrasound to promote healing of fresh fractures at high risk of non-healing raises no major safety concerns. ";"The current evidence on efficacy is very limited in quantity and quality. Therefore, this procedure should only be used in the context of research. Further research should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.";2018;;;"Low value";Fractures;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4364;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief. ";"The use of needle lavage in patients with symptomatic osteoarthritis of the knee does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness or swelling.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4365;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee. ";"Both glucosamine and chondroitin sulfate do not provide relief for patients with symptomatic osteoarthritis of the knee.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5133;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sofosbuvir?velpatasvir?voxilaprevir is recommended as an option for treating chronic hepatitis C in adults.";"It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need. These recommendations are not intended to affect treatment with sofosbuvir?velpatasvir?voxilaprevir that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2018;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4366;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee. ";"In patients with symptomatic osteoarthritis of the knee, the use of lateral wedge or neutral insoles does not improve pain or functional outcomes. Comparisons between lateral and neutral heel wedges were investigated, as were comparisons between lateral wedged insoles and lateral wedged insoles with subtalar strapping. The systematic review concludes that there is only limited evidence for the effectiveness of lateral heel wedges and related orthoses. In addition, the possibility exists that those who do not use them may experience fewer symptoms from osteoarthritis of the knee.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4622;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Persistent hypotension, acidosis (pH <7.2), hypothermia (temperature < 34�C) and coagulopathy are strong predictors of the need for abbreviated laparotomy and open abdomen in trauma patients.";"(Grade 2A)-Weak recommendation, high-quality evidence";2018;;;"High value";"open abdomen ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4367;19;"Choosing Wisely Canada";"Canadian Orthopaedic Assoc., Canadian Arthroplasty Soc. & Arthroscopy Assoc. of Canada";English;"Don?t use post-operative splinting of the wrist after carpal tunnel release for long-term relief. ";"Routine post-operative splinting of the wrist after the carpal tunnel release procedure showed no benefit in grip or lateral pinch strength or bowstringing. In addition, the research showed no effect in complication rates, subjective outcomes or patient satisfaction. Clinicians may wish to provide protection for the wrist in a working environment or for temporary protection. However, objective criteria for their appropriate use do not exist. Clinicians should be aware of the detrimental effects including adhesion formation, stiffness and prevention of nerve and tendon movement.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4623;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Risk factors for abdominal compartment syndrome such as damage control surgery, injuries requiring packing and planned reoperation, extreme visceral or retroperitoneal swelling, obesity, elevated bladder pressure when abdominal closure is attempted, abdominal wall tissue loss and aggressive resuscitation are predictors of the necessity for open abdomen.";"(Grade 2B)-Weak recommendation, moderate-quality evidence.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5135;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Glecaprevir?pibrentasvir is recommended as an option for treating chronic hepatitis C in adults.";"Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir?pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments. Clinical trials show that glecaprevir?pibrentasvir is effective for treating chronic hepatitis C across all genotypes. There was only 1 trial directly comparing glecaprevir?pibrentasvir with other direct-acting antiviral regimens, but comparing individual arms of clinical trials of other direct-acting antivirals suggests that glecaprevir?pibrentasvir works as well as most direct-acting antiviral drugs that NICE already recommends for treating hepatitis C.";2018;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4368;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Disease Canada ";English;"Don?t routinely use antibiotics other than amoxicillin in the treatment of children with presumed community-acquired pneumonia (in the outpatient setting). ";"Preschool-aged children with CAP (community acquired pneumonia) frequently do not require antibiotics, as most disease is caused by viral infections. Children with suspected CAP of bacterial origin should usually receive amoxicillin for outpatient treatment, or ampicillin or penicillin G for inpatient treatment. These agents have sufficient activity against the common bacterial pathogens causing CAP without being unnecessarily broad. Third-generation cephalosporins should be reserved for children who are unimmunized or with severe infection, or where there are high rates of penicillin-resistance among invasive pneumococcal isolates. Additional agents may be indicated in cases of suspected staphylococcal pneumonia, atypical pathogens, or influenza.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4624;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Decompressive laparotomy is indicated in abdominal compartment syndrome if medical treatment has failed after repeated and reliable intra-abdominal pressure measurements.";"(Grade 2B)-Weak recommendation, moderate-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4369;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Disease Canada ";English;"Don?t use a bag for collection of urine cultures to diagnose urinary tract infections. ";"Bacterial growth in cultures of bag urine specimens are more likely to be falsely positive in young children with suspected urinary tract infection (UTI) due to contamination with perineal flora. A bag urine culture cannot therefore be used to establish the diagnosis of UTI and may lead to overtreatment. Although a negative bag culture would rule out a UTI, a positive culture requires confirmation by a more specific method, incurring substantial delay. Cultures of urine specimens obtained by catheterization or suprapubic aspiration are more specific and as such are preferred as the routine method of urine collection in non-toilet trained children. Clean-catch, the standard technique of urine collection for toilet-trained children, is a non-invasive method sometimes attempted in infants but is also associated with relatively high rates of contamination.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4625;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"The inability to definitively control the source of contamination or the necessity to evaluate the bowel perfusion may be an indicator to leave the abdomen open in post-traumatic bowel injury.";"(Grade 2B)-Weak recommendation, moderate-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4370;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Disease Canada ";English;"Don?t routinely collect or process specimens for Clostridium difficile testing in infants less than one year of age with diarrhea. ";"Infants are commonly asymptomatic carriers of C. difficile (14-63%), but clinical illness is rarely reported before 12-24 months of age. It has been hypothesized that infants lack the cellular machinery for Clostridium toxin internalization. When investigating an infant with diarrhea, alternative diagnoses should be considered even with a positive test for C. difficile. Testing should be limited to immunosuppressed infants or those with underlying intestinal conditions (e.g. Hirschsprung disease, inflammatory bowel disease) when other etiologies have been ruled out. Therefore, it is prudent to avoid routine testing in children less than 12 months, and for children 1-3 years of age, test for other causes of diarrhea first, particularly viral.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4626;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Decompressive laparotomy is indicated in abdominal compartment syndrome if medical treatment has failed after repeated and reliable intra-abdominal pressure measurements.";"(Grade 2B)-Weak recommendation, moderate-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4882;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2018;363:k4762";English;"It is recommended using rapid tests to determine if patients have bacterial or viral infections to avoid resistance to antibiotics.";"Read the article for more information.";2018;;;"High value";-;"<a href=""https://www.bmj.com/content/363/bmj.k4762"" target=""_blank"">Link to the recommendation on the website of the initiative </a>" 5138;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures should only be used with special arrangements for clinical governance, consent and audit or research.";"Clinicians wishing to do low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures should: Inform the clinical governance leads in their NHS trusts. Ensure that patients understand the uncertainty about the procedure's efficacy and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended. Audit and review clinical outcomes of all patients having low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. NICE has identified relevant audit criteria and has developed an audit tool. The procedure should be used with other treatments for delayed-union and non-union fractures. It should be managed by specialists in treating these fractures. NICE encourages further research into low-intensity pulsed ultrasound to promote healing of delayed-union and non-union fractures. Further research should include details of patient selection, fracture site, and risk factors and comorbidities that delay fracture healing.";2018;;;"High value";Fractures;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4371;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Disease Canada ";English;"It is not recommended to treat uncomplicated acute hematogenous osteomyelitis with prolonged intravenous therapy. ";"Large retrospective cohort studies have shown no difference in treatment failure rate between children with uncomplicated acute hematogenous osteomyelitis treated with prolonged IV therapy when compared with shorter IV therapy and early transition to oral, to complete the course of therapy. ?Prolonged? IV therapy definitions varied and ranged from 7 days or more in one cohort to the entire treatment course of 3 to 6 weeks in another. Of note, complications with PICC lines in the prolonged treatment arms were seen at a rate between 3-15%. Consideration for use of prolonged IV therapy is in complicated disease (significant bone destruction; resistant or unusual pathogen; immunocompromised patient; sepsis or septic shock; venous thrombosis; metastatic foci or important abscess formation). Guidance as to when to consider transition to oral therapy includes a good clinical response and consideration of the following: afebrile for 48-72 hours; normalization of inflammatory markers or decrease in CRP by 50%; absence of complications or metastatic foci; and negative blood culture if culture was initially positive.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4627;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"The open abdomen is an option for emergency surgery patients with severe peritonitis and severe sepsis when: abbreviated laparotomy due to the severe physiological derangement, needing a deferred intestinal anastomosis, a planned second look for intestinal ischemia, persistent source of peritonitis, or extensive visceral oedema with the for development of abdominal compartment syndrome.";"Grade 2C. Weak recommendation, low-quality or very low-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4372;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to perform fusion surgery to treat patients with mechanical axial low back pain from multilevel spine degeneration in the absence of: ? leg pain with or without neurologic symptoms and/or signs of concordant neurologic compression ? structural pathology such as spondylolisthesis or deformity. ";"For over half a century back pain has been the most common reason for spinal fusion. Yet there is no unequivocal evidence that fusion is superior to comprehensive conservative treatment for treating back pain without focal structural pathology and concordant mechanical or neurological symptoms. It is often impossible to locate the precise source of the pain; in many cases the symptoms are multifactorial and can encompass elements such as centralized pain that exist outside the spine. The extreme heterogeneity of the low back pain population leads to unpredictable surgical results and consistently poor outcomes in those with pain from multilevel spine degeneration.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4628;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"The open abdomen should be considered following management of hemorrhagic vascular emergencies such as ruptured abdominal aortic aneurysm.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4373;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t routinely image patients with low back pain regardless of the duration of symptoms unless: ? there are clinical reasons to suspect serious underlying pathology (i.e., red flags) ? imaging is necessary for the planning and/or execution of a particular evidenced-based therapeutic intervention on a specific spinal condition. ";"Unless the image has a direct bearing on the treatment decision it is not required. Spinal ?abnormalities? in asymptomatic individuals are common and increase with age. For those with back dominant symptoms (i.e., axial back pain) there is an extremely high false positive rate; most of the findings have no correlation with the clinical picture. For the majority of low back complaints obtaining spinal imaging does not improve patient care but can lead to inappropriate interventions and does have a detrimental impact on patient outcomes. Red flags include cauda equina syndrome; severe or progressive neurologic deficits; suspected cancer; suspected infection: suspected fracture and suspected epidural abscess or hematoma.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4629;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to consider the open way following surgical management of acute mesenteric ischemic insults in vascular emergencies.";"Grade 2C.Weak recommendation, low-quality or very low-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6677;29;"Choosing Wisely Australia";"The Australia and New Zealand Child Neurology Society";English;"It is not recommended to do routine electroencephalograms are not recommended in children presenting with febrile seizures.";"There is no evidence that epileptiform discharges (that is distinctive electroencephalograph patterns associated with epileptic disorders) in children with febrile seizures have any diagnostic or prognostic implications. An EEG test should not be a routine investigation for these and other patients presenting with febrile seizures Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4374;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to use epidural steroid injections (ESI) for patients with axial low back pain who do not have leg dominant symptoms originating in the nerve roots. ";"Steroids are potent anti-inflammatory agents, but axial low back pain is not primarily an inflammatory condition and any inflammation that does exist generally cannot be accessed via the spinal canal. The outcomes of ESI for axial low back pain are poor compared to its use in radiculopathy due to disc herniation. Although serious adverse events are rare, catastrophic events can occur and any symptom relief from the injection typically lasts only for a matter of weeks. The inconsequential benefits of ESI for axial low back pain do not outweigh its risks, no matter how small they may be.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4630;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Leaving the abdomen open after surgical necrosectomy for infected pancreatic necrosis is not recommended except in those situations with high risk factors to develop abdominal compartment syndrome.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence";2018;;;"Low value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4886;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lesinurad is not recommended within its marketing authorisation, that is, with a xanthine oxidase inhibitor for treating hyperuricaemia in adults with gout whose serum uric acid is above the target level despite an adequate dose of a xanthine oxidase inhibitor alone.";"This recommendation is not intended to affect treatment with lesinurad that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Drug treatments for gout include 2 xanthine oxidase inhibitors, allopurinol or, if that is not tolerated, febuxostat. Evidence from 2 randomized controlled trials shows that more people on lesinurad plus allopurinol reach a target serum uric acid level than people on allopurinol alone. This outcome is seen as clinically relevant when treating gout, but the number of flares and tophi healing are more important outcomes for patients. It is plausible that lowering serum uric acid levels reduces the number of flares and improves healing of tophi, but the clinical evidence does not show that lesinurad plus allopurinol improves these outcomes compared with allopurinol alone. The main factors affecting the cost effectiveness of lesinurad are the assumptions that lowering serum uric acid levels in people with gout improves quality of life and that it prolongs life. Results from observational studies suggest that people with chronic gout have a shorter life expectancy than people without gout. However, there is no robust evidence from randomized trials to show that lowering serum uric acid levels extends life. ";2018;;;"Low value";"Blood Conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4375;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to miss the opportunity to brace the skeletally immature patient with adolescent idiopathic scoliosis (AIS) who has more than one year of growth remaining and a curve magnitude greater than 20 degrees. ";"Significant controversy still exists regarding the use of bracing in AIS patients at risk for curve progression and eventual surgery. A recent high-level study has convincingly shown that bracing impacts the natural history of AIS and, in those properly braced, significantly reduces the need for a subsequent operation. In light of the resulting decrease in the indications for surgical intervention, the bias against bracing should be reevaluated.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4631;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"The role of Damage Control Resuscitation in open abdomen management is fundamental and may influence outcome.";"Grade 2A. Weak recommendation, high-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6679;29;"Choosing Wisely Australia";"The Australia and New Zealand Child Neurology Society";English;"It is not recommended to undertake repeat blood level monitoring of antiepileptic drug (AED) treatments in epileptic patients.";"The serum concentration of an antiepileptic drug (AED) varies markedly between patients taking the same dosage because of differences in people?s ability to absorb, distribute, metabolise and excrete drugs. The utility of drug blood level monitoring assumes that plasma drug level correlates better with clinical response or side effects than with dosage. Evidence from a major randomised controlled trial suggests that repeat blood level monitoring of antiepileptic drug (AED) treatments has no discernible impact on patient outcomes in terms of remissions from seizures or incidence of adverse effects. Exceptions include their use in assessing compliance, titrating AEDs in complex polypharmacy regimens, or adjusting for altered AED metabolism in disease states, puberty, or pregnancy. ";2018;;;"Low value";-;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 4376;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to order peri-operative antibiotics beyond a 24-hour post-operative period for noncomplicated instrumented cases in patients who are not at high risk for infection or wound contamination. ";"Administration of a single pre-operative dose for spine cases without instrumentation is adequate. Although a deep surgical site infection associated with spinal implants can be a devastating adverse event, the prolonged use of peri-operative antibiotics has not been shown to reduce the incidence. Their extended use in routine low risk cases has no proven evidence of benefit but increases the chance of creating resistant bacterial strains. A rational, evidencebased approach is required.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4632;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"A multidisciplinary approach is encouraged, especially during the patient?s ICU admission.";"Grade 2A. Weak recommendation, high-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4888;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of bronchial thermoplasty for severe asthma is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.";"The procedure should only be done by a multidisciplinary team in specialist centres with on-site access to intensive care. It should only be done by clinicians with training in the procedure and experience in managing severe asthma. Clinicians should enter details of all patients who have the procedure onto the UK Severe Asthma Registr. Further research should report details of patient selection and long?term safety and efficacy outcomes.";2018;;;"High value";Asthma;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6680;29;"Choosing Wisely Australia";"The Australia and New Zealand Child Neurology Society";English;"It is not recommended to perform computed tomography children with new onset seizures";"The yield from neuroimaging of children presenting with new onset afebrile seizures is typically low, with one study finding that it led to a change in clinical management for only four percent of patients. As there are already a well-tested set of indicators for determining the likelihood of intracranial abnormalities in children with new onset unprovoked seizures, a combination of clinical history, examination, and electroencephalograph (where relevant) should first be used to determine whether the condition warrants neuroimaging. Clinical indicators for intracranial abnormalities, which are likely to change initial patient management, include (i) a focal seizure in children aged less than three years, (ii) abnormal neurological examination, (iii) Todd?s post-ictal paresis, or (iv) presence of a condition predisposing to seizures. In children where an intracranial abnormality is considered likely, and neuroimaging is indicated, magnetic resonance imaging is recommended over computed tomography because (i) there is superior anatomic resolution and characterisation of pathologic processes from using magnetic resonance imaging, and (ii) there is radiation exposure and escalated future cancer risk associated with computed tomography. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 4377;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to use an opioid analgesic medication as first-line treatment for acute, uncomplicated, mechanical, back-dominant pain. ";"Over 90% of acute low back pain is a mechanical problem that is often self-limiting and can be controlled with physical treatment and non-narcotic medication. The most common entry point to prescription opioid addiction is through opioids prescribed for back pain. Adequate pain control using opioids is frequently not achieved and patients face the added risks of physical dependence and withdrawal hyperalgesia, which can lead to continued use.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4633;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended the Intra-abdominal pressure measurement in critically ill patients at risk for intra-abdominal hypertension and abdominal compartment syndrome.";"Grade 1B. Strong recommendation, moderate-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5145;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of mosaicplasty for knee cartilage defects is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit.";"The procedure should only be done by surgeons experienced in cartilage surgery and with specific training in mosaicplasty for knee cartilage defects. Clinicians should enter data from all patients having the procedure onto the ICRS Patient Registry.";2018;;;"High value";"Knee conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6681;29;"Choosing Wisely Australia";"The Australia and New Zealand Child Neurology Society";English;"It is not recommended to routinely undertake neuroimaging for new onset primary headache without first examining for neurological abnormality in children.";"Studies suggest that the yield of neuroimaging findings in children with headache that actually change patient management is no higher than 2.5 per cent. This supports the practice of selective imaging of paediatric headache patients with clinical presentation suspicious for intracranial abnormality. Neuroimaging on a routine basis is therefore not indicated in children with new onset primary headaches and a normal neurological examination. It should be reserved for a selected group. An evidence review was developed for these recommendations and served as the basis for an online survey sent to all ANZCNS members. Based on survey responses, each of the nine was assigned a score and ranked accordingly. Based on this information and a final evidence review, these top 5 recommendations were chosen. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4378;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to treat post-operative back pain with opioid analgesic medication unless it is functionally directed and strictly time limited. ";"Using post-operative opioid analgesics creates problems with constipation, nausea and dizziness while interfering with early mobilization and, in some patients, promoting long term use. It should be used only in a strictly limited manner and with well-defined parameters. Alternate pain management regimens offer improved pain control, enhanced rehabilitation and fewer complications.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4634;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended the physiologic optimization as one of the determinants of early abdominal closure.";"Grade 2A. Weak recommendation, high-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4379;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"It is not recommended to use opioid analgesic medication in the ongoing treatment of chronic, non-malignant back pain. ";"There is no clear evidence for the benefits of long-term opioid medication on pain, function or quality of life. There is a clear correlation with a range of adverse effects including falls, fractures, testosterone suppression, hyperalgesia and depression. It increases the risk of dependence, addiction and overdose. Long-term use either before or following spine surgery is associated with increased medical costs and a reduced rate of return to work.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4635;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended that Inotropes and vasopressors administration should be tailored according to patient condition and the performed surgical interventions.";"Grade 1A. Strong recommendation, high-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4891;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to be aware that an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from a person's stable state. A range of factors (including viral infections and smoking) can trigger an exacerbation. Many exacerbations (including some severe exacerbations) are not caused by bacterial infections so will not respond to antibiotics. ";"Consider an antibiotic for people with an acute exacerbation of COPD, but only after taking into account: the severity of symptoms, particularly sputum colour changes and increases in volume or thickness beyond the person's normal day-to-day variation, whether they may need to go into hospital for treatment (see the NICE guideline on COPD in over 16s), previous exacerbation and hospital admission history, and the risk of developing complications, previous sputum culture and susceptibility results and the risk of antimicrobial resistance with repeated courses of antibiotics.";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5147;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Autologous chondrocyte implantation (ACI) using chondrosphere is recommended as an option for treating symptomatic articular cartilage defects of the femoral condyle and patella of the knee (International Cartilage Repair Society grade III or IV) in adults.";"Only if: the person has not had previous surgery to repair articular cartilage defects there is minimal osteoarthritic damage to the knee (as assessed by clinicians experienced in investigating knee cartilage damage using a validated measure for knee osteoarthritis) and the defect is over 2 cm2. Current surgical treatments for symptomatic articular cartilage defects of the knee include microfracture, ACI and mosaicplasty. Clinical trial results show that ACI using chondrosphere is as effective in the short term as microfracture, which is the most commonly used surgical option. But it is unclear how well chondrosphere works in the longer term compared with microfracture, because there are little data available beyond 2 years. Chondrosphere has greater benefit in articular cartilage defects larger than 2 cm2. ";2018;;;"High value";"Knee conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4380;29;"Choosing Wisely Australia";"Australian Rheumatology Association";English;"It is not recommended to perform arthroscopy with lavage and/or debridement or partial meniscectomy for patients with symptomatic osteoarthritis of the knee and/or degenerate meniscal tear.";"There is consistent evidence to indicate that arthroscopic lavage and/or debridement to treat people for symptomatic knee osteoarthritis, and/or partial meniscectomy for patients with a degenerate meniscal tear (with or without underlying osteoarthritis), is no more effective than placebo surgery or non-operative alternatives. There appears to be a high rate of conversion from knee arthroscopy to total knee arthroplasty, which rises with increased age, further suggesting arthroscopic surgery should be avoided in people over the age of 50 years. Additionally, arthroscopy is associated with peri- and post-operative risks and considerable cost.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4636;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended the fluid balance should to be carefully scrutinized in ICU management in trauma and non-trauma patients.";"Grade 2A.Weak recommendation, high-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4892;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bronchoscopic thermal steam ablation is not recommended for emphysema of the upper lobe. Therefore, the procedure should only be used in the context of the investigation.";"Further research should evaluate safety and efficacy in the short and long term and include details of patient selection. NICE may update the guidance on publication of further evidence.";2018;;;"Low value";"Chronic obstructive pulmonary disease";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4381;29;"Choosing Wisely Australia";"Australian Rheumatology Association";English;"It is not recommended to order antinuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease. ";"Antinuclear antibodies (ANAs) are present in healthy individuals and ANA testing is only useful in patients with symptoms and/or signs of a rheumatic disease where it can aid in the confirmation or exclusion of systemic connective tissues diseases. ANA testing has a very high negative predictive value for excluding connective tissue diseases as a cause for patients? symptoms. However, a positive ANA result does not have a high positive predictive value for diagnosing these conditions in isolation, and further sub-serology testing is needed to accurately diagnose and classify these conditions.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4637;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to pay attention to body temperature should be given, avoiding hypothermia in the ICU management of trauma and non-trauma patients.";"Grade 2A.Weak recommendation, high-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4893;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to consider the diagnosis of chronic obstructive pulmonary disease (COPD) as a cause of breathlessness or cough. The diagnosis is suspected on the basis of symptoms and signs and is supported by spirometry.";"Suspect a diagnosis of COPD in people over 35 who have a risk factor (generally smoking or a history of smoking) and who present with 1 or more of the following symptoms: exertional breathlessness, chronic cough, regular sputum production, frequent winter 'bronchitis', wheeze.";2018;;;"High value";COPD;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4382;29;"Choosing Wisely Australia";"Australian Rheumatology Association";English;"It is not recommended to undertake imaging for low back pain in patients without indications of a serious underlying condition.";"Most episodes of low back pain (~90%) do not require imaging. Imaging may identify irrelevant incidental findings and increase the risk of exposure to unnecessary, and sometimes invasive treatment, in addition to increasing costs. For patients with low back pain and no suggestion of serious underlying conditions there are no significant differences in pain or disability outcomes between immediate imaging as compared with usual care without imaging.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4638;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to downregulate the presence of coagulopathy or high risk of bleeding balancing the therapeutic necessity of negative pressure and the hemorrhage risk in the ICU management of trauma and non-trauma patients.";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4383;29;"Choosing Wisely Australia";"Australian Rheumatology Association";English;"It is not recommended to use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection. ";"Currently there is no high-quality evidence to support the superiority of ultrasound-guided subacromial injections compared with injections guided by landmarks alone. Based upon moderate quality evidence from five trials, a Cochrane review was unable to find any advantage (in terms of pain, function, range of motion or adverse events) of ultrasound-guided injection over either landmark-guided or intramuscular injection. These results are consistent with a more recent trial. In view of the currently available data and the significant added cost, there is little clinical justification in using ultrasound to guide injections for shoulder pain.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4639;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended negative pressure for wound therapy with continuous fascial traction as the preferred technique for temporary abdominal closure.";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4384;29;"Choosing Wisely Australia";"Australian Rheumatology Association";English;"Do not order antidouble stranded (ds) DNA antibodies in ANA negative patients unless clinical suspicion of systemic lupus erythematosus (SLE) remains high. ";"International recommendations advise testing for anti-dsDNA antibodies only after detecting a positive ANA in patients with symptoms consistent with systemic lupus erythematosus. In patients who are ANA negative, anti-dsDNA should only be ordered in clinical situations where the pretest probability of SLE is very high. Where positive, repeating anti-dsDNA antibodies titres is a useful test for monitoring disease activity, especially in lupus nephritis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4640;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended temporary abdominal closure without negative pressure in low resource settings accepting a lower delayed fascial closure rate and higher intestinal fistula rate.";"Grade 2A. Weak recommendation, high-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4896;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pirfenidone is recommended as an option for treating idiopathic pulmonary fibrosis in adults only if: the person has a forced vital capacity (FVC) between 50% and 80% predicted, the company provides pirfenidone with the discount agreed in the patient access scheme and treatment is stopped if there is evidence of disease progression .";"This recommendation is not intended to affect treatment with pirfenidone that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2018;;;"High value";"Pulmonary fibrosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5664;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There is uncertainty regarding the effects of mobile phone interventions to increase adherence to prescribed medication for primary prevention of cardiovascular disease.";"Some trials reported small beneficial effects, while others found no effect. There is low-quality evidence that these interventions did not cause harmful effects. According to this review, there is currently uncertainty regarding the effectiveness of these interventions. We identified six ongoing trials conducted in different settings, including low-income settings, that could generate more accurate estimates of the effect of medication adherence interventions for primary prevention provided by mobile phone.";2018;;;Uncertain;"Prevention of patients";"Link to the recommendation on the website of the initiative" 4385;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists";English;"It is not recommended to prescribe opioids (particularly long-acting opioids) as first-line or monotherapy for chronic non-cancer pain (CNCP).";"The true place of opioids in chronic non-cancer pain (CNCP) is unknown. Most trials of their efficacy have been of less than twelve weeks duration and have shown only modest effects. By contrast opioid use in CNCP has been associated with increased distress, poorer self-rated health, inactivity during leisure, unemployment, higher healthcare utilisation and lower quality of life, suggesting failure to appreciate the complex nature of these conditions. Opioids should not be used alone or as analgesics of first choice in patients with CNCP. A trial of opioid may be indicated in some patients, according to published guidance. If such an opioid trial is undertaken, then a long-acting preparation should be prescribed, in conjunction with non-drug therapies ? physical, behavioural and cognitive ? that promote functional restoration, reduce distress and potentially lower pain intensity.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4641;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"No definitive recommendations can be given about temporary abdominal closure with negative pressure wound therapy in combination with fluid instillation even if it seems to improve results in trauma patients.";"Not grades";2018;;;"Low value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4897;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend low-level laser therapy for preventing or treating oral mucositis caused by radiotherapy or chemotherapy. Current evidence shows no major safety concerns. Evidence on efficacy is adequate in quality and quantity. Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.";" ";2018;;;"High value";"Complications of cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4386;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists";English;"It is not recommended to continue opioid prescription for chronic non-cancer pain (CNCP) without ongoing demonstration of functional benefit, periodic attempts at dose reduction and screening for long-term harms. ";"Comprehensive assessment of patients with CNCP is essential before prescribing an opioid. An opioid ?contract? should describe the purpose of the prescription and would include agreed criteria for functional improvement, risks and side-effects of opioid analgesics, and ground rules regarding their use and cessation. There should be a single prescriber (and a deputy) to take responsibility for opioid prescription, in accordance with the regulatory requirements of the relevant jurisdiction.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4642;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to do open abdomen re-exploration no later than 24-48 hours after the index and any subsequent operation, with the duration from the previous operation shortening with increasing degrees of patient non-improvement and hemodynamic instability. ";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4387;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists";English;"It is not recommended to prescribe pregabalin and gabapentin for pain which does not fulfil the criteria for neuropathic pain.";"The IASP definition of neuropathic pain (2011) requires demonstration of a lesion or disease of the somatosensory system. In effect, that means demonstration of neurological signs. Descriptors that may suggest the pain may be neuropathic, such as burning, painful cold, electric shock-like etc., on their own do not meet this criterion. Pregabalin has a restricted PBS authority for ?neuropathic pain?. Although the definition being applied is not stated in the PBS Authority listing, use of the 2011 IASP definition is recommended. As with any pharmacotherapy used in pain medicine, the outcome of a trial of pregabalin or of gabapentin should be judged by improvement in everyday physical, emotional and cognitive functioning, including activity, sleep, absence of adverse effects, and improvement in quality of life.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4643;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to maintain abdomen opened if requirements for on-going resuscitation and/or the source of contamination persists, if a deferred intestinal anastomosis is needed, if there is the necessity for a planned second look for ischemic intestine and lastly if there are concerns about abdominal compartment syndrome development";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4899;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cabozantinib is recommended, within its marketing authorisation, for adults with untreated advanced renal cell carcinoma that is intermediate? or poor?risk as defined in the International Metastatic Renal Cell Carcinoma Database Consortium criteria. It is recommended only if the company provides cabozantinib according to the commercial arrangement.";"Current treatment for untreated advanced renal cell carcinoma is usually pazopanib or sunitinib. Clinical trial evidence shows that cabozantinib extends the time until cancer progresses compared with current treatment. But the evidence on whether cabozantinib increases how long people live is less certain. It appears to be at least as effective as current treatment, but it's not clear how much extra benefit it offers. Cost-effectiveness estimates for cabozantinib compared with current treatment are uncertain. This is because there is not much evidence available to estimate how long people live, and the costs and benefits of treatments after cabozantinib do not fully reflect those in the NHS. The cost?effectiveness estimates are within the range that NICE usually considers a cost?effective use of NHS resources, taking into account the uncertain estimates. Therefore, cabozantinib is recommended as an option for treating advanced renal cell carcinoma in the NHS.";2018;;;"High value";"Renal Cancer";"Link to the recommendation on the website of the initiative " 4388;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists";English;"It is not recommended to prescribe benzodiazepines for low back pain.";"Lifetime prevalence of low back pain in Australia is reported to be as high as 80% with one in ten experiencing significant activity limitation. Although benzodiazepines continue to be commonly prescribed as ?muscle relaxants? for low back pain (LBP), there is an absolute lack of evidence of benefit for this indication. Only one RCT has been conducted on diazepam in acute LBP during the last 40 years, and it showed no additional benefit when added to NSAID therapy alone. A recent systematic review found no additional studies to support the use of benzodiazepines in treating acute or chronic back pain. Well-described risks are associated with benzodiazepine usage, including abuse, addiction, tolerance and overdose. Accidental death from pharmaceutical benzodiazepines in Australia were highest in the 40-49 and 30-39 year age groups. The number of deaths in the older age groups also remains high. There is no place for use of benzodiazepine for low back pain.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4644;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Immediate and adequate nutritional support is recommended in patients with an open abdomen who are in a hyper-metabolic condition.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4900;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tivozanib is recommended as an option for treating advanced renal cell carcinoma in adults";"Only if: - they have had no previous treatment and - the company provides tivozanib with the discount agreed in the patient access scheme. This recommendation is not intended to affect treatment with tivozanib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Why the committee made this recommendation Current treatment in the NHS for untreated advanced renal cell carcinoma is usually sunitinib or pazopanib. There is no evidence to suggest that tivozanib is more effective than pazopanib and sunitinib in extending overall and progression-free survival. At best, tivozanib may have a similar effect to sunitinib or pazopanib. Also, the evidence does not clearly show that people tolerate the adverse effects of tivozanib better than those of sunitinib or pazopanib. The cost of treating renal cell carcinoma with tivozanib is likely to be lower than the cost of treating it with sunitinib or pazopanib, but tivozanib is also likely to be less effective. The estimated cost savings are high enough to compensate for the estimated lower effectiveness. Also, there is a need to be able to offer tivozanib to people who do not tolerate existing treatments. Therefore, tivozanib is recommended as an option for treating advanced renal cell carcinoma in adults who have had no previous treatment.";2018;;;"High value";"Renal Cancer";"Link to the recommendation on the website of the initiative " 4389;29;"Choosing Wisely Australia";"Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists";English;"It is not recommended to refer axial lower lumbar back pain for spinal fusion surgery.";"Chronic low back pain (CLBP) that is not due to underlying disease (infection, cancer) and is not associated with neurological signs is a common problem that is difficult to treat. Historically, lumbar spinal fusion was used for the treatment of demonstrated spinal instability following trauma or cancer. More recently, lumbar spinal fusion has been used for leg pain attributed to an underlying structural change such as spinal stenosis or spondylolisthesis. Spinal fusion has been proposed as a treatment for uncomplicated axial CLBP. The rationale for it is elusive, as accurate determination of a single source of the pain, especially when central sensitisation may have occurred, is not usually possible. Though some positive studies have been reported, pooled data from multiple randomised trials do not provide support for performing spinal fusion surgery in preference to non-operative treatment. In the absence of adequate rationale and compelling new evidence, lumbar spinal fusion is not recommended for treatment of uncomplicated axial CLBP.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4645;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Replacing with a balanced nutritional regimen is recommended in open abdomen techniques resulting in significant nitrogen loss.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4901;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lenvatinib plus everolimus is recommended as an option for treating advanced renal cell carcinoma in adults who have had 1 previous vascular endothelial growth factor (VEGF)-targeted therapy.";"Only if: - their Eastern Cooperative Oncology Group (ECOG) performance status score is 0 or 1 - the company provides lenvatinib with the discount agreed in the patient access scheme. This recommendation is not intended to affect treatment with lenvatinib plus everolimus that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. In the NHS, advanced renal cell carcinoma that has progressed after 1 tyrosine kinase inhibitor is treated with axitinib, nivolumab or cabozantinib. The evidence from a single clinical trial suggests that, on average, people live around 10.1 months longer if they have lenvatinib plus everolimus rather than everolimus alone. In the trial, lenvatinib plus everolimus caused side effects, leading many patients to interrupt or even stop treatment. This is despite the patients enrolled in the trial being relatively fit (that is, they had an ECOG performance status score of 0 or 1). The cost-effectiveness analyses for lenvatinib plus everolimus show it's more effective and less costly than cabozantinib and nivolumab. Compared with axitinib, the cost-effectiveness estimates are within what NICE normally considers acceptable. So, NICE is recommending lenvatinib plus everolimus as an option for use in the NHS in people with an ECOG performance status score of 0 or 1.";2018;;;"High value";"Renal Cancer";"Link to the recommendation on the website of the initiative " 6693;29;"Choosing Wisely Australia";"The Australia and New Zealand Child Neurology Society";English;"Do not routinely perform electroencephalographs (EEGs) for children presenting with syncope (fainting).";"The incidence of epileptiform discharges in patients with syncope is roughly similar to its incidence among healthy subjects, and that therefore EEG has very low diagnostic yield among these patients. Guidelines recommend that an EEG should not be performed if syncope is the most likely cause of the transient loss of consciousness.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4390;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use.";"Recommendation grade B ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4646;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to start early enteral nutrition as soon as possible in the presence of a functional and viable gastrointestinal tract.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4902;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Avelumab is recommended as an option for treating metastatic Merkel cell carcinoma in adults, only if they have had 1 or more lines of chemotherapy for metastatic disease.";"Avelumab is recommended for use within the Cancer Drugs Fund as an option for treating metastatic Merkel cell carcinoma in adults, only if: - they have not had chemotherapy for metastatic disease and - the conditions in the managed access agreement for avelumab are followed. This recommendation is not intended to affect treatment with avelumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Treatment options for metastatic Merkel cell carcinoma are limited. People are usually offered chemotherapy or best supportive care. Avelumab could potentially be used as a first-line treatment or after chemotherapy. Clinical trial evidence suggests that avelumab may improve overall survival compared with chemotherapy. But chemotherapy has not been compared directly with avelumab so the results are highly uncertain. The evidence on avelumab is promising, but the trial included only a small number of people and data are still being collected. Avelumab as a first-line or second-line treatment meets NICE's criteria to be considered a life-extending end-of-life treatment. ";2018;;;"High value";"Skin Cancer Metastases";"Link to the recommendation on the website of the initiative " 4391;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians offer or refer adults with a body mass index of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions.";"Recommendation grade B ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4647;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to delay enteral nutrition in patients with a discontinuous intestinal tract (temporarily stapled stumps), or in situations of high-cost fistula without the possibility of obtaining access to distal feeding to the fistula or with signs of intestinal obstruction.";"Grade 2C. Weak recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4903;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dabrafenib with trametinib is recommended, within its marketing authorisation, as an option for the adjuvant treatment of resected stage III BRAF V600 mutation-positive melanoma in adults. It is recommended only if the company provides dabrafenib and trametinib with the discounts agreed in the commercial arrangements. ";"There are currently no adjuvant treatments available for stage III BRAF V600 mutation-positive melanoma and there is a substantial risk of the cancer returning and becoming incurable. Dabrafenib with trametinib is a new adjuvant treatment aimed at curing the cancer by reducing the likelihood that it will spread. It is therefore an important development in managing stage III melanoma. Clinical trial evidence shows that dabrafenib with trametinib extends the length of time people have before their melanoma recurs compared with routine surveillance. Evidence from the trial and from clinical experts strongly suggests that it also increases the overall length of time people live by reducing how many people develop metastatic disease.";2018;;;"High value";"Skin Cancer";"Link to the recommendation on the website of the initiative / " 4392;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends early screening for syphilis infection in all pregnant women.";"Recommendation grade A ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4648;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Oral feeding is recommended whenever possible, since it is not contraindicated.";"Grade 2C. Weak recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4904;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Pembrolizumab is recommended for use within the Cancer Drugs Fund as an option for the adjuvant treatment of stage III melanoma with lymph node involvement in adults who have had complete resection. It is recommended only if the conditions in the managed access agreement for pembrolizumab are followed.";"This recommendation is not intended to affect treatment with pembrolizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. There are currently no adjuvant immunotherapies recommended by NICE for people who have stage III melanoma with lymph node involvement who have had complete resection. Clinical evidence comes from KEYNOTE?054, an ongoing randomised trial. It is likely to improve recurrence-free survival but the size of the benefit is unclear in the long term, because the trial is ongoing. Also, data about overall survival and how long people might live without developing distant metastases are limited. This means that the estimates of cost effectiveness are also very uncertain.";2018;;;"High value";"Skin Cancer";"Link to the recommendation on the website of the initiative " 5160;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended Ixekizumab alone or with methotrexate is recommended as an option to treat active psoriatic arthritis in adults, only on determinantet conditions:";"Ixekizumab alone, or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults, only if: it is used as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (recommendations 1.1 and 1.2) or the person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after the first 12 weeks or TNF-alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis). Ixekizumab is only recommended if the company provides it according to the commercial arrangement.";2018;;;"High value";" Arthritis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4393;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting).";"Recommendation grade A ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4649;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"No recommendations can be made about early mobilization of patients with open abdomen";"Not graded";2018;;;"Low value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5161;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE";English;"It is recommended to use Tofacitinib, with methotrexate, as an option for treating active psoriatic arthritis in adults, on determinanted conditions.";"Tofacitinib, with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults, only if: it is used as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (recommendations 1.1 and 1.2) or the person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after 12 weeks or TNF?alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis). Tofacitinib is only recommended if the company provides it according to the commercial arrangement.";2018;;;"High value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4394;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool.";"Recommendation grade B";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4650;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Fascia and/or abdomen should be definitively closed as soon as possible in trauma and non-trauma patients";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4395;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.";"Recommendation grade B ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4651;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Early fascial and/or abdominal definitive closure should be the strategy for management of the open abdomen once any requirements for on-going resuscitation have ceased, the source control has been definitively reached, no concern regarding intestinal viability persist, no further surgical re-exploration is needed and there are no concerns for abdominal compartment syndrome";"Grade 1B. Strong recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4396;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls.";"Recommendation grade B";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4652;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended primary fascia closure to restore the abdominal closure.";"Grade 2A. Weak recommendation, high-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4908;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cabozantinib is recommended, within its marketing authorisation, as an option for treating progressive medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease, only if the company provides cabozantinib with the discount agreed in the patient access scheme.";"Cabozantinib and vandetanib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Both drugs are currently available through the Cancer Drugs Fund for progressive and symptomatic disease. Best supportive care is the only other available option for people who cannot have cabozantinib or vandetanib. Clinical trial evidence suggests that cabozantinib is effective in delaying disease progression compared with best supportive care, but may not prolong survival. Without reliable comparative data, it was considered that cabozantinib and vandetanib are likely to be similarly effective. ";2018;;;"High value";"Thyroid Cancer";"Link to the recommendation on the website of the initiative " 4397;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer.";"Recommendation grade B ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4653;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Component separation is an effective technique; however it should not be used for fascial temporary closure. It should be considered only for definitive closure.";"Grade 2C. Weak recommendation, low-quality or very low-quality evidence.";2018;;;"Low value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4909;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lenvatinib and sorafenib are recommended as options for treating progressive, locally advanced or metastatic differentiated thyroid cancer (papillary, follicular or H�rthle cell) in adults whose disease does not respond to radioactive iodine.";"Only if: - they have not had a tyrosine kinase inhibitor before or - they have had to stop taking a tyrosine kinase inhibitor within 3 months of starting it because of toxicity (specifically, toxicity that cannot be managed by dose delay or dose modification). Lenvatinib and sorafenib are recommended only if the companies provide them according to the commercial arrangements. This recommendation is not intended to affect treatment with lenvatinib or sorafenib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Lenvatinib and sorafenib (tyrosine kinase inhibitors) are the only treatment options for progressive, locally advanced or metastatic differentiated thyroid cancer after surgery and radioactive iodine. For people who cannot have lenvatinib or sorafenib, best supportive care is the only option. Clinical trial evidence shows that lenvatinib and sorafenib are both effective in delaying disease progression, but there is a higher response rate (that is, more tumours shrink) with lenvatinib and it may delay progression for longer. Clinical expert advice is that this response is associated with an improvement in symptoms, which is valued by patients. Lenvatinib and sorafenib also increase the length of time people live, but it is uncertain by how long. ";2018;;;"High value";"Thyroid Cancer";"Link to the recommendation on the website of the initiative " 4398;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"It is recommended to carefully select the antibiotic and its dosage as a measure to prevent the resistance of microorganisms to antibiotics.";"Acute uncomplicated cystitis in healthy women should not be treated systematically with fosfomycin trometamol with multiple doses of 3 g";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4654;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Planned ventral hernia (skin graft or skin closure only) remains an option for the complicated open abdomen (i.e. in the presence of entero-atmospheric fistula or in cases with a protracted open abdomen due to underlying diseases) or in those settings where no other alternatives are viable.";"Grade 2C. Weak recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4910;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vandetanib is not recommended, within its marketing authorisation, for treating aggressive and symptomatic medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease.";"This recommendation is not intended to affect treatment with vandetanib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Vandetanib and cabozantinib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Best supportive care is the only other available option for people who cannot have vandetanib or cabozantinib. Clinical trial evidence suggests that vandetanib may delay disease progression compared with best supportive care, but the benefit is uncertain. The evidence about whether vandetanib increases the overall length of time people live is unreliable. Clinical experts consider that vandetanib and cabozantinib are similarly effective, so more robust data from a cabozantinib trial are used because of the uncertainties in the evidence.";2018;;;"Low value";"Thyroid Cancer";"Link to the recommendation on the website of the initiative " 5422;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The use of the upper lip bite test showed the most favorable diagnostic test accuracy properties for difficult laryngoscopy, ";"In this Cochrane systematic review, the authors searched for studies of the accuracy of airway assessment tests in adults. They did not restrict their searches by date, type or language of publication and did them in December 2016. They included 127 cohort type studies and 6 case-control studies (total: 844,206 participants). These evaluated seven different pre-specified index tests, as well as 69 that had not been pre-specified, and 32 combinations of test. They also identified 27 studies that are awaiting classification for the review.";2018;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative" 4399;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Asociaci�n de Enfermer�a Familiar y Comunitaria de Catalu�a";Spanish;"It is not recommended the use of crep�-type bandages in patients with chronic venous insufficiency and its use should be avoided because they are not effective for this pathology and delay healing, favor recurrence and generate more costs.";"In patients with venous pathology, such as chronic venous insufficiency and presence of venous ulcer, it is not recommended to apply crepe-type bandages because they do not favor venous return or exert any beneficial effect on the underlying pathology.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4655;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"The use of synthetic mesh (polypropylene, polytetrafluoruroethylene (PTFE) and polyester products) as a fascial bridge should not be recommended in definitive closure interventions after open abdomen and should be placed only in patients without other alternatives";"Grade 1B. Strong recommendation, moderate-quality evidence.";2018;;;"Low value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4911;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless MRI is contraindicated.";"Refer people with a suspected glioma to a specialist multidisciplinary team at first radiological diagnosis for management of their tumour. Consider advanced MRI techniques, such as MR perfusion and MR spectroscopy, to assess the potential of a high-grade transformation in a tumour appearing to be low grade on standard structural MRI.";2018;;;"High value";"Brain cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5423;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"In general, bedside airway tests have relatively low sensitivity and limited accuracy, so their effectiveness is uncertain";"In this Cochrane systematic review, the authors searched for studies of the accuracy of airway assessment tests in adults. They did not restrict their searches by date, type or language of publication and did them in December 2016. They included 127 cohort type studies and 6 case-control studies (total: 844,206 participants). These evaluated seven different pre-specified index tests, as well as 69 that had not been pre-specified, and 32 combinations of test. They also identified 27 studies that are awaiting classification for the review.";2018;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative" 4400;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";" International Society of Doctors for the Environment ? ISDE Italian section";English;"It is recommended to use renewable energy sources when posible; these can be provided by solar power, photovoltaic systems, wind power, geothermic sources and buildings constructed using materials which save energy. The use of private cars should be reduced preferring the use of bicycles, public transport, car pooling and walking.";"Air pollution is the main cause of many respiratory illnesses, such as bronchial asthma, cardiovascular diseases and cancer. The principal source of air pollution are industry, domestic heating and transport vehicles such as cars, planes etc. It is responsibility of the medical doctor to direct the patient to a more healthy lifestyle as described above.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4656;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Biologic meshes are reliable for definitive abdominal wall reconstruction in the presence of a large wall defect, bacterial contamination, comorbidities and difficult wound healing.";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4401;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";" International Society of Doctors for the Environment ? ISDE Italian section";English;"Don?t drink bottled water, choosing, if possible, water from the tap which often has better organoleptic characteristics and is submitted to rigorous quality control. ";"Water is a precious ?common good?: without water nobody can survive. Bottled water only adds costs in terms of plastic or glass containers and their disposal. The water can be polluted by toxic products: great attention is needed to avoid this dangerous damage.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4657;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Non?cross-linked biologic meshes seem to be preferred in sublay position when the linea alba can be reconstructed.";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4913;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The Intrabeam radiotherapy system is not recommended for routine commissioning for adjuvant treatment of early invasive breast cancer during breast-conserving surgical removal of the tumour.";"Use of the Intrabeam radiotherapy system is recommended only using machines that are already available and in conjunction with NHS England specified clinical governance, data collection and submission arrangements. The procedure should only be carried out by clinicians with specific training in the use of the Intrabeam radiotherapy system. Patient selection for Intrabeam radiotherapy should be done by a multidisciplinary team experienced in the management of early invasive breast cancer, which includes both breast surgeons and clinical oncologists.";2018;;;"Low value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4402;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";" International Society of Doctors for the Environment ? ISDE Italian section";English;"Antibiotics are not recomended for common respiratory infections (colds, rhinosinusitis, cough/bronchitis, flu syndromes) and bacteria in the urine without symptoms, because generally they are useless, and expose patient and family to risks, both present and future. The rule is to avoid them, leaving to doctors? autonomy the assessment of any exceptions. ";"Microorganisms are essential in the ecosystem: the symbiosis between saprophytic germs and our organism is always important, and in particular in the early years of development. Few germs are pathogenic: most of them make us live and grow in health. The above infections are mainly from viruses, against which antibiotics (AB) are useless. Even when caused by bacteria, the prognosis is usually good and AB are not needed. Doctors must discourage self-administration, and kindly resist to pressures to prescribe them, showing the results of the scientific literature. A possible alternative is the deferred prescription, to be limited to patients trained to use it only in case of exacerbation. Once an AB cycle has started, if there is a clear improvement, patients should talk to their doctors, who may decide whether to anticipate the interruption. The improper use of antibiotics, as well as ineffective and with long-term adverse effects, causes antibiotic resistance, able to persist and be transmitted to family members, with serious risks in fragile individuals and during pregnancy. In Europe, Italy has the highest consumption of overall antimicrobials (humans + animals) in mg per biomass. 30% of consumption is for human use, on which the doctor has a direct impact, 70% for animal husbandry, on intensive farms. Doctors should advise on the reduction of meat consumption, in the interest of health and the ecosystem.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4658;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Cross-linked biologic meshes in fascial-bridge position (no linea alba closure) are recomended, due to the fact that can be associated with less ventral hernia recurrence.";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4914;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fulvestrant is not recommended, within its marketing authorisation, for treating locally advanced or metastatic oestrogen-receptor positive breast cancer in postmenopausal women who have not had endocrine therapy before.";"This recommendation is not intended to affect treatment with Fulvestrant that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. People with untreated disease are first offered an aromatase inhibitor, either anastrozole or letrozole. These drugs are considered to be similarly effective. Tamoxifen is used for women in whom an aromatase inhibitor is not tolerated or is contraindicated. Fulvestrant is a further treatment option that may have additional benefits for some women. However, the final results on overall survival from the FALCON trial are not available yet, so it is unclear whether fulvestrant will extend overall survival compared with aromatase inhibitors. Because of the uncertainty in the clinical evidence, the cost effectiveness of fulvestrant compared with existing treatments is highly uncertain. However, it is likely to be above the range normally considered a cost-effective use of NHS resources, so fulvestrant cannot be recommended.";2018;;;"Low value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4403;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"International Society of Doctors for the Environment ? ISDE Italian section";English;"It is not recomended not carry out X-rays unless a specific clinical indication. ";"X-rays are very useful in the diagnosis of several illnesses. We must however not ignore the possible harmful effects they can cause (toxicity, carcinogenicity). Therefore they should only be used and not abused.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4659;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is not recomended negative pressure wound therapy in combination with biologic mesh to facilitate granulation and skin closure. ";"Grade 2B. Weak recommendation, moderate-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4915;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pertuzumab, in combination with trastuzumab and docetaxel, is recommended, within its marketing authorisation, for treating HER2?positive metastatic or locally recurrent unresectable breast cancer, in adults who have not had previous anti?HER2 therapy or chemotherapy for their metastatic disease, only if the company provides pertuzumab within the agreed commercial access arrangement.";"This recommendation is for a drug that has been available on the Cancer Drugs Fund for several years and the committee recognised this as an exceptional circumstance. In this context, the committee considered it reasonable to apply flexibility in its interpretation of the criteria for special consideration as a life-extending treatment for people with a short life expectancy, but noted that the weight applied to the quality-adjusted life years gained would not be at the maximum allocated in other, more regular, circumstances where the end of life criteria have been applied. With this in mind, the committee accepted that the incremental cost-effectiveness ratio, taking into account the commercial access arrangement, provides for an acceptable use of NHS resources.";2018;;;"High value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4404;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"International Society of Doctors for the Environment ? ISDE Italian section";English;"Limit foods of animal origin and industrial production is recomended. Give preference to fruits, vegetables, whole cereals and legumes, better if fresh, from your local area, seasonal and cultivated in a biological way. ";"The food must be healthy, varied and moderate, following the general guidelines of the so-called ""Food Pyramid"", which involves less use of natural resources and less pollution (""Ecological Footprint""). A vegetarian change would not only reduce the overall mortality of 6-10%, but would be able to act on climate change with a decrease of 25% of CO2. The citizen, as a responsible consumer, must be aware of the fact that the agro-food supply chain, in all its phases, from production to distribution to consumption, is responsible for important consequences also at the social level (from food sophistication to exploitation of laborers, from intensive monocultures to drought in large areas of our planet).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4660;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Preemptive measures to prevent entero-atmospheric fistula and frozen abdomen are recomended (i.e. early abdominal wall closure, bowel coverage with plastic sheets, omentum or skin, no direct application of synthetic prosthesis over bowel loops, and deep burying of intestinal anastomoses under bowel loops)";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4916;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Eribulin is not recommended for treating locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen";"This guidance is not intended to affect treatment with eribulin that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. People with advanced breast cancer who have had 1 chemotherapy regimen are usually then offered an anthracycline, a taxane or capecitabine, depending on what they have had already. The clinical trial results for eribulin showed that it did not increase progression-free survival, but there was an average overall survival increase of 4.6 months compared with capecitabine. Since treatment is changed when the disease progresses, and eribulin would have been stopped at that stage, it is not clear whether the increase in overall survival is because of eribulin, or related to the treatments given after eribulin. Eribulin is already recommended after 2 previous chemotherapy treatments, and there are no trials which compare its effectiveness given after 1 or 2 previous treatments, so this remains uncertain.";2018;;;"Low value";"Breast cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4405;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Endocrinology and Metabolic Diseases Study Group";English;"It is not recomended to perform an extended panel of thyroid tests when thyroid diseases are suspected, perform only TSH or TSH Reflex. Do not screen asymptomatic subjects and measure only FT3 for monitoring levothyroxine treatment in patients with hypothyroidism. ";"TSH and TSH reflex are usually sufficient in the assessment of thyroid function. TSH reflex is preferred for diagnosis and TSH in monitoring. It is more appropriate to request TSH and FT4 when the pituitary-thyroid axis is not intact and its equilibrium is not stable. The interpretation of the FT3 results can be difficult mainly for methodological problems. The determination of TSH is sufficient to verify the correct dosage in patients treated with levothyroxine.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4661;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recomended that entero-atmospheric fistula management should be tailored according to patient conditions, fistula output and position and anatomical features. ";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4406;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Endocrinology and Metabolic Diseases Study Group";English;"It is not recomended to measure random serum cortisol and plasma corticotrophin (ACTH) and urinary 17-ketosteroids and do not perform insulin tolerance tests, Loperamide test and Dexamethasone test (8 mg), when Cushing syndrome is suspected. ";"For screening Cushing syndrome one of the following three tests is recommended: Urinary Free Cortisol (at least two 24-hour collections), night salivary cortisol (two samples collected in two different days), serum cortisol after overnight dexamethasone suppression test, 1mg (oDST) or after dexamethasone suppression test, 2 mg/day for 48 hours.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4662;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Is is recomended to evaluated and corrected and protein supplemented the nitrogen balance in the presence of entero-atmospheric fistula ";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence. In the presence of entero-atmospheric fistula the caloric intake and protein demands are increased; the nitrogen balance should be evaluated and corrected and protein supplemented.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4407;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Endocrinology and Metabolic Diseases Study Group";English;"It is not recomended to perform urinary vanilmandelic acid and plasma and/or urinary catecholamines for diagnosing pheochromocytoma. ";"For diagnosing pheochromocytoma do perform free plasma metanephrines and, if they are not available, fractionated urinary metanephrines. Since plasma or urine metanephrines sensitivity is high, a negative result excludes pheochromocytoma, while the same conclusion is not possible catecholamines and their metabolites (e.g. urinary vanilmandelic acid).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4663;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recomended to review and optimize the nutrition upon recognition of entero-atmospheric fistula.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5175;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend Glecaprevir?pibrentasvir, within its marketing authorisation, as an option for treating chronic hepatitis C in adults, only if the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.";"It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need. Current treatment options for chronic hepatitis C depend on genotype, cirrhosis status and treatment history. Glecaprevir?pibrentasvir is suitable for all genotypes and has a shorter treatment duration than most other direct-acting antiviral treatments. Clinical trials show that glecaprevir?pibrentasvir is effective for treating chronic hepatitis C across all genotypes. There was only 1 trial directly comparing glecaprevir?pibrentasvir with other direct-acting antiviral regimens, but comparing individual arms of clinical trials of other direct-acting antivirals suggests that glecaprevir?pibrentasvir works as well as most direct-acting antiviral drugs that NICE already recommends for treating hepatitis C. The analysis shows that cost-effectiveness estimates for glecaprevir?pibrentasvir across all populations are substantially below what NICE usually considers acceptable. It is therefore recommended for treating chronic hepatitis C. ";2018;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4408;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Endocrinology and Metabolic Diseases Study Group";English;"It is not recomended to perform anti-TPO (thyroid peroxidase) and anti-Tg (thyroglobulin) antibodies together when autoimmune thyroiditis is suspected, but only anti-TPO. ";"Anti-TPO antibodies are useful in the diagnosis of an autoimmune thyroid disease, not in monitoring. Do not retest anti-TPO antibodies when a positive result has already been found. The specificity of anti-Tg antibodies is low. Perform them only when hypothyroidism is suspected and the anti-TPO antibodies are negative. Treatment must be based on TSH concentration not on antibodies concentration.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4664;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"It is recommended to separate the wound into different compartments to facilitate the collection of the fistula outlet in patients with entero-atmospheric fistula. Entero-atmospheric fistula effluent isolation is essential for proper wound healing. Separating the wound into different compartments to facilitate the collection of fistula output is of paramount importance.";"Grade 2A.Weak recommendation, high-quality evidence Entero-atmospheric fistula effluent isolation is essential for proper wound healing. Separating the wound into different compartments to facilitate the collection of fistula output is of paramount importance.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5176;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend sofosbuvir?velpatasvir?voxilaprevir as an option for treating chronic hepatitis C in adults, only if it is used as specified in table 1 and the company provides the drug at the same price or lower than that agreed with the Commercial Medicines Unit.";"It is recommended that the decision to treat and prescribing decisions are made by multidisciplinary teams in the operational delivery networks put in place by NHS England, to prioritise treatment for people with the highest unmet clinical need. These recommendations are not intended to affect treatment with sofosbuvir?velpatasvir?voxilaprevir that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Treatment options for chronic hepatitis C depend on the genotype of the virus and the person's cirrhosis status and treatment history. They include direct-acting antivirals (DAA) and interferon-containing treatments. There are currently no treatments with a marketing authorisation available for people who have had unsuccessful treatment with DAA. Clinical trials show that sofosbuvir?velpatasvir?voxilaprevir is effective for treating all genotypes of chronic hepatitis C, irrespective of the person's cirrhosis status and treatment history. The company's economic evidence is limited to people who have had DAA (genotypes 1?6) and people with genotype 3 hepatitis C who have not had DAA before. This reflects the groups with the highest unmet clinical need. Cost-effectiveness estimates for sofosbuvir?velpatasvir?voxilaprevir are within what NICE usually considers acceptable. Therefore sofosbuvir?velpatasvir?voxilaprevir can be recommended for these groups for treating chronic hepatitis C, as specified in table 1.";2018;;;"High value";Hepatitis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4409;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Endocrinology and Metabolic Diseases Study Group";English;"It is not recomended to perform population screening for 25OH vitamin D deficiency. ";"The Endocrine Society Guidelines recommend screening in individuals at risk of deficiency and not for assessing the health of the general population, as there is no evidence of its efficacy in terms of health outcomes. Despite the high prevalence of deficiency / insufficiency reported in the literature, awareness and supplementation programs in adults and children are considered more effective than screening. The Endocrine Society recommends the monitoring of 25OH-D levels in subjects at risk of deficiency and in osteoporosis assessment or functional diagnosis of proximal myopathies.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4665;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Negative pressure wound therapy is recommended in the presence of an enteroatmospheric fistula in the open abdomen.";"Grade 2A.Weak recommendation, high-quality evidence";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4921;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The Dynamic Spectral Imaging System (DYSIS) colposcope with DYSISmap shows promise and is recommended for assessing suspected cervical abnormalities in people having colposcopy. Centres using the technology should audit their outcomes.";"Further research is recommended on the effects of using the DYSIS colposcope with DYSISmap on clinical and patient outcomes in a human papilloma virus primary screening setting, and on patient experience (see sections 6.1 to 6.3). The ZedScan I shows promise in assessing suspected cervical abnormalities, but there is currently not enough evidence to recommend its routine adoption. Further research on the effects of using the technology on clinical and patient outcomes is recommended (see sections 6.1 to 6.3). Colposcopy services that implemented the ZedScan I before this guidance was published are encouraged to take part in studies that address these research recommendations.";2018;;;"High value";"Cervical cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4410;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Study Group on Autoimmune Diseases";English;"It is not recomended to seek Anti-TPO and anti-Tg antibodies in the case of autoimmune thyrotoxicosis / hyperthyroidism; search instead for anti-TSHR antibodies (TRAb). The research of anti-TPO is useful only in case of negativity of TRAb (possible diagnosis of non-Graves thyrotoxicosis). ";"In the diagnosis of hyperthyroidism, the research of anti-TPO and anti-Tg is widely requested as a first test, while the diagnostic antibody is the one directed towards the TSH receptor.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4666;32;"Otros art�culos/Other articles on this topic";"The World Society for Emergency Surgery (WSES)";English;"Definitive management of entero-atmospheric fistula should be delayed to after the patient has recovered and the wound completely healed.";"Grade 1C. Strong recommendation, low-quality or very low-quality evidence.";2018;;;"High value";"The open abdomen in trauma and non-trauma patients: WSES guidelines ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4411;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Study Group on Autoimmune Diseases";English;"It is not recomended to request anti-TPO (anti-thyroid peroxidase) and anti-Tg (anti-thyroglobulin) antibody tests in the monitoring of autoimmune thyroid disease. ";"The repetition over time of anti-TPO and anti-Tg antibodies for follow-up, in case of diagnosed autoimmune thyropathy, has no clinical utility.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4412;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Study Group on Autoimmune Diseases";English;"It is not recomended to require specific autoantibodies (AChR, MuSK, Lrp4) as a profile when myasthenia gravis is suspected, but the initial test is represented only by anti-AchR antibodies. ";"The determination of anti-Musk antibodies should be reserved for anti-AChR negative patients, while that of anti-Lrp4 antibodies should be limited to anti-AChR and anti-MuSK negative patients. Since the three autoantibodies are mutually exclusive, it is not useful to simultaneously request the determination of all three antibodies, because about 80% of patients with myasthenia have only anti-AChR, 16% only anti-MuSK and the remaining 4% only anti-Lrp4 antibodies.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4924;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The PleurX peritoneal catheter drainage system in the NHS is recommended by the evidence. The available clinical evidence suggests that the PleurX peritoneal catheter drainage system is clinically effective, has a low complication rate and has the potential to improve quality of life: it enables early and frequent treatment of symptoms of ascites, in the community, rather than ";"The PleurX peritoneal catheter drainage system should be considered for use in patients with treatment-resistant, recurrent malignant ascites. The PleurX peritoneal catheter drainage system is associated with an estimated cost saving of �1,051 per patient when compared with inpatient large-volume paracentesis.";2018;;;"High value";"cancer complications";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5180;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend being aware that:";"- the bacteria that cause Lyme disease are transmitted by the bite of an infected tick - ticks are mainly found in grassy and wooded areas, including urban gardens and parks - tick bites may not always be noticed - infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete - particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas - Lyme disease may be more prevalent in parts of central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada. Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission. Give people advice about: - where ticks are commonly found (such as grassy and wooded areas, including urban gardens and parks) - the importance of prompt, correct tick removal and how to do this (see the Public Health England website for information on removing ticks) - covering exposed skin and using insect repellents that protect against ticks - how to check themselves and their children for ticks on the skin - sources of information on Lyme disease, such as Public Health England, and organisations providing information and support, such as patient charities.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4413;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Study Group on Autoimmune Diseases";English;"It is not recomended to perform invasive endoscopic investigation with multiple biopsies in all patients suspected of autoimmune gastritis but only in those presenting with alteration of serum markers of gastric function (pepsinogen I and II, gastrin 17) and/or antibodies against gastric parietal cells (PCA) and anti-intrinsic factor (IFA).";"In the presence of gastric function compatible with atrophy and autoantibody positivity the suspicion is substantial and it is necessary to proceed to gastric biopsy.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4925;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It's recommended by current evidence on the safety of low-level laser therapy for oral mucositis as it shows no major safety concerns. Evidence on efficacy is adequate in quality and quantity. Therefore, this procedure can be used provided that standard arrangements are in place for clinical governance, consent and audit.complications of cancer";"No further information.";2018;;;"High value";"Cancer complications";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5181;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend diagnosing Lyme disease in people with erythema migrans, a red rash that:";"- increases in size and may sometimes have a central clearing - is not usually itchy, hot or painful - usually becomes visible from 1 to 4 weeks (but can appear from 3 days to 3 months) after a tick bite and lasts for several weeks - is usually at the site of a tick bite. Be aware that a rash, which is not erythema migrans, can develop as a reaction to a tick bite that: - usually develops and recedes during 48 hours from the time of the tick bite - is more likely than erythema migrans to be hot, itchy or painful - may be caused by an inflammatory reaction or infection with a common skin pathogen. Consider the possibility of Lyme disease in people presenting with several of the following symptoms, because Lyme disease is a possible but uncommon cause of: - fever and sweats - swollen glands - malaise - fatigue - neck pain or stiffness - migratory joint or muscle aches and pain - cognitive impairment, such as memory problems and difficulty concentrating (sometimes described as 'brain fog') - headache - paraesthesia. Consider the possibility of Lyme disease in people presenting with symptoms and signs relating to 1 or more organ systems (focal symptoms) because Lyme disease is a possible but uncommon cause of: - neurological symptoms, such as facial palsy or other unexplained cranial nerve palsies, meningitis, mononeuritis multiplex or other unexplained radiculopathy; or rarely encephalitis, neuropsychiatric presentations or unexplained white matter changes on brain imaging - inflammatory arthritis affecting 1 or more joints that may be fluctuating and migratory - cardiac problems, such as heart block or pericarditis - eye symptoms, such as uveitis or keratitis - skin rashes such as acrodermatitis chronica atrophicans or lymphocytoma. If a person presents with symptoms that suggest the possibility of Lyme disease, explore how long the person has had symptoms and their history of possible tick exposure, for example, ask about: - activities that might have exposed them to ticks - travel to areas where Lyme disease is known to be highly prevalent. Do not rule out the possibility of Lyme disease in people with symptoms but no clear history of tick exposure. Do not diagnose Lyme disease in people without symptoms, even if they have had a tick bite. Be cautious about diagnosing Lyme disease in people without a supportive history or positive serological testing because of the risk of: - missing an alternative diagnosis - providing inappropriate treatment. Follow usual clinical practice to manage symptoms, for example, pain relief for headaches or muscle pain, in people being assessed for Lyme disease. Take into account that people with Lyme disease may have symptoms of cognitive impairment and may have difficulty explaining their symptoms. For adults, follow the recommendations in NICE's guideline on patient experience in adult NHS services. ";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4414;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"SIPMeL ? Study Group on Autoimmune Diseases";English;"It is not recomended to perform a search for anti-insular cell antibodies (ICA) and anti-insulin antibodies (IAA) in the case of suspected late-onset autoimmune diabetes (LADA) or gestational diabetes mellitus. Search instead simultaneously for anti-GAD, anti-IA2 and anti-ZnT8 antibodies. ";"The finding of even one antibody positivity among anti-GAD, anti-IA2 and anti-ZnT8 is a diagnostic criterion of LADA and suggests an autoimmune pathogenesis in gestational diabetes mellitus.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5182;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend diagnosing and treating Lyme disease without laboratory testing in people with erythema migrans.";"Use a combination of clinical presentation and laboratory testing to guide diagnosis and treatment in people without erythema migrans. Do not rule out diagnosis if tests are negative but there is high clinical suspicion of Lyme disease. If there is a clinical suspicion of Lyme disease in people without erythema migrans: - offer an enzyme-linked immunosorbent assay (ELISA) test for Lyme disease and - consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion. Test for both IgM and IgG antibodies using ELISAs based on purified or recombinant antigens derived from the VlsE protein or its IR6 domain peptide (such as C6 ELISA). If the ELISA is positive or equivocal: - perform an immunoblot test for Lyme disease and - consider starting treatment with antibiotics while waiting for the results if there is a high clinical suspicion of Lyme disease. If the ELISA for Lyme disease is negative and the person still has symptoms, review their history and symptoms, and think about the possibility of an alternative diagnosis. If Lyme disease is still suspected in people with a negative ELISA who were tested within 4 weeks from symptom onset, repeat the ELISA 4 to 6 weeks after the first ELISA test. If Lyme disease is still suspected in people with a negative ELISA who have had symptoms for 12 weeks or more, perform an immunoblot test. Diagnose Lyme disease in people with symptoms of Lyme disease and a positive immunoblot test. If the immunoblot test for Lyme disease is negative (regardless of the ELISA result) but symptoms persist, consider a discussion with or referral to a specialist, to: - review whether further tests may be needed for suspected Lyme disease, for example, synovial fluid aspirate or biopsy, or lumbar puncture for cerebrospinal fluid analysis or - consider alternative diagnoses (both infectious, including other tick-borne diseases, and non-infectious diseases). Choose a specialist appropriate for the person's history or symptoms, for example, an adult or paediatric infection specialist, rheumatologist or neurologist. If the immunoblot test for Lyme disease is negative and symptoms have resolved, explain to the person that no treatment is required.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4415;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Primary Care Pediatricians (FIMP)";English;"It is not recomended to prescribe any drug (nebulized and/or by systemic route) for treatment of Bronchiolitis. ";"Bronchiolitis is the most common infection of the lower respiratory tract in children less than 1 year of age. It is caused by a virus, the most common is respiratory syncytial virus (RSV). Most of children affected by bronchiolitis usually heal spontaneously. Despite their common use, there is no evidence that bronchodilators and/or corticosteroids (nebulized or by oral route) are useful to slow the course of the disease or to avoid hospitalization, neither there are other effective medications to treat bronchiolitis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4927;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It's recommended offering transoral laser microsurgery to people with newly?diagnosed T1a squamous cell carcinoma of the glottic larynx.";"Offer a choice of transoral laser microsurgery or radiotherapy to people with newly?diagnosed T1b?T2 squamous cell carcinoma of the glottic larynx. Offer a choice of transoral surgery or radiotherapy to people with newly?diagnosed T1?T2 squamous cell carcinoma of the supraglottic larynx.";2018;;;"High value";"Head and neck cancers";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5183;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend telling people that tests for Lyme disease have limitations. Explain that both false-positive and false-negative results can occur and what this means.";"Explain to people that most tests for Lyme disease assess for the presence of antibodies and that the accuracy of tests may be reduced if: - testing is carried out too early (before antibodies have developed) - the person has reduced immunity, for example, people on immunosuppressant treatments, which might affect the development of antibodies. Advise people that tests from non-UKAS laboratories may not have been fully evaluated to diagnose Lyme disease. Explain to people that: - the symptoms and signs associated with Lyme disease overlap with those of other conditions - they will be assessed for alternative diagnoses if their tests are negative and their symptoms have not resolved - symptoms such as tiredness, headache and muscle pain are common, and a specific medical cause is often not found.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4416;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Primary Care Pediatricians (FIMP)";English;"It is not recomended to diagnose Urinary Tract Infection based on urine cultures alone. ";"Urine culture has to be performed after having a urine sample checked for the presence of leucocytes and/or nitrites, with dipstick, or by microscopic urinalysis, and in some special cases, together with urinoculture. In the absence of a pathologic multistick test or urinalysis it is not possible to evaluate if the eventual positive urine culture is due to a real urinary tract infection, to contamination of the specimen, or to occasional bacteriuria. The clean-catch urine specimen is the most recommended methodology for urine collection (i.e collect a morning urine sample in a sterile container after having thrown away the first stream).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4928;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It's recommended FDG PET-CT to guide management for people treated with radical chemoradiotherapy who have an oropharyngeal primary cancer site and 2 or more positive nodes in the neck, all of which are less than 6 cm across.";"Consider FDG PET-CT to guide management for people treated with radical chemoradiotherapy who have an oropharyngeal primary site with 1 positive node in the neck that is less than 6 cm across, or an oropharyngeal primary site with 1 or more positive nodes larger than 6 cm across in the neck or a hypopharyngeal or laryngeal primary site with 1 or more positive nodes in the neck. For people having an FDG PET-CT scan after chemoradiotherapy, perform the scan 3 to 6 months after chemoradiotherapy has finished. Do not offer neck dissection to people with no abnormal FDG uptake or residual soft tissue mass on an FDG PET-CT scan.";2018;;;"High value";"Head and neck cancers";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5184;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE) ";English;"Do recommend following usual clinical practice for emergency referrals, for example, in people with symptoms that suggest central nervous system infection, uveitis or cardiac complications such as complete heart block, even if Lyme disease is suspected.";" ";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4417;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Primary Care Pediatricians (FIMP)";English;"It is not recomended to treat a fever systemically unless there are symptoms of discomfort. If you decide to treat it, use an appropriate dose avoiding combined/alternate use of paracetamol and ibuprofen. ";"Paracetamol and ibuprofen are the first-choice antipyretic drugs. Fever needs a pharmacological treatment only if and when it causes malaise and/or it is accompanied by pain. Antipyretic drugs must not be used with the only aim of decreasing the body temperature of the feverish child. The latter method leads to an inappropriate and excessive use of antipyretic medications. Furthermore, very often it leads to a combined/alternate use of paracetamol and ibuprofen that in most cases is not necessary for the child health and wellbeing, because of the risk of incurring in unpleasant and avoidable side effects. In order to assure their effectiveness, paracetamol and ibuprofen must be dosed appropriately. It is possible to substitute one drug with another whenever the former is not effective in managing discomfort/pain.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4929;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Selective internal radiation therapy (SIRT) is not recommended as a human therapy, it can only be used in the context of research. Current evidence on the safety of SIRT for unresectable primary intrahepatic cholangiocarcinoma shows that there are well-recognised, serious but rare safety concerns. Evidence on its efficacy is inadequate in quantity and quality.";"Further research in the form of prospective studies, including randomised controlled trials, should address patient selection, quality-of-life outcomes and overall survival. Patient selection for the research studies should be done by a multidisciplinary team. The procedure should only be done in specialist centres by clinicians trained and experienced in managing cholangiocarcinoma. Clinicians should enter details about all patients having SIRT for unresectable primary intrahepatic cholangiocarcinoma onto a suitable registry.";2018;;;"Low value";"Liver cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5185;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend discussing the diagnosis and management of Lyme disease in children and young people under 18 years with a specialist, unless they have a single erythema migrans lesion and no other symptoms. ";"Choose a specialist appropriate for the child or young person's symptoms dependent on availability, for example, a paediatrician, paediatric infectious disease specialist or a paediatric neurologist. If an adult with Lyme disease has focal symptoms, consider a discussion with or referral to a specialist, without delaying treatment. Choose a specialist appropriate for the person's symptoms, for example, an adult infection specialist, rheumatologist or neurologist.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4418;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Primary Care Pediatricians (FIMP)";English;"It is not recomended to use oral corticosteroids for fever management. ";"Corticosteroids have a strong antipyretic and anti-inflammatory effect. However, their use must be reserved to conditions in which the severity of the anti-inflammatory response threatens the child?s health. These drugs must not be used for treatment of a child with fever due to frequent upper-respiratory infections typical of pre-school age. Systemic corticosteroid medications act by exercising a strong immunosuppressive effect and it could cause opportunistic infections, and/or it could worsen viral infections. The decision of prescribing a corticosteroid therapy must consider potential risks, and it should strongly be avoided treating fever of unknown origin (FUO).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4930;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lenvatinib is recommended as an option for untreated, advanced, unresectable hepatocellular carcinoma in adults, only if they have Child?Pugh grade A liver impairment and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 and the company provides it according to the commercial arrangement.";"This recommendation is not intended to affect treatment with lenvatinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Advanced unresectable hepatocellular carcinoma is treated with sorafenib, but some people cannot tolerate it because of side effects. Clinical trial evidence shows that lenvatinib slows disease progression and causes more tumours to shrink than sorafenib. The evidence also shows that people having lenvatinib live for about as long as those having sorafenib. Lenvatinib has different side effects to sorafenib and this would benefit some people.";2018;;;"High value";"Liver cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5186;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend offering antibiotic treatment according to their symptoms as described in table 1 for adults and young people (aged 12 and over) diagnosed with Lyme disease.";"For children (under 12) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 2. Ask women (including young women under 18) if they might be pregnant before offering antibiotic treatment for Lyme disease. If symptoms worsen during treatment for Lyme disease, assess for an allergic reaction to the antibiotic. Be aware that a Jarisch?Herxheimer reaction may cause an exacerbation of symptoms but does not usually warrant stopping treatment. Consider clinical review during or after treatment for Lyme disease to assess for possible side effects and response to treatment.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4419;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Primary Care Pediatricians (FIMP)";English;"Do not use topical nasal therapy through Nebulizers with drugs not specifically approved for this route of administration. ";"Very often topical therapies through micronized nasal shower or other nebulizers are prescribed in order to treat upper-respiratory tract infections (particularly otitis, rhinosinusitis, adenoid hypertrophy, rhinopharyngitis, etc.). In most cases the use of corticosteroid and antibiotic drugs is off-label, because indications or route of administration are other than that approved by the Italian Regulatory Agency of Drugs (AIFA) . No official guidelines for the treatment of these infections recommend such therapeutic practice. There is some emerging evidence only for the use of hypertonic solution and hyaluronic acid. Therefore, topical nasal therapeutic practices with drugs not specifically approved must be avoided.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5187;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend reviewing the person's history and symptoms (if symptoms that may be related to Lyme disease persist, do not continue to improve or worsen after antibiotic treatment) to explore:";"- possible alternative causes of the symptoms - if re?infection may have occurred - if treatment may have failed - details of any previous treatment, including whether the course of antibiotics was completed without interruption - if symptoms may be related to organ damage caused by Lyme disease, for example, nerve palsy. If the person's history suggests re?infection, offer antibiotic treatment for Lyme disease according to their symptoms (see tables 1 and 2). Consider a second course of antibiotics for people with ongoing symptoms if treatment may have failed. Use an alternative antibiotic to the initial course, for example, for adults with Lyme disease and arthritis, offer amoxicillin if the person has completed an initial course of doxycycline. If a person has ongoing symptoms following 2 completed courses of antibiotics for Lyme disease: - do not routinely offer further antibiotics and - consider discussion with a national reference laboratory or discussion or referral to a specialist. Explain to people with ongoing symptoms following antibiotic treatment for Lyme disease that: - continuing symptoms may not mean they still have an active infection - symptoms of Lyme disease may take months or years to resolve even after treatment - some symptoms may be a consequence of permanent damage from infection - there is no test to assess for active infection and an alternative diagnosis may explain their symptoms.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4420;31;"Smarter medicine";"Soci�t� suisse de Chirurgie (SSC)";English;"Do not perform axillary dissection at clinical stages I and II of breast cancer if the lymph nodes are clinically normal, without having previously performed a sentinel lymph node biopsy. ";"Sentinel lymph node biopsy has been shown to be effective in exploring the armpit for abnormal lymph nodes, and has also been shown to have fewer side effects in the short and long term; it is associated with a notably lower risk of lymphoedema (permanent swelling of the arm). If the lymph node(s) are not cancerous, no axillary dissection should be performed. If one or two sentinel lymph nodes are invaded by noninvasive cancer, the patient would have breast conservative surgery and full breast radiotherapy is planned with appropriate systemic therapy, no axillary dissection should be performed. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5188;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend offering regular clinical review and reassessment to people with ongoing symptoms, including people who have no confirmed diagnosis.";"Explore any ongoing symptoms with the person and offer additional treatment if needed following usual clinical practice. Be alert to the possibility of symptoms related to Lyme disease that may need assessment and management, including: - chronic pain - depression and anxiety (see NICE's guideline on common mental health problems) - fatigue - sleep disturbance. Support people who have ongoing symptoms after treatment for Lyme disease by: - encouraging and helping them to access additional services, including referring to adult social care for a care and support needs assessment, if they would benefit from these - communicating with children and families' social care, schools and higher education, and employers about the person's need for a gradual return to activities, if relevant.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5700;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"It is encouraged the teledermatology to identify skin cancer in adults.";"The use of a more broadly defined threshold to identify ""possibly"" malignant cases or lesions to be considered for excision is likely to facilitate proper triage of lesions requiring in-person specialist evaluation. Despite the increase in the use of teledermatology at the international level, the evidence base to support the ability to accurately diagnose injuries and to triage injuries from primary to secondary care is insufficient, and needs more pragmatic and prospective evaluation.";2018;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative" 4421;31;"Smarter medicine";"Soci�t� suisse de Chirurgie (SSC)";English;"It is not recomended to perform routinely ""whole body"" CT in patients with minor or localized trauma.";"Aggressive use of whole body CT scans improves the early diagnosis of injury and may even have a positive impact on the survival of polytrauma patients. Nevertheless, the significant exposure to radiation and the costs involved in these examination should be taken into account, especially in patients whose injury is secondary to low-energy trauma in the absence of clinical data for major trauma.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4933;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless MRI is contraindicated.";"Refer people with a suspected glioma to a specialist multidisciplinary team at first radiological diagnosis for management of their tumour. Consider advanced MRI techniques, such as MR perfusion and MR spectroscopy, to assess the potential of a high-grade transformation in a tumour appearing to be low grade on standard structural MRI. The evidence indicated that standard structural MRI is useful in distinguishing high-grade from low-grade glioma. The committee noted that this knowledge will inform management. Based on their experience, the committee recommended a protocol that they defined as a minimum standard for imaging acquisition.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5189;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend assessing and diagnosing Lyme disease during pregnancy in the same way as for people who are not pregnant. Treat Lyme disease in pregnant women using appropriate antibiotics for the stage of pregnancy.";"Tell women with Lyme disease during pregnancy that they are unlikely to pass the infection to their baby and emphasise the importance of completing the full course of antibiotic treatment. Advise women who had Lyme disease during pregnancy to tell this to their healthcare professional if they have any concerns about their baby. In this situation, healthcare professionals should discuss the history with a paediatric infectious disease specialist and seek advice on what investigations to perform. Start treatment for Lyme disease under specialist care for babies of women treated for Lyme disease during pregnancy if the baby has IgM antibodies specific for Lyme disease or there is any suspicion the baby may be infected.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5701;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"Are not recommended smartphone apps for screening of patients with suspected melanoma skin lesions.";"They are associated with a high probability of omission of melanomas. Applications based on the storage and sending of images could have a potential role in the timely consultation of patients with potentially malignant lesions, since they facilitate active self-care practices, and the early participation of patients with suspicious skin lesions; however, they can involve a significant increase in resources and workload. Given the paucity of evidence and the low methodological quality of existing studies, it is not possible to draw conclusions for practice. However, this is a constantly advancing field, and new and better applications with consistent study reports could change these conclusions significantly.";2018;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative" 4422;31;"Smarter medicine";"Soci�t� suisse de Chirurgie (SSC)";English;"Do not perform colorectal cancer screening in asymptomatic patients with a life expectancy of less than 10 years without a family history or personal history of colorectal neoplasia.";"Colorectal cancer screening has been shown to reduce mortality associated with this common disease; colonoscopy can detect and remove adenomatous polyps, the precancerous lesion of many cancers, reducing the incidence of the disease later in life. Nevertheless, screening and surveillance modalities are inappropriate if the risks outweigh the benefits. The risk of colonoscopy increases with age and comorbidities. The risk / benefit ratio of colorectal cancer screening and surveillance for each patient should be defined in a personalized way based on previous clinical data, family history, estimated risk of intervention, life expectancy and patient's preferences.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4934;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ceritinib is recommended, within its marketing authorisation, as an option for untreated anaplastic lymphoma kinase (ALK)?positive advanced non-small-cell lung cancer in adults, only if the company provides it with the discount agreed in the patient access scheme.";"Most people with untreated ALK?positive advanced non-small-cell lung cancer are offered crizotinib. Chemotherapy may be offered if the person's ALK mutation status isn't known, and therefore is not a relevant comparator for ceritinib. There are no trials directly comparing ceritinib with crizotinib; the clinical trial compares ceritinib with chemotherapy. Because the clinical trial has not finished, it is unable to show how much ceritinib prolongs life compared with chemotherapy. But it shows that ceritinib is more effective than chemotherapy at increasing the length of time people live without their disease progressing. An indirect comparison suggests that ceritinib is more effective than crizotinib. Clinical experts support using ceritinib instead of crizotinib. The most plausible cost-effectiveness estimate for ceritinib compared with crizotinib is around what NICE normally considers acceptable. Therefore ceritinib can be recommended as an option for adults with untreated ALK?positive advanced non-small-cell lung cancer.";2018;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5190;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend explaining to people diagnosed with Lyme disease that:";"- Lyme disease is a bacterial infection treated with antibiotics - most people recover completely - prompt antibiotic treatment reduces the risk of further symptoms developing and increases the chance of complete recovery - it may take time to get better, but their symptoms should continue to improve in the months after antibiotic treatment - they may need additional treatment for symptom relief. Tell people who are starting antibiotics for Lyme disease that some people may have a Jarisch?Herxheimer reaction to treatment. Explain that: - this causes a worsening of symptoms early in treatment - it can happen when large numbers of bacteria in the body are killed - it does not happen to everyone treated for Lyme disease - they should contact their doctor and keep taking their antibiotics if their symptoms worsen. Advise people with Lyme disease to talk to their doctor if their symptoms have not improved or if symptoms return after completing treatment. Explain to people with Lyme disease that infection does not give them lifelong immunity and that it is possible for them to be re?infected and develop Lyme disease again.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4423;31;"Smarter medicine";"Soci�t� suisse de Chirurgie (SSC)";English;"It is not recommended to perform chest X-rays at admission or preoperatively in ambulatory patients with no specific clinical history and clinical examination.";"It is not recommended for outpatients to routinely perform chest X-rays at admission or preoperatively without specific indication in relation to clinical history and / or results of the clinical examination. Only 2% of x-rays performed lead to a change in the patient's management. A chest X-ray may be warranted if there is suspicion of cardiopulmonary pathology or if there is a history of a chronic stable cardiopulmonary pathology in patients over 70 years old who have not had a chest x-ray in the last six months.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4935;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Atezolizumab is recommended as an option for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK?positive tumor), only if atezolizumab is stopped at 2 years of uninterrupted treatment or earlier if the disease progresses and the company provides with the discount agreed.";"This recommendation is not intended to affect treatment with atezolizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Treatments for NSCLC after chemotherapy include docetaxel alone, pembrolizumab (for tumours expressing the PD?L1 protein) and nintedanib plus docetaxel for adenocarcinoma.";2018;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4424;31;"Smarter medicine";"Soci�t� suisse de Chirurgie (SSC)";English;"It is not recomended to perform CT scans to examine children with suspicion of appendicitis until an ultrasound has been performed.";"Although CT is effective in detecting suspected appendicitis in children, ultrasound is the imaging study of choice in children. If the results of the ultrasound examination are equivocal, this may be followed by a CT scan. This approach is cost-effective, reduces potential radiation risks and is extremely accurate, with sensitivity and specificity currently at 94% in experienced hands. To improve the diagnosis without using CT - knowing that the individual experience of the operators is variable - we can reasonably consider training to improve the experience of operators in ultrasound adapted to different communities and establish decision rules clinical evidence-based.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4425;31;"Smarter medicine";"Soci�t� Suisse de Radio-Oncologie (SSRO)";English;"It is not recomended to start whole breast radiotherapy as part of a conservative breast treatment in women aged 50 or older at an early stage of invasive breast cancer, without taking into account shorter treatment schedules.";"? Whole breast radiotherapy decreases local recurrence and improves the survival prognosis for women with invasive breast cancer who have received conservative breast treatment. Most studies have used ""conventionally split"" programs with five to six weeks of therapy, often followed by one to two weeks of additional boosting. ? Recent studies, however, have demonstrated equivalent tumor control and cosmetic outcome among specific populations of patients who have undergone shorter treatments (approximately four weeks). It is up to patients and their physicians to review such options to determine the most appropriate treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5449;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty of the overall effect of rehabilitation of critically ill adults, in particular its optimum dose, intensity, frequency and duration. ";"Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit. They may develop physical complications, such as muscle weakness, which is commonly referred to as Intensive Care Unit-Acquired Weakness (ICU-AW). Physical rehabilitation and early mobilization might be used to manage this ICU-AW. In this systematic review, the authors searched for randomized trials, crossover trials and case-control studies that evaluated rehabilitation or early mobilization interventions for adults who had been in an ICU for at least 48 hours. They restricted their search to studies published in English or Spanish between 2006 and 2016, and did the search in May 2016. They identified 8 randomized trials, 1 cross-over trial and 2 case-control studies (total: 850 participants). Early rehabilitation of critically ill patients has some benefits in functional status, muscle strength, duration of mechanical ventilation, walking capacity at discharge and health-related quality of life; but had no significant effect on the length of stay or number of cases of Intensive Care Unit-Acquired Weaknesses. Early mobilization of critically ill patients is associated with an increased probability of walking more distance at discharge.";2018;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4426;31;"Smarter medicine";"Soci�t� Suisse de Radio-Oncologie (SSRO)";English;"Do not start the management of low-risk prostate cancer without considering active surveillance.";"? Patients with prostate cancer have several reasonable options for management. These include surgery and radiotherapy, but also conservative monitoring without treatment when the patient's case is appropriate. ? Sharing decision-making between the patient and their physician can help to better align the patient's care plan with treatment, and ensure more effective delivery of care. ? ASTRO has published decision support documents for patients regarding prostate cancer and many other types of cancer. These types of instruments can help patients make their choices with greater confidence to better match their treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4938;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Crizotinib is recommended for use within the Cancer Drugs Fund as an option for treating ROS1?positive advanced non-small-cell lung cancer (NSCLC) in adults, only if the conditions in the managed access agreement are followed.";"This recommendation is not intended to affect treatment with crizotinib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2018;;;"High value";"Lung liver";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4427;31;"Smarter medicine";"Soci�t� Suisse de Radio-Oncologie (SSRO)";English;"It is not recomended to routinely use extended fractionation programs (more than 10 sessions) in the palliative treatment of bone metastases.";"? Studies suggest equivalent pain relief after 30 Gy given over 10 sessions, 20 Gy over 5 sessions, or 8 Gy in a single session. ? A single session is less restrictive but may involve a higher rate of reprocessing on the same area. ? A single session of 8 Gy should be considered as a priority for patients with limited survival prognosis or with transportation difficulties.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4939;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab is recommended as an option for untreated PD?L1-positive metastatic non-small-cell lung cancer (NSCLC) in adults whose tumours express PD?L1 (with at least a 50% tumour proportion score) and have no epidermal growth factor receptor- or anaplastic lymphoma kinase-positive mutations. ";"Only if pembrolizumab is stopped at 2 years of uninterrupted treatment or earlier in the event of disease progression and the company provides pembrolizumab according to the commercial access agreement. People with untreated metastatic PD?L1-positive NSCLC are usually offered platinum-based chemotherapy (docetaxel, gemcitabine, paclitaxel, vinorelbine or pemetrexed, with a platinum-based drug). Clinical trial evidence shows that pembrolizumab increases the length of time people live by nearly 16 months compared with chemotherapy. Although there is uncertainty about the long-term treatment benefit of pembrolizumab after treatment is stopped, there was sufficient evidence of an important extension-to-life benefit in people with untreated stage 4 metastatic PD?L1-positive NSCLC compared with standard care. The most plausible cost-effectiveness estimate for pembrolizumab compared with chemotherapy is within the range NICE normally considers acceptable for an end-of-life treatment. Therefore it can be recommended as an option for untreated metastatic PD?L1-positive (with at least a 50% tumour proportion score) NSCLC if treatment is stopped after 2 years.";2018;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4428;31;"Smarter medicine";"Soci�t� Suisse de Radio-Oncologie (SSRO)";English;"Do not advise radiotherapy following a hysterectomy for patients with low-risk endometrial cancer.";"? Patients with low-risk of endometrial cancer (including those who no longer have diseased cells after a hysterectomy, despite a positive biopsy), with grade 1 or 2 tumor extension, an invasion of less than 50% and with no additional high-risk characteristics such as age (over 60 years old), invasion of the lymphovascular space or cervical involvement, have a very low risk of recurrence at the end of surgery. ? Meta-analysis studies of radiotherapy for low-risk endometrial cancer show increased side effects without improvement in overall survival prognosis compared to surgery alone.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4940;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Alectinib is recommended, within its marketing authorisation, as an option for untreated anaplastic lymphoma kinase (ALK)-positive advanced non-small-cell lung cancer (NSCLC) in adults. It is recommended only if the company provides alectinib according to the commercial arrangement.";"People with untreated ALK-positive advanced NSCLC are usually offered crizotinib. The main evidence for alectinib comes from an ongoing clinical trial. This suggests that alectinib is more effective than crizotinib in delaying disease progression, including in the central nervous system. There is not enough evidence to tell how long alectinib prolongs life compared with crizotinib. There is uncertainty about how treatments after disease progression affect people's quality and length of life. But using the most plausible assumptions and with the commercial arrangement, the cost-effectiveness estimates for alectinib compared with crizotinib are within the range NICE normally considers acceptable. Therefore, alectinib is recommended for untreated advanced ALK-positive NSCLC.";2018;;;"High value";"Lung cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4429;31;"Smarter medicine";"Soci�t� Suisse de Radio-Oncologie (SSRO)";English;"Do not systematically add total brain radiotherapy to stereotactic radiosurgery for limited brain metastases.";"? Randomized studies have not shown any benefit in terms of overall survival prognosis due to the addition of total brain radiotherapy to stereotactic radiosurgery in the management of selected patients with good physical condition and brain metastases of solid tumors. ? Adding complete brain radiation to stereotactic radiosurgery results in decreased cognitive function and, in patients' view, worsening fatigue and quality of life. These results corroborate the impaired cognitive functions and diminished verbal skills that patients report in randomized prophylactic cranial irradiation studies for small cell and non-small cell lung cancer. ? Patients treated with radiosurgery for brain metastases may develop metastases in other areas of the brain. Careful monitoring and the judicious use of remedial treatment in case of cerebral recurrence allow the patients concerned to enjoy an excellent quality of life without deteriorating the overall survival prognosis. It is up to patients to discuss these options with their Radiation Oncologist.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativaLink to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4685;19;"Choosing Wisely Canada";"Canadian Anesthesiologists' Society";English;"Don?t order baseline laboratory studies (complete blood count, coagulation testing, or serum biochemistry) for asymptomatic patients undergoing low-risk non-cardiac surgery.";"Conducting baseline laboratory investigations before low-risk non-cardiac surgery contributes little value to perioperative care. A focused clinical history and physical examination may reliably identify relevant abnormalities sought by routine laboratory testing before low-risk surgery. In addition, evidence suggests that abnormal results in this setting only rarely influence management and do not improve clinical outcomes. Preoperative testing may add value in the setting of a symptomatic patient or higher risk surgery, but should not be performed routinely before low-risk surgery on asymptomatic patients.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4430;31;"Smarter medicine";"Soci�t� Suisse de N�phrologie (SSN)";English;"Do not start chronic dialysis without guaranteeing a shared decision-making process with the patient and their family.";"The decision to start a chronic dialysis must be part of a shared and individualized decision-making process between patients, their families and their doctors. This process includes the assessment of individual patient goals and preferences, as well as providing information on the prognosis, expected benefits and potential side effects of dialysis within these goals and preferences. Limited observational data suggest that survival may not differ significantly for older adults with a high comorbidity burden who initiate chronic dialysis, compared to those who are conservatively managed.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4431;31;"Smarter medicine";"Soci�t� Suisse de N�phrologie (SSN)";English;"Do not perform cancer screening in asymptomatic end-stage renal disease patients without first discussing the risks and benefits.";"In end-stage renal disease patients with limited life expectancy, oncologic screening - including mammography, colonoscopy, prostate specific antigen (PSA) and vaginal smears - does not improve survival. False positive tests can be harmful and induce unnecessary procedures, overtreatment, incorrect diagnosis and increased stress. An individualized approach to cancer screening, integrating patient risk factors, life expectancy and transplantation status, is needed.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4432;31;"Smarter medicine";"Soci�t� Suisse de N�phrologie (SSN)";English;"Avoid nonsteroidal anti-inflammatory drugs (NSAIDs) in people with hypertension, heart failure, and/or chronic kidney disease.";"For the pharmacological treatment of musculoskeletal pain, the use of NSAIDs, including cyclooxygenase type 2 (COX-2) inhibitors, may raise blood pressure, render antihypertensives less effective, cause fluid retention, and aggravate renal function. Other agents, such as paracetamol, tramadol or short-term use of narcotic analgesics, may be safer and as effective as NSAIDs.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4688;19;"Choosing Wisely Canada";"Canadian Anesthesiologists? Society";English;"Don?t order a baseline electrocardiogram for asymptomatic patients undergoing low-risk non-cardiac surgery.";"Electrocardiograms (ECGs) performed before elective, non-cardiac, surgeries are frequently abnormal. This is especially true when this test is done in older patients. Despite the frequency of these abnormalities, ECGs do little to improve risk prediction beyond simply asking patients about their health. Serious cardiac events like heart attack are rare following lowrisk surgeries; there is little that physicians can do to further lower this risk. A preoperative ECG will therefore not improve outcome but may lead to more testing or treatment that is of little benefit. ECGs used to identify the cause of symptoms (palpitations, chest pain, dyspnea, etc.) remain useful diagnostic tools regardless of whether the patient is having surgery.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4433;31;"Smarter medicine";"Soci�t� Suisse de N�phrologie (SSN)";English;"Do not start treatment with erythropoiesis stimulating agents (erythropoietin, ESA) for asymptomatic patients with chronic kidney disease with hemoglobin levels ?10 g/dl.";"The administration of ESA to patients with chronic kidney disease to normalize their hemoglobin levels has no proven benefit in terms of survival or cardiovascular disease, and may be harmful compared to a treatment regimen that delays ESA administration or sets relatively standard objectives (9-11g/dL). ESAs should be prescribed to keep hemoglobin at its lowest level, both to limit transfusions and to best meet the needs of each patient.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4434;31;"Smarter medicine";"Soci�t� Suisse de N�phrologie (SSN)";English;"Avoid, if possible, the insertion of venous catheters for patients with chronic stage 4-5 renal disease into an arm potentially amenable to an arteriovenous fistula.";"Preservation of venous capital is critical in stage 4-5 of CKD patients. Arteriovenous fistulas (AVFs) are the best access for hemodialysis, with fewer complications and lower patient mortality than transplants or catheters. Excessive venipuncture damages veins, destroying potential AVF sites. PICC lines (peripherally inserted central catheters) and subclavian vein punctures may cause venous thrombosis and central venous stenosis. Early consultation in nephrology increases the use of AVF at the beginning of hemodialysis and may avoid inappropriate PICC or peripheral venipuncture.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4690;19;"Choosing Wisely Canada";"Canadian Anesthesiologists? Society";English;"Don?t order a baseline chest X-ray in asymptomatic patients, except as part of surgical or oncological evaluation.";"While chest X-rays (CXRs) remain an important part of surgeon?s evaluation before cancer or thoracic surgeries, it is better if these staging examinations are complete before committing a patient to surgery. CXRs are not indicated in the routine pre?anesthetic assessment. In the absence of symptoms, CXRs yield few diagnoses and many false positives. CXRs do not improve risk prediction or stratification. CXR in the pre-anesthetic evaluation should be reserved for patients with symptoms consistent with acute cardiopulmonary illness (dyspnea, wheeze, productive sputum, etc.).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4435;31;"Smarter medicine";"Soci�t� Suisse de Neurologie (SSN)";English;"Do not use electroencephalography (EEG) for headaches.";"EEG has no advantage over clinical evaluation in diagnosing headache, does not improve clinical outcomes, and increases costs. Recurrent headaches are the most common pain problem and affect 15 to 20% of people.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4691;19;"Choosing Wisely Canada";"Canadian Anesthesiologists? Society";English;"Don?t perform resting echocardiography as part of preoperative assessment for asymptomatic patients undergoing low to intermediate-risk non-cardiac surgery.";"Resting echocardiography has a clear role for resolving diagnostic questions in surgical patients, such as identifying the basis for suspicious systolic murmurs or new dyspnea on exertion. Outside these indications, resting echocardiography does not contribute significant additional prognostic information to usual clinical evaluation. It is not useful as a screening tool to identify surgical patients at risk for cardiac complications.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4436;31;"Smarter medicine";"Soci�t� Suisse de Neurologie (SSN) ";English;"Do not practice carotid imaging for simple syncope without other neurological symptoms.";"Carotid occlusion does not cause fainting but rather focal neurological deficits such as unilateral weakness. Carotid imaging does not identify the cause of fainting and increases costs. Fainting is a common discomfort that affects 40% of people in their lifetime.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativ" 4437;31;"Smarter medicine";"Soci�t� Suisse de Neurologie (SSN) ";English;"Do not use opiates to treat migraine except as a last resort.";"Opiates to treat migraine should be avoided because there are specific treatments for migraine more effective. Frequent use of opiates can aggravate headaches. Opiates should be reserved for patients with conditions that prevent the use of specific treatments for migraine, or for whom these treatments have failed.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4693;19;"Choosing Wisely Canada";"Canadian Anesthesiologists? Society";English;"Don?t perform cardiac stress testing for asymptomatic patients undergoing low to intermediate risk non-cardiac surgery.";"Stress testing can help resolve diagnostic uncertainty in surgical patients, such as determining whether individuals with chest discomfort and vascular risk factors have undiagnosed coronary artery disease. It can also help identify patients at elevated risk for cardiac complications after major vascular surgery. Nonetheless, asymptomatic individuals with good functional capacity have a very low risk of cardiac complications after low-to-intermediate non-cardiac surgery. Stress testing in such individuals is not useful for delineating expected perioperative risk and guiding clinical care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6741;36;"Choosing Wisely UK";NICE;English;"It is uncertain to perform coagulation tests only in patients taking anticoagulant medication, massive bleeding, or a suspected bleeding disorder. ";"There is no specific recommendation from NICE about this patient groups. Related guidance from NICE about preoperative testing before surgery advocates a similar targeted approach.";2018;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative" 4438;31;"Smarter medicine";"Soci�t� Suisse de Neurologie (SSN) ";English;"Do not prescribe interferon-beta or glatiramer acetate for patients with progressive-stage multiple sclerosis.";"Interferon-beta and glatiramer acetate do not prevent the progressive development of permanent disability in progressive forms of multiple sclerosis. These medications also have side effects that can adversely affect the quality of life of the patient. Finally, they have a high cost.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5718;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Providing appropriate specialized training is recommended to equip health workers with the necessary skills, knowledge, and confidence during emerging infections";"Factors associated with psychological outcomes among healthcare workers involved in the SARS crisis were examined to identify recommendations for ways to reduce the risk of adverse mental health outcomes within healthcare organisations affected by epidemics, pandemics or emerging infectious diseases. In this systematic review, the authors searched for quantitative research of a variety of designs. They restricted their search to articles published in English and did their search in 2015. They included 22 studies, and developed a list of considerations for protecting the mental health of healthcare workers during emerging infections. Managers should ensure they are approachable and supportive and should encourage supportive relationships among their staff. Managers should ensure there is regular adequate communication of up-to-date facts about the epidemic and how to best protect oneself. Managers should prepare employees for the potential impact of negative experiences such as isolation and discrimination and ensure support measures are in place for those who may face these experiences. ";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4439;31;"Smarter medicine";"Soci�t� Suisse de Neurologie (SSN)";English;"Do not recommend CEA for asymptomatic carotid stenosis unless the complication rate is low (<3%).";"Seminal studies have reported an initial surgical complication rate of 2.3% (ACAS study) at 3.1% (ACST trial) in patients undergoing carotid endarterectomy (CEA) for asymptomatic stenosis> 60%. In these cases, the reduction of the absolute risk of stroke or death was approximately 5 to 6% after 5 years in the operated group. As a result, several medical organizations have recommended that CEA should be performed in asymptomatic patients only if the risk of perioperative complications is <3% and life expectancy exceeds 3 to 5 years. Recent AHA guidelines state that it is ""reasonable"" to practice CEA for asymptomatic stenosis >70% if the rate of surgical complications is ""low"". The reported rates of surgical complications vary considerably by site, and depend on how complications are followed (self-reported or neurologist-assessed or administrative data). Despite calls for careful monitoring, most patients will likely have to rely on rates reported by the surgeon himself.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4440;31;"Smarter medicine";"Soci�t� suisse d?anesth�siologie et de r�animation (SSAR)";English;"Do not perform an intervention with high perioperative morbidity/mortality and terminal suffering expected without discussing its indication in advance with all relevant disciplines and in consultation with the patient (shared decision-making).";"The risk of increased morbidity and postoperative mortality increases with age, which is increasingly documented from an age > 70 years and also increases with limited functional capacity. This diminished physical performance is the subject of intensive research on frailty. This describes the patient's increased vulnerability to stressors such as surgery and leads to an increased risk of complications. If the perioperative morbidity / mortality is very high, it is necessary to discuss with the patient a desirable and realistic therapeutic goal for all those involved in the treatment. It is also important that treatment boundaries, such as ICU admission, are clearly defined and that alternative solutions are identified with a focus on the well-being and dignity of the patient.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5208;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend giving advice about managing symptoms with self-care to all people with catheter-associated UTI.";"Be aware that: - a catheter-associated urinary tract infection (UTI) is a symptomatic infection of the bladder or kidneys in a person with a urinary catheter - the longer a catheter is in place, the more likely bacteria will be found in the urine; after 1 month nearly all people have bacteriuria - antibiotic treatment is not routinely needed for asymptomatic bacteriuria in people with a catheter";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6744;36;"Choosing Wisely UK";"Royal College of Emergency Medicine";English;"A computed tomography scan is recommended for patients with subarachnoid hemorrhage within the first 6 hours of headache onset. ";"Standard investigations for patients suspected of having suffered a sub-arachnoid haemorrhage involve a CT scan and then, if the CT is normal, a lumbar puncture. Lumbar punctures are painful procedures, usually require hospital admission and some people develop worse headaches afterwards. CT Scanners have become better at detecting blood in the brain. A normal scan performed with 6 hours of onset of a severe headache means that the risk of having a sub-arachnoid haemorrhage is extremely low.";2018;;;"High value";Diagnostic;"Link to the recommendation on the website of the initiative" 4441;31;"Smarter medicine";"Soci�t� suisse d?anesth�siologie et de r�animation (SSAR)";English;"Do not perform a blood transfusion if hemoglobin is >70 g / L - This applies to patients without relevant systemic disease in whom bleeding is controlled.";"An optimal threshold for the transfusion of erythrocyte concentrates can be determined on the basis of evidence, since different thresholds have been used in different studies for different clinical situations. However, it is clear that lowering the hemoglobin threshold to decide to transfuse reduces the number of transfusions and reduces transfusion-related morbidity and mortality. Transfusions should always consider comorbidities and clinical parameters such as the evaluation of hemodynamics and coagulation as part of a Patient Blood Management (PBM) policy. Patients with anemia should be optimized as much as possible before the operation and blood saving measures should be considered and consistently applied for any interventions where significant blood loss can be expected.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5209;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend considering removing or, if this cannot be done, changing the catheter as soon as possible in people with a catheter-associated UTI if it has been in place for more than 7 days. Do not allow catheter removal or change to delay antibiotic treatment.";"Obtain a urine sample before antibiotics are taken. Take the sample from the catheter, via a sampling port if provided, and use an aseptic technique (in line with the NICE guideline on healthcare-associated infections): - if the catheter has been changed, obtain the sample from the new catheter. - if the catheter has been removed, obtain a midstream specimen of urine. Send the urine sample for culture and susceptibility testing, noting a suspected catheter-associated infection and any antibiotic prescribed. Offer an antibiotic (see the recommendations on choice of antibiotic) to people with catheter-associated UTI. Take account of: - the severity of symptoms - the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract, or immunosuppression - previous urine culture and susceptibility results - previous antibiotic use, which may have led to resistant bacteria. When urine culture and susceptibility results are available: - review the choice of antibiotic and - change the antibiotic according to susceptibility results if the bacteria are resistant, using narrow-spectrum antibiotics wherever possible. ";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4442;31;"Smarter medicine";"Soci�t� suisse d?anesth�siologie et de r�animation (SSAR)";English;"Do not perform any routine preoperative examination (laboratory, ECG, chest x-ray) in patients without relevant systemic disease.";"Routine preoperative diagnostic examination does little to identify patients with increased perioperative risk of complications. Pathological laboratory, ECG or chest x-ray findings are rare in this situation and do not result in changes in perioperative management, especially in interventions without increased risk. Accurate anamnesis and clinical examination with evaluation of physical performance are always decisive for risk assessment. In the case of suggestive anamnesis or limitation to effort, specific additional examinations are indicated. This applies in particular to high-risk interventions in which some pre-operative examinations are necessary to ensure adequate perioperative care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5210;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend, when an antibiotic is given, giving advice, as well as the general advice on self-care, about:";"possible adverse effects of antibiotics, particularly diarrhoea and nausea seeking medical help if: - symptoms worsen at any time or - symptoms do not start to improve within 48 hours of taking the antibiotic or - the person becomes systemically very unwell.";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4443;31;"Smarter medicine";"Soci�t� suisse d?anesth�siologie et de r�animation (SSAR)";English;"Avoid perioperative hypothermia (active and perioperative management of body temperature).";"Perioperative hypothermia is a phenomenon that results from the suppression of central thermoregulation during anesthesia on the one hand, and prolonged exposure of large parts of the body during surgery to cool operating room temperatures on the other hand. The occurrence of hypothermia is, on the basis of evidence, related to postoperative complications such as wound infections, delayed healing, coagulation disorders, and increased risk of bleeding or related adverse cardiovascular events. By early and proactive warming, mainly through body surface warming systems, body homeostasis can be maintained, thereby contributing to the reduction of postoperative morbidity and mortality.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5211;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend reassessing people with catheter-associated UTI if symptoms worsen at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:";"- other possible diagnoses - any symptoms or signs suggesting a more serious illness or condition, such as sepsis - previous antibiotic use, which may have led to resistant bacteria.";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6747;36;"Choosing Wisely UK";"Royal College of Emergency Medicine";English;"Urine toxicity test is not recommended for patients with overdose as it does not usually change the treatment. ";"Urine toxicology tests are usually performed on patients suspected of having taken a drug overdose. The results of these tests very rarely change treatment. There are also a number of newer recreational drugs that are not detected by these tests.";2018;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative" 4444;31;"Smarter medicine";"Soci�t� suisse d?anesth�siologie et de r�animation (SSAR)";English;"Do not perform any surgery until patients are externally examined and optimized (correct anemia, improve physical fitness and nutritional status, prescribe smoking cessation and reduce alcohol consumption; promote same day surgery).";"An early outpatient evaluation before any surgical procedure provides many benefits. The correct ambulatory preoperative risk assessment allows for better planning of the entire perioperative process and smooth execution of the intervention. The correction of anemia reduces the risk of blood transfusion and complications if the window of time before surgery is long enough, improves physical performance, promotes early initiation of respiratory therapy, optimizes nutritional status and reduces or eliminates harmful substances (tobacco, alcohol), and contributes significantly to the reduction of postoperative mortality and morbidity. This goes hand in hand with a reduction in hospital stay and is an important goal for patients and practitioners. Many of these preoperative measures, despite the positive results that accompany them, are currently only partially implemented in many institutions and it is imperative to increase awareness.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5212;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE) ";English;"Do recommend referring people with catheter-associated UTI to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example, sepsis).";"Consider referring or seeking specialist advice for people with catheter-associated UTI if they: - are significantly dehydrated or unable to take oral fluids and medicines or - are pregnant or - have a higher risk of developing complications (for example, people with known or suspected structural or functional abnormality of the genitourinary tract, or underlying disease [such as diabetes or immunosuppression]) or - have recurrent catheter-associated UTIs or - have bacteria that are resistant to oral antibiotics.";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4445;22;"The Canadian Task Force for Preventive Health Care Guidelines";"The Canadian Task Force for Preventive Health Care Guidelines";English;"The CTFPHC recommend screening pregnant women once during the first trimester with urine culture for asymptomatic bacteriuria.";"This recommendation applies to pregnant women who are not experiencing symptoms of a UTI and are not at increased risk for asymptomatic bacteriuria. This weak recommendation in favour of screening for asymptomatic bacteriuria in pregnancy recognizes that some women who are not at increased risk of asymptomatic bacteriuria in pregnancy and are more concerned with potential harms of antibiotics may choose not to be screened or treated for asymptomatic bacteriuria. In such circumstances, there is potential value for discussion between clinicians and patients in order to reach evidence informed and values based decisions. This guideline does not apply to women at increased risk of asymptomatic bacteriuria in pregnancy who should follow guidance for higher risk populations.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4957;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For guidance on using temozolomide for treating newly diagnosed grade III glioma, see the NICE technology appraisal guidance on carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma.";"After surgery, offer sequential radiotherapy and 4 to 6 cycles of PCV chemotherapy to people who have: a Karnofsky performance status of 70 or more and a newly diagnosed grade III glioma with 1p/19q codeletion (anaplastic oligodendroglioma). Agree with the person with the anaplastic oligodendroglioma the order of PCV chemotherapy and radiotherapy after discussing the potential advantages and disadvantages of each option with them. After surgery, offer radiotherapy followed by up to 12 cycles of adjuvant temozolomide to people who have: a Karnofsky performance status of 70 or more and a newly diagnosed IDH-wildtype or mutated grade III glioma without 1p/19q codeletion (anaplastic astrocytoma). Do not offer nitrosoureas (for example, CCNU [lomustine]) concurrently with radiotherapy to people with newly diagnosed grade III glioma.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5213;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend adivising people with catheter-associated UTI about using paracetamol for pain.";" ";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5469;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento con l�quidos y vasopresores)";English;"Liberal fluid therapy is not recommended in children with sepsis or septic shock as it could increase the mortality rate in hospital and at four-week follow-up. ";"There are no studies comparing liberal versus conservative fluid therapy in adults. Sepsis and septic shock are life-threatening complications of an infection, which are associated with high morbidity and mortality in children and adults. Liquid treatment is considered a critical intervention during the initial treatment of sepsis. The objective of this review was to evaluate the evidence on whether conservative or liberal fluid treatment can improve clinical outcomes in patients with sepsis and septic shock. It was concluded that the evidence that goes from low to high quality indicates that liberal fluid treatment could increase the mortality rate in children with sepsis or septic shock in hospital and at four-week follow-up. It cannot be specified if there are differences in adverse events because the evidence is of low quality. No study compared liberal versus conservative fluid therapy in adults. There are three ongoing studies that could alter the conclusions. ";2018;;;"Low value";"Treatment COVID-19 ";"Link to the recommendation on the website of the initiative" 4446;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of aliskiren (antihypertensive renin inhibitor) has shown more risks than benefits in the prevention of cardiovascular events";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4958;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer regular clinical review for people with glioma to assess changes in their physical, psychological and cognitive wellbeing.";"Base decisions on the timing of regular clinical reviews and follow?up imaging for people with glioma on: any residual tumour, life expectancy, the person's preferences ,treatments used before, treatment options available, tumour subtype. Consider standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as part of regular clinical review for people with glioma, to assess for progression or recurrence, unless MRI is contraindicated. Consider advanced MRI techniques, such as MR perfusion, diffusion tensor imaging and MR spectroscopy, if findings from standard imaging are unclear about whether there is recurrence and early identification is potentially clinically useful. For people with glioma having routine imaging: explain to them, and their relatives and carers, that imaging can be difficult to interpret and results can be of uncertain significance and be aware that having routine imaging and waiting for the results may cause anxiety. Consider a baseline MRI scan within 72 hours of surgical resection for all types of glioma. Consider a baseline MRI scan 3 months after the completion of radiotherapy for all types of glioma. Arrange a clinical review, including appropriate imaging, for people with glioma who develop new or changing neurological symptoms or signs at any time.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative
" 5214;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend advising people with catheter-associated UTI about drinking enough fluids to avoid dehydration.";" ";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5470;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Early rehabilitation of critically ill patients has some benefits in functional status, muscle strength, duration of mechanical ventilation, walking capacity at discharge and health-related quality of life.";"Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit. They may develop physical complications, such as muscle weakness, which is commonly referred to as Intensive Care Unit-Acquired Weakness (ICU-AW). Physical rehabilitation and early mobilization might be used to manage this ICU-AW. In this systematic review, the authors searched for randomized trials, crossover trials and case-control studies that evaluated rehabilitation or early mobilization interventions for adults who had been in an ICU for at least 48 hours. They restricted their search to studies published in English or Spanish between 2006 and 2016, and did the search in May 2016. They identified 8 randomized trials, 1 cross-over trial and 2 case-control studies (total: 850 participants). Early rehabilitation of critically ill patients has some benefits in functional status, muscle strength, duration of mechanical ventilation, walking capacity at discharge and health-related quality of life; but had no significant effect on the length of stay or number of cases of Intensive Care Unit-Acquired Weaknesses. Early mobilization of critically ill patients is associated with an increased probability of walking more distance at discharge. The overall effect of rehabilitation of critically ill adults is uncertain, in particular its optimum dose, intensity, frequency and duration.";2018;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4447;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of bezafibrate, ciprofibrate and fenofibrate have shown more risks than benefits in the prevention of cardiovascular events";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4959;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected meningioma, unless MRI is contraindicated.";"Consider CT imaging for meningioma (if not already performed) to assess bone involvement if this is suspected. Evidence indicated that standard structural MRI is useful in distinguishing high-grade from low-grade glioma, and the committee agreed that it is appropriate to extrapolate from this evidence to a belief that MRI can be used to distinguish meningioma from healthy brain tissue. In the committee's experience, CT scans can be more accurate than MRI for assessing meningioma with bone involvement.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5215;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do recommend taking account of local antimicrobial resistance data when prescribing an antibiotic for catheter-associated UTI, and:";"- follow table 1 for non-pregnant women and men aged 16 years and over - follow table 2 for pregnant women aged 12 years and over - follow table 3 for children and young people under 16 years. Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics. Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.";2018;;;"High value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4448;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of dronedarone has not shown greater efficacy than amiodarone at preventing atrial fibrillation recurrence and is associated with numerous adverse events.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4960;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer regular clinical review for people with meningioma to assess changes in their physical, psychological and cognitive wellbeing.";"Base decisions on the timing of regular clinical reviews and follow?up imaging for people with meningioma on: any residual tumour, life expectancy, the person's preferences, treatments used before, treatment options available, tumour grade. Consider standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as part of regular clinical review for people with meningioma, to assess for progression or recurrence, unless MRI is contraindicated. For people with meningioma having routine imaging, be aware that having routine imaging and waiting for the results may cause anxiety. Arrange a clinical review, including appropriate imaging, for people with meningioma (including incidental meningioma) who develop new or changing neurological symptoms or signs at any time.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 5216;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend routinely offering antibiotic prophylaxis to prevent catheter-associated UTIs in people with a short-term or a long-term (indwelling or intermittent) catheter.";"Give advice about seeking medical help if symptoms of an acute UTI develop.";2018;;;"Low value";"Antibiotic use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4449;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of ivabradine, an inhibitor of the cardiac If current, have more risks than benefits in angina or heart failure";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4961;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Transaxial interbody lumbosacral fusion is recommended for severe chronic low back pain only if there are standard arrangements for clinical governance, consent, and audit.";"This procedure should only be done by a surgeon with specific training in the procedure, who should carry out their initial procedures with an experienced mentor. Clinicians should enter data onto the British Spine Registry. ";2018;;;"High value";"Low back pain";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4450;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of nicorandil as a preventive treatment in angina has more risks than benefits such as severe mucocutaneous ulceration";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4962;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of the iFuse implant system is recommended to treat chronic sacroiliac joint pain in people with a confirmed diagnosis of chronic sacroiliac joint pain and whose pain is not adequately controlled by non-surgical treatment.";"The case for adopting the iFuse implant system to treat chronic sacroiliac joint pain is supported by the evidence. Using iFuse leads to improved pain relief, better quality of life and less disability compared with non-surgical management. iFuse should be considered for use in people with a confirmed diagnosis of chronic sacroiliac joint pain (based on clinical assessment and a positive response to a diagnostic injection of local anaesthetic in the sacroiliac joint) and whose pain is inadequately controlled by non-surgical management. Cost modelling indicates significant savings. Savings mainly come from fewer steroid joint injections and less pain relief medication with iFuse compared with non-surgical management.";2018;;;"High value";"Low back pain";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4451;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of olmesartan has not shown greater efficacy than other angiotensin II receptor blockers (ARB) against hypertension and is associated with numerous adverse events.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4707;19;"Choosing Wisely Canada";"Canadian Critical Care Society";English;"Don?t start or continue life supporting interventions unless they are consistent with the patient?s values and realistic goals of care.";"Patients and their families often value the avoidance of invasive or overly aggressive life-sustaining measures when they are at the end of life. However, many dying patients receive aggressive life-sustaining therapies, in part due to clinicians? failures to elicit patients? preferences and to provide recommendations.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4452;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of ranolazine has shown more risks than benefits in the treatment of angina";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4708;19;"Choosing Wisely Canada";"Canadian Critical Care Society";English;"Don?t prolong mechanical ventilation by over-use of sedatives and bed rest.";"Maintaining critically ill patients in an immobile or minimally mobile state during care may potentiate muscle loss and deconditioning. Excessive and/or prolonged use of sedatives is associated with worse outcomes, including increased delirium, excessive use of diagnostic imaging for coma, increased number of tracheostomies, greater duration of mechanical ventilation and ICU length-of-stay.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4964;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nerve transfer is not recommended to partially restore upper limb function in tetraplegia, it should only be used with special arrangements for clinical governance, consent, and audit or investigation.";"Clinicians wishing to do nerve transfer to partially restore upper limb function in tetraplegia should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended. - Audit and review clinical outcomes of all patients having nerve transfer to partially restore upper limb function in tetraplegia. NICE has identified relevant audit criteria and has developed an audit tool. Patient selection and treatment should be done by a multidisciplinary team with expertise in managing spinal cord injury, and nerve and tendon transfers. This team should typically include a surgeon with experience in the surgical management of tetraplegia and nerve transfer, an occupational therapist, a physiotherapist with experience in spinal injury rehabilitation, a spinal injuries consultant and a neurophysiologist. NICE may update the guidance on publication of further evidence.";2018;;;"Low value";"Spinal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4453;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of trimetazidine has shown more risks than benefits in the treatment of angina";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4709;19;"Choosing Wisely Canada";"Canadian Critical Care Society";English;"Don?t continue mechanical ventilation without a daily assessment for the patient?s ability to breathe spontaneously.";"Screening for readiness for liberation from mechanical ventilation with spontaneous breathing trials allows clinicians earlier recognition of patients that may be liberated from mechanical ventilation.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5989;6;"Less Is More Collection - JAMA Network";"Curfman G. JAMA Intern Med. 2019;179(2):195.";English;"It is not advised to use anticoagulation therapy in patients with non?ST-segment elevation acute coronary syndrome.";"Clinical research has focused on parenteral anticoagulation as a potential therapeutic intervention in patients with non?ST-segment elevation acute coronary syndrome (NSTE-ACS). Clinical trials with such medication reported clinical benefit, and consequently clinical practice guidelines recommend the immediate use of these agents in all patients with NSTE-ACS. This observational study seeks to evaluate whether parenteral anticoagulation therapy adds significantly to modern approaches to treatment, such as unfractionated heparin, low-molecular-weight heparin, and the pentasaccharide fondaparinux. The authors conducted a propensity score?matched analysis of 997 patients who received parenteral anticoagulation therapy and an equal number of patients who did not. The authors concluded that among patients receiving dual antiplatelet therapy and percutaneous coronary intervention with drug-eluting stents, parenteral anticoagulation therapy may provide no additional clinical benefit, and that because of the risk of major bleeding, anticoagulation should be used cautiously in patients with NSTE-ACS receiving dual antiplatelet therapy ";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4454;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of vernakalant for the cardioversion of episodes of atrial fibrillation has shown more risks than benefits";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4710;19;"Choosing Wisely Canada";"Canadian Critical Care Society";English;"Don?t order routine chest radiographs for critically ill patients, except to answer a specific clinical question.";"Chest radiographs (?X-rays?, CXRs) are not indicated for routine assessment of critically-ill patients except when indicated for specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, pulmonary artery catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in patient?s clinical condition, and if the information will likely impact a specific decision related to diagnosis or treatment. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4966;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer all people with oesophago-gastric cancer access to an oesophago-gastric clinical nurse specialist through the person's multidisciplinary team.";"Make sure the person with oesophago-gastric cancer is given information, in a format that is appropriate for them, to take away and review in their own time after you have spoken to them about their cancer and care. Inform people with oesophago-gastric cancer about peer-to-peer local or national support groups for them to join if they wish.";2018;;;"High value";" Oesophageal cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4455;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of mequitazine, a sedating antihistamine with antimuscarinic activity, may have more risks than benefits in treating allergies";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4711;19;"Choosing Wisely Canada";"Canadian Critical Care Society";English;"Don?t routinely transfuse red blood cells in hemodynamically stable ICU patients with a hemoglobin concentration greater than 70 g/l (a threshold of 80 g/L may be considered for patients undergoing cardiac or orthopedic surgery and those with active cardiovascular disease).";"Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, including stroke and infections, may also be reduced.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4967;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lesinurad is not recommended within its marketing authorisation, that is, with a xanthine oxidase inhibitor for treating hyperuricaemia in adults with gout whose serum uric acid is above the target level despite an adequate dose of a xanthine oxidase inhibitor alone.";"This recommendation is not intended to affect treatment with lesinurad that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Drug treatments for gout include 2 xanthine oxidase inhibitors, allopurinol or, if that is not tolerated, febuxostat. Evidence from 2 randomised controlled trials shows that more people on lesinurad plus allopurinol reach a target serum uric acid level than people on allopurinol alone. This outcome is seen as clinically relevant when treating gout, but the number of flares and tophi healing are more important outcomes for patients. It is plausible that lowering serum uric acid levels reduces the number of flares and improves healing of tophi, but the clinical evidence does not show that lesinurad plus allopurinol improves these outcomes compared with allopurinol alone. The main factors affecting the cost effectiveness of lesinurad are the assumptions that lowering serum uric acid levels in people with gout improves quality of life and that it prolongs life. Results from observational studies suggest that people with chronic gout have a shorter life expectancy than people without gout. However, there is no robust evidence from randomised trials to show that lowering serum uric acid levels extends life.";2018;;;"Low value";"Blood conditions ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5991;6;"Less Is More Collection - JAMA Network";"Platt KD. JAMA Intern Med. 2019;179(2):269-272";English;"Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hipoglicemia.";"The current recommendation for adults with stable type 2 diabetes on agents that do not cause hipoglicemia is to avoid routine multiple daily self-glucose monitoring. This recommendation is based on robust evidence, including a Cochrane review of 12 randomized clinical trials with more than 3000 patients, showing no statistical difference between patients who do not self-monitor their blood glucose multiple times per day and those who do self-monitor their blood glucose multiple times per day in glycemic control. Furthermore, in a retrospective study to quantify the rate of use and cost of self-monitoring blood glucose supplies that are potentially used inappropriately (specifically focusing on test strips, the most costly supply for regular blood glucose monitoring) showing that a substantial percentage of patients with type 2 diabetes may still be inappropriately self-monitoring blood glucose. ";2018;;;"Low value";Management;"Link to the recommendation on the website of the initiative" 4456;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of injectable promethazine have more risks than benefits in treating severe urticaria";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4457;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of topical tacrolimus have more risks than benefits in treating atopic eczema";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6761;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"Avoidance of antibiotics for group B streptococcus until the onset of labor is recommended for all pregnant women.";"GBS is recognised as the most frequent cause of severe early-onset infection in newborn infants. GBS is present in the bowel flora of 20?40% of adults (colonisation) and those who are colonised are called ?carriers?. This includes pregnant women. Prevention of late-onset group B streptococcal (GBS) disease and treatment of established GBS is not considered beyond initial antibiotic therapy.";2018;;;"High value";Diagnostic;"Link to the recommendation on the website of the initiative" 4458;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of gliptins such as alogliptin, linagliptin, saxagliptin, sitagliptin and vildagliptin, alone or in combination with metformin, have more risks than benefits in diabetes";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4970;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Padeliporfin is not recommended, within its marketing authorisation, for untreated, unilateral, low-risk prostate cancer in adults.";"This recommendation is not intended to affect treatment with padeliporfin that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Current treatments for low-risk prostate cancer include active surveillance and, for people whose disease has progressed (usually beyond low-risk disease), radical therapies such as surgery and radiotherapy. Focal therapies such as cryotherapy and high-intensity focused ultrasound can also be used, but are not routinely available. Professional organisations and NHS England say that there is a growing trend for people with low-risk disease to have active surveillance rather than radical therapy. This is because long-term studies show that people with low-risk disease live as long whichever they have, but radical therapies are associated with long-term, severe side effects. Also, improvements in diagnostic tests mean that low-risk disease can be more accurately identified.";2018;;;"Low value";Metastases;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5994;6;"Less Is More Collection - JAMA Network";"Bikdeli B. JAMA Intern Med. 2019;179(2):263-265.";English;"It is not advisable to place an inferior vena cava filter in patients with acute pulmonary embolism.";"Acute pulmonary embolism is a common cause of morbidity and mortality in older adults. Inferior vena cava (IVC) filters are frequently used to prevent subsequent PE since prior reports from administrative databases suggested their efficacy. This study sought to determine the association between use of IVC filters and mortality rates in patients with PE using 3 distinct statistical approaches. The results showed hypothesis-generating findings for increased risk in patients receiving IVC filters, reflected in higher 30-day and 1-year mortality rates. ";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4459;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of pioglitazone have more risks than benefits in diabetes";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4971;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tocilizumab, when used with a tapering course of glucocorticoids (and when used alone after glucocorticoids), is recommended as an option for treating giant cell arteritis in adults, only if: they have relapsing or refractory disease; they have not already had tocilizumab; tocilizumab is stopped after 1 year of uninterrupted treatment at most and the company provides it with the discount agreed in";"This recommendation is not intended to affect treatment with tocilizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Giant cell arteritis is usually treated with a high dose of glucocorticoids, which is gradually reduced over time. High doses of glucocorticoids may cause a number of problems, including skin problems, weight gain, diabetes and osteoporosis. Clinical trial results show that after having tocilizumab plus a tapering course of glucocorticoids for 1 year, more people stay in remission and need lower doses of glucocorticoids compared with people having glucocorticoids alone.";2018;;;"High value";"Blood conditions ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4460;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of orlistat have more risks than benefits in inducing weight loss";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4972;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for adopting Memokath?051 for treating ureteric obstruction is partially supported by the evidence.";"The case for adopting Memokath?051 for treating ureteric obstruction is partially supported by the evidence. The evidence is limited but suggests that in selected cases, Memokath?051 is effective at relieving ureteric obstruction and improving quality of life. When inserted by trained clinicians and in appropriate patients, Memokath?051 is associated with equivalent success rates and a better patient experience compared with double?J stents. Using Memokath?051 may also reduce the number of stent replacements needed compared with using double?J stents. Memokath?051 stents should be considered as an option in patients with: - malignant ureteric obstruction and anticipated medium- or long-term survival after adjunctive therapy - benign ureteric obstruction who cannot have or do not want reconstructive surgery, or - ureteric obstruction of any kind who cannot have or do not want a double?J stent, or for whom repeat procedures are a particularly high risk.";2018;;;"High value";"Bladder cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4461;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the neuroleptics domperidone, droperidol and metopimazine have more risks than benefits in the treatment of gastroesophageal reflux ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4973;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Romiplostim is recommended as an option for treating chronic immune (idiopathic) thrombocytopenic purpura in adults, only if: their condition is refractory to standard active treatments and rescue therapies or they have severe disease and a high risk of bleeding that needs frequent courses of rescue therapies";"These recommendations are not intended to affect treatment with romiplostim that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2018;;;"High value";"Blood conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4462;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of nifuroxazide have more risks than benefits in the treatment of diarrhoea ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4974;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Eltrombopag is recommended as an option for treating chronic immune (idiopathic) thrombocytopenic purpura in adults, only if: their condition is refractory to standard active treatments and rescue therapies or they have severe disease and a high risk of bleeding that needs frequent courses of rescue therapies.";"These recommendations are not intended to affect treatment with eltrombopag that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.";2018;;;"High value";"Blood conditions ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4463;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of prucalopride have more risks than benefits in the treatment of chronic constipation";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4464;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of tibolone have more risks than benefits for postmenopausal hormone replacement therapy";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6768;36;"Choosing Wisely UK";"Royal College of Pathologists (2018)";English;"It is not recommended unnecessary duplicate genetic testing for inherited variants in adults";"Genetic testing can help identify a disease risk or inherited condition. However, sometimes a genetic test is not the best way to identify a disease risk or inherited condition. A routine blood test or procedure might be just as good. A research article showed that approximately 0.8% of all genetic test requests received for germline mutations were unnecessary duplicate samples from patients who had already been successfully tested. ";2018;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 4465;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of moxifloxacin have more risks than benefits in treating infectious diseases";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6769;36;"Choosing Wisely UK";"Royal College of Pathologists (2018)";English;"It is not recommended give an adult patient a blood transfusion without informing them about the risks and benefits";"A blood transfusion is the transfer of blood or one of its components from a healthy person (donor) to a sick person (recipient). It is done to increase the blood's ability to carry oxygen, restore the body's blood volume, and correct clotting problems. Evidence from a NICE clinical practice guideline suggests that patients have a limited understanding of many aspects of transfusion, but want to be part of an informed decision-making process. Evidence also indicates that patients are reassured by the provision of written information.";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4466;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of telithromycin have more risks than benefits in treating infectious diseases";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6770;36;"Choosing Wisely UK";"Royal College of Pathologists (2018)";English;"It is not recommended to transfuse red cells for iron deficiency anaemia without haemodynamic instability";"Iron deficiency anemia is a type of anemia that develops when there is not enough iron in the body. It is the most common type of anemia. Blood transfusions rapidly increase the amount of red blood cells and iron in the blood. They can be used to treat severe iron deficiency anemia. This recommendation was based on the NICE clinical practice guidelines.";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4467;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the cholinesterase inhibitors donepezil, galantamine and rivastigmine have more risks than benefits in the treatment of alzheimer";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5747;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is not clear if information technology can help primary health care professionals in the management of laboratory testing. ";"In this systematic review, the authors searched for research on the impact of a specific IT system on the laboratory testing process in primary care. They restricted their search to studies published between 2000 and January 2018. They included 22 studies. IT systems can help to provide primary care providers with easier access to test results, reduce turnaround times and increase their use of prescribed tests based on best practice guidelines. The use of paper-based processes in parallel with IT systems increased the potential for medical errors due to cognitive overload for the primary care provider. IT systems that are not viewed as reliable or user-friendly have a negative impact on the performance of primary care providers. Organizational issues arose when results tracking relied on the memory of the prescriber. ";2018;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6771;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is recommended that referral for cataract surgery should be based on a shared decision-making process about how it may affect quality of life in adults.";"This guideline covers managing cataracts in adults aged 18 and over. It aims to improve care before, during and after cataract surgery by optimising service organisation, referral and surgical management, and reducing complications. It further aims to improve the availability of information for people with cataracts before, during and after cataract surgery. This guideline includes recommendations on: patient information, referral for cataract surgery, preoperative assessment and biometry, preventing wrong, lens implant errors, surgical timing and technique, preventing and managing complications, postoperative assessment. The decision to refer a person with a cataract for surgery should be based on a discussion that includes: -How the cataract affects the person?s vision and quality of life -Whether 1 or both eyes are affected -What cataract surgery involves, including possible risks and benefits -How the person?s quality of life may be affected if they choose not to have cataract surgery -Whether the person wants to have cataract surgery. It is aimed at healthcare professionals, commissioners and providers, people with cataracts, their families and carers. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4468;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of memantine have more risks than benefits in the treatment of alzheimer";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4980;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected brain metastases, unless MRI is contraindicated.";"To help establish current disease status, offer extracranial imaging (appropriate to the primary tumour type) to people with any radiologically suspected brain metastases that may be suitable for focal treatment. Perform all intracranial and extracranial diagnostic imaging and, if appropriate, biopsy of extracranial disease, before referral to the neuro-oncology multidisciplinary team. In the absence of evidence, the committee recommended standard structural MRI based on their experience, because it is important to establish the exact number of metastases in the brain, which can guide further treatment. The committee described how failing to establish this could be dangerous.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative" 5748;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Integration of health and social care services has been found to improve some patient outcomes";"In this systematic review, the authors searched for research into the effects of introducing models of integration or co-ordination in healthcare or health and social care settings in countries that were a member of the Organisation for Economic Collaboration and Development, with a focus on reaching conclusions relevant to the UK national health system. They restricted their search to articles published in English since 2006 and did their most recent search in May 2017. They included 43 systematic reviews, 54 studies from the UK, 49 high quality studies from outside the UK with a comparator group, and 21 low quality non-UK studies without a comparator group. Integrated care appears to enhance patient satisfaction, increase perceived quality of care and increase patient access to health and social care services. In the UK, integrated care was also found to reduce patient waiting time and outpatient appointments and increase the likelihood that a patient?s wishes for their end of life are met. The impact of integrated care on some outcomes, including service costs and numbers of patients using community and hospital services, is uncertain.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6772;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists (2018)";English;"It is recommended the outpatient management of nausea and vomiting in pregnancy for patients in whom primary care measures have been unsuccessful.";"Nausea and vomiting in pregnancy is defined as the symptom of nausea and/or vomiting during early pregnancy when there are no other causes, and hyperemesis gravidarum is the severe form of nausea and vomiting in pregnancy. There are variations in the management of women suffering from nausea and vomiting in pregnancy or hyperemesis gravidarum, with an occasional lack of understanding of its severity and options for treatment and support. The guideline offers advice to multidisciplinary professionals involved in the care of women with these conditions, including how to counsel and support women before, during and after their pregnancies. Nausea and vomiting of pregnancy affects up to 80% of pregnant women and is one of the most common indications for hospital admission among pregnant women, with typical stays of 3-4 days.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4469;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the immunosuppressants alemtuzumab, natalizumab, and teriflunomide have more risks than benefits in the treatment of multiple sclerosis";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4981;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer regular clinical review for people with brain metastases to assess changes in their physical, psychological and cognitive wellbeing.";"Base decisions on the timing of regular clinical reviews and follow?up imaging for people with brain metastases on:: extracranial disease status, life expectancy, primary cancer, the person's preferences, treatment options available. Consider standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as part of regular clinical review for people with brain metastases, to assess for progression or recurrence, unless MRI is contraindicated. Consider advanced MRI techniques, such as MR perfusion, diffusion tensor imaging and MR spectroscopy, if findings from standard imaging are unclear about whether there is recurrence and early identification is potentially clinically useful. For people with brain metastases having routine imaging: explain to them, and their relatives and carers, that imaging can be difficult to interpret and results can be of uncertain significance and be aware that having routine imaging and waiting for the results may cause anxiety. Arrange a clinical review, including appropriate imaging, for people with brain metastases who develop new or changing neurological symptoms or signs at any time.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 6773;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is recommended that patients and doctors shared decision making to decide when to initiate treatment and what treatment to use for wet active age related macular degeneration. ";"This guideline covers the diagnosis and management of age-related macular degeneration in adults. It aims to improve the speed with which people are diagnosed and treated to prevent vision loss. Age-related macular degeneration is the term given to age-related changes, with no other obvious cause, that occur in the central area of the retina (macula), sometimes with the formation of new blood vessels. It is aimed at primary and secondary care health professionals, social care professionals, ophthalmic and optometric service providers and managers, people with age-related macular degeneration, their families and carers. It consists of pharmacological treatment: -Antiangiogenic therapies. -Coadjuvant therapies Change and discontinuation of antiangiogenic therapy for late (wet) macular degeneration -Non-pharmacological treatment: -Antiangiogenic therapies Non-pharmacological treatment -Strategies to slow progression: e.g. not offering thermal laser therapy (e.g. argon, diode) to treat drusen in people with early macular degeneration). -Supporting people with macular degeneration and visual impairment There is strong evidence that vision loss is related to delays in diagnosis or treatment. However, there is a lack of evidence assessing the impact of a particular model of care/services on reducing any of the time intervals throughout the referral and treatment process, or the subsequent influence of different models of care on people's visual acuity and quality of life. Therefore, a well-conducted trial would provide the empirical basis for assessing the long-term effectiveness of different organisational models on the referral, diagnosis and treatment of people with late onset (wet active) macular degeneration.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4470;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the flunarizine and oxetorone, have more risks than benefits in the prevention migraine attacks";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4982;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Consider referring the person with a brain tumour for a neurological rehabilitation assessment of physical, cognitive and emotional function at diagnosis and every stage of follow?up.";"Offer people with brain tumours and their relatives and carers (as appropriate) information on accessing neurological rehabilitation, and on what needs it can help address. Give people with brain tumours and their relatives and carers (as appropriate) information on: neurological rehabilitation options in the community, as an outpatient, or an inpatient and how to get a neurological rehabilitation assessment.";2018;;;"High value";"Brain cancers";"Link to the recommendation on the website of the initiative " 4471;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the tolcapone have more risks than benefits in the antiparkinsonian therapy";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4472;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of defibrotide has shown more risks than benefits in treating severe hepatic veno-occlusive disease following haemopoietic stem cell transplantation";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4473;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of mifamurtide has shown more risks than benefits in treating osteosarcoma";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4474;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of nintedanib, a tyrosine kinase inhibitor in combination with docetaxel has shown more risks than benefits in treating certain types of non-small cell lung cancer";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4475;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of olaparib has shown more risks than benefits when used as maintenance treatment for advanced ovarian cancer in women in remission";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4476;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of panobinostat has shown more risks than benefits in prolonging survival in refractory or relapsed multiple myeloma";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6780;36;"Choosing Wisely UK";"Royal College of Pathologists (2018)";English;"It is not recommended to use statins in inappropriate patients";"Statins are today the most effective drugs when it comes to reducing cholesterol. They work by preventing the production of LDL cholesterol in the liver, reducing mortality. The NICE clinical practice guideline recommends the use of statins only in appropriate patients.";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4477;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of trabectedin has shown more risks than benefits in treating ovarian cancer or soft-tissue sarcomas";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6525;33;"Choosing Wisely � : Things we do for no reason";"Caulfield C., Stephens J";English;"Hospitalization for the evaluation of patients with low-risk chest pain is not recommended";"Chest pain is one of the most common complaints among patients presenting to the emergency de- partment. Moreover, at least 30% of patients who present with chest pain are admitted for observa- tion, and >70% of those admitted with chest pain undergo car- diac stress testing (CST) during hospitalization. Several clinical risk prediction models have validated evaluation processes for managing patients with chest pain, helping to identify those at a low risk of major adverse cardiac events. Among these, the Thrombolysis in Myocardial Infarction or HEART score can identify patients safe to be discharged with outpatient CST within 72 h. It is unnecessary to hospitalize all low-risk patients for cardiac testing because it may expose them to needless risk and avoidable care costs, with little additional benefit. Recommendations: ? Patients presenting with chest pain should undergo a complete history taking and physical examination, as well as ECG and cardiac biomarker testing (eg, troponin I level at presentation and approximately 3 h later). ? Clinical risk prediction models, such as TIMI or HEART scores, should then be used to determine the risk of MACE. ? Patients at a low risk may be safely discharged with outpatient CST performed within 72 h. ? Patients at an intermediate or high risk of MACE should be hospitalized for further evaluation, as should those with low- risk chest pain who are unable to attend follow-up for outpatient CST within 72 h. ? Clinicians should provide a shared decision-making plan with each patient, taking care to discuss the risks and bene- fits of in-hospital versus outpatient CST.";2018;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4478;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of vandetanib has shown more risks than benefits in prolonging survival in patients with metastatic or inoperable medullary thyroid cancer";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4990;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the efficacy and safety of intranasal phototherapy for allergic rhinitis is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.";"Further research should include: details of patient selection including medication use; underlying medical conditions; the intensity, duration and wavelength of light used; patient-reported outcomes; comparison with existing treatments; and the effects of repeated long-term use. NICE may update the guidance if further evidence is published. ";2018;;;"Low value";Allergies;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6526;33;"Choosing Wisely � : Things we do for no reason";"Hall A., et al.";English;"The Default Use of Hypotonic Maintenance Intravenous Fluids in Pediatrics is not recommended";"Hypotonic intravenous (IV) fluids have historically been the maintenance IV fluid of choice for hospitalized children. Iatrogenic hyponatremia is a common phenomenon among hos- pitalized patients and hypotonic IV fluids significantly increase the risk for hyponatremia. Although infrequent, hyponatremic encephalopathy can have catastrophic complications, making the avoidance of iatrogenic hyponatremia a priority in the hospital. Multiple studies have demonstrated that compared with hypotonic IV fluids, isotonic IV fluids decrease the risk of hyponatremia without significant untoward side effects. Therefore, clinicians should preferentially treat most children with isotonic maintenance IV fluids instead of hypotonic IV fluids. RECOMMENDATIONS: ? When needed, maintenance IV fluids should always be tailored to each individual patient. ? For most acutely ill hospitalized children, isotonic IV fluids should be the maintenance IV fluid of choice. ?Consider monitoring electrolytes to determine the effects of maintenance IV fluids.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6782;36;"Choosing Wisely UK";"Royal College of Ophthalmologists (2018)";English;"It is not recommended to refer a patient for chronic open-angle glaucoma and related conditions without first considering certain tests available in the community.";"Glaucoma is a common eye disease in which the optic nerve, which connects the eye to the brain, is damaged. The cause is usually a buildup of fluid in the front part of the eye, which increases intraocular pressure. Glaucoma can lead to vision loss if not diagnosed and treated early. It can affect people of all ages, but is most common in adults in their 70s and 80s. Tests available in the community are: -Central visual field assessment by standard automated perimetry (full or supra-threshold). -Optic nerve assessment and fundus examination by slit lamp stereoscopic biomicroscopy (with pupil dilation if necessary), and optical coherence tomography or optic nerve head imaging if available. -Intraocular pressure measurement by Goldmann type applanation tonometry. -Peripheral anterior chamber configuration and depth assessments by gonioscopy or, if not available or preferred by the patient, van Herick's test or optical coherence tomography tomography. Patients should be referred for further investigation and diagnosis of chronic open-angle glaucoma and related conditions after consideration of repeat measurements if there is optic nerve head damage on slit lamp stereoscopic biomicroscopy or there is a visual field defect compatible with glaucoma or intraocular pressure equal to or greater than 24 mmHg by Goldmann-type applanation tonometry. If these criteria are not met, individuals with an intraocular pressure less than 24 mmHg are advised to continue to see their primary ophthalmologist regularly. In January 2022: have reviewed the evidence and made new recommendations on treatment and organization of care for people with ocular hypertension and chronic open-angle glaucoma.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4479;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of vinflunine has shown more risks than benefits in prolonging survival in advanced and metastatic bladder cancer";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6527;33;"Choosing Wisely � : Things we do for no reason";"Herzke C., et al.";English;"The ?48 Hour Rule-out? for Well-Appearing Febrile Infants (aged 0-90 days) is not recommended";"Fever, defined as a rectal temperature of ?38�C (100.4�F), is a common reason for hospital admission of infants aged ? 90 days. Febrile infants are often admitted to the hospital due to risk for serious bacterial infections, such as urinary tract infection, bacteremia, and meningitis. The traditional observation time is 48 hours following the collection of blood, urine, and cerebrospinal fluid cultures. In the majority of these infants, bacterial infection is not the source of fever. When a bacterial source is identified, less than 0.3% of the bacteria will be detected more than 24 hours after the cultures were obtained in low-risk infants.1 Recent studies show that the traditional 48 hour hospital observation period is unnecessary for infants aged ? 90 days who are at low risk for serious bacterial infection based on available scoring systems. Recommendations: ? Determine if febrile infants aged 0-90 days are at low risk for serious bacterial infection and obtain appropriate bacterial cultures. ? If hospitalized for observation, discharge low-risk febrile infants aged 0?90 days after 36 hours or less if bacterial cultures remain negative. ? If hospitalized for observation, consider reducing the length of inpatient observation for low-risk febrile infants aged 0?90 days with reliable follow-up to 24 hours or less when the culture results are negative.";2018;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4480;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of ciclosporin has shown more risks than benefits in the the treatment of dry eye disease with severe keratitis";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4481;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of idebenone has shown more risks than benefits in the treatment of Leber?s hereditary optic neuropathy";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6529;33;"Choosing Wisely � : Things we do for no reason";"Wolfe H., et al.";English;"The neutropenic diet is not recommended in neutropenic cancer patients.";"For several decades, providers have routinely restricted the diets of neutropenic cancer patients by eliminating foods that might harbor pathogenic microbes to reduce infection rates. These diets, known as neutropenic or low-bacteria diets, are prescribed across the country with little uniformity in the extent or content of prescription. These diets are difficult to follow and force patients to omit fresh fruits and vegetables and limit dairy and meat products from their diet. These dietary omissions compromise nutritional intake in patients who are already at high risk of malnutrition. Randomized trials have shown that these restrictive diets are not superior in preventing infections than more liberalized diets. Evidence shows that adherence to the Safe Food-Handling guidelines issued by the Food and Drug Administration, a mandate for all hospital kitchens, provides adequate protection against food-borne infection, precluding the need for the neutropenic diet. Thus, routine use of the neutropenic diet should be abandoned. Recommendations: ? Neutropenic diets, or low-bacteria diets, should not be prescribed to neutropenic patients. ? Properly handled and adequately washed fresh fruits and vegetables can safely be consumed by patients with neutropenia. ? Patients and hospitals should follow FDA-published safe food-handling guidelines to prevent food contamination.";2018;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 6785;36;"Choosing Wisely UK";"Royal College of Ophthalmologists (2018)";English;"It is recommended to discuss the risks and benefits of having cataract surgery in both eyes on the same day in patients chosen for cataract surgery.";"Esta gu�a cubre el tratamiento de las cataratas en adultos mayores de 18 a�os. Su objetivo es mejorar la atenci�n antes, durante y despu�s de la cirug�a de cataratas, optimizando la organizaci�n de los servicios, la derivaci�n y el tratamiento quir�rgico, y reduciendo las complicaciones. Adem�s, pretende mejorar la disponibilidad de informaci�n para las personas con cataratas antes, durante y despu�s de la cirug�a de cataratas. Las cataratas suelen empeorar lentamente con el tiempo. La cirug�a para sustituir el cristalino opaco es la �nica forma de mejorar la vista. La decisi�n de operarse no debe basarse �nicamente en los resultados de sus pruebas oftalmol�gicas (agudeza visual). Puede tener otras razones personales para decidir operarse, como sus actividades cotidianas, aficiones e intereses. Puede optar por posponer la intervenci�n durante un tiempo y someterse a revisiones peri�dicas para controlar la situaci�n. No existen medicamentos ni colirios que hayan demostrado mejorar las cataratas o impedir que empeoren. La cirug�a de cataratas es una intervenci�n sencilla que suele durar entre 30 y 45 minutos. Suele realizarse en el mismo d�a, con anestesia local, y el paciente puede volver a casa el mismo d�a. Durante la operaci�n, el cirujano har� un peque�o corte en el ojo para extraer el cristalino opaco y sustituirlo por uno de pl�stico transparente. Si tiene cataratas en ambos ojos, puede ser recomendable tratarlos el mismo d�a. Este procedimiento se conoce como cirug�a bilateral secuencial inmediata de cataratas. Por lo general, s�lo se recomienda a personas con bajo riesgo de complicaciones. El cirujano hablar� con usted si se trata de una opci�n. De lo contrario, la cirug�a se realiza con un intervalo de 6 a 12 semanas para permitir la recuperaci�n de un ojo cada vez. Revisaron esta gu�a en noviembre de 2021. Decidir�n si actualizan la recomendaci�n sobre la cirug�a de cataratas asistida por l�ser cuando se haya publicado la actualizaci�n de la revisi�n Cochrane sobre la cirug�a de cataratas asistida por l�ser frente a la cirug�a de cataratas por facoemulsificaci�n con ultrasonido est�ndar. ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4482;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of agomelatine has shown more risks than benefits in treating depression";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5762;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Nurse-led services are recommended in the context of outpatient care";"The COVID-19 pandemic is placing a strain on healthcare services. Existing research on nurse-led services may provide useful information for policy makers. In this systematic review, the authors searched for comparative effectiveness studies of nurse-led services in the ambulatory or community care setting. They restricted their searches to articles published in English up to April 2016. They included 19 randomised trials, 5 pre-post studies and 1 non-randomised controlled trial. The studies were from Asia (3 studies), Australia (4), Europe (15) and USA (3). Nurse-led care is a safe and feasible model of care for consideration across various ambulatory care settings. With appropriate training and support, nurse-led care can lead to similar or better health-related quality of life compared to physician-led care or standard care for patients with chronic conditions. The economic impact of nurse-led care is uncertain.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6530;33;"Choosing Wisely � : Things we do for no reason";"Zwemer E. and Stephens J.";English;"Blood Cultures for Uncomplicated Skin and Soft Tissue Infections in Children is not recommended ";"Skin and soft tissue infections (SSTIs) are common pediatric diagnoses, which account for an estimated 390,000 ED visits annually1 and represent the 7th most common reason for pediatric hospital admission in the United States. The rates of SSTIs have increased over the past several decades partly due to the rise of methicillin-resistant Staphylococcus aureus (MRSA). RECOMMENDATIONS: ? Do not obtain blood cultures in pediatric patients with uncomplicated SSTIs. ? If purulent material is available spontaneously or after incision and drainage, then send it for Gram stain and bacterial culture. ? Blood cultures are reasonable in patients with complicated SSTIs and in immunocompromised patients with SSTIs. ? Despite limited data, blood cultures may be reasonable in neonates with SSTIs. Febrile infants with SSTIs aged less than 90 days should be managed under existing febrile infant guidelines.";2018;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4483;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of duloxetine has shown more risks than benefits in treating depression";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5763;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Uncertainty exists regarding patient-mediated interventions (patient feedback about clinical practice, patients being members of committees, or patient?led training) to improve healthcare worker practice";"COVID-19 is placing great strain on healthcare workers but maintaining the quality of care and patient safety is crucial. Therefore, it is important to understand how patient-mediated interventions can influence healthcare practice. In this Cochrane systematic review, the authors searched for randomised trials of the effects of patient-mediated interventions on the performance of healthcare workers. They did not restrict their search by date or language of publication and did the search in August 2018. They included 15 individual randomised trials and 10 cluster randomized trials (total: 12,268 patients), and also identified 2 ongoing trials. Patient-reported health information interventions are likely to improve the quality of healthcare services. Patient education interventions are likely to improve the quality of healthcare services. Across all patient-mediated interventions, the effects on adverse events, desirable patient health outcomes, patient satisfaction and resource use are uncertain.";2018;;;Uncertain;"Management of patients ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6531;33;"Choosing Wisely � : Things we do for no reason";"Ambrus D., O'Connor M.";English;"Sliding-Scale Insulin as Monotherapy for Glycemic Control in Hospitalized Patients is not recommended";"The basic premise of sliding-scale insulin (SSI) is to correct hyperglycemia through the frequent administration of short-acting insulin dosed according to a patient?s blood glucose level with the help of a prespecified rubric. RECOMMENDATIONS ? Instead of using SSI monotherapy for hospitalized patients who require insulin, add basal and prandial insulin, using a weight-based approach if necessary for insulin-naive patients. ? Engage with leadership at your center to learn how inpatient hyperglycemia protocols and blood sugar management teams can help provide evidence-based and individualized treatment plans for your patients.";2018;;;"Low value";-;"

Enlace a la recomendacio?n en la pa?gina web de la iniciativa

" 6787;36;"Choosing Wisely UK";"Royal College of Ophthalmologists (2018)";English;"It is recommended that a validated risk stratification algorithm be used when considering whether a patient should undergo cataract surgery.";"Referral for cataract surgery is based on a decision to refer the person with cataract for surgery in a discussion with them (and their family members or carers as appropriate) that includes: - how the cataract affects the person's vision and quality of life -whether one or both eyes are affected -what cataract surgery involves, including possible risks and benefits -how the person's quality of life may be affected if he or she decides not to have cataract surgery -whether the person wishes to have cataract surgery. Do not restrict access to cataract surgery based on visual acuity. Risk stratification is based on: Consider using a validated risk stratification algorithm for people who have been referred for cataract surgery to identify people at increased risk of complications during and after surgery. Explain the results of the risk stratification to the person and discuss how it may affect their decisions. To minimise the risk of complications during and after surgery, ensure that trainee surgeons are closely supervised when performing cataract surgery on: -people at high risk of complications, or -people for whom the impact of complications would be particularly severe (e.g. people with only one functional eye). Explain to people at risk of developing a dense cataract that there is an increased risk of complications if surgery is delayed and the cataract becomes denser.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4484;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of citalopram and escitalopram has shown more risks than benefits in treating depression";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4996;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Niraparib is recommended for use within the Cancer Drugs Fund as an option for treating relapsed, platinum-sensitive high-grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer that has responded to the most recent course of platinum-based chemotherapy in adults";"This recommendation is not intended to affect treatment with niraparib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. People with relapsed, platinum-sensitive high-grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer have a high unmet clinical need because the disease has a poor prognosis and chemotherapy is the only available treatment for many people. Niraparib appears to be a promising treatment for this disease. Olaparib may be another treatment option, but it is only recommended for people with a BRCA mutation who have had 3 or more courses of platinum-based chemotherapy. A clinical trial shows that niraparib extends progression-free survival compared with routine surveillance, but the final results on overall survival are not available yet. Therefore, it's not clear whether niraparib will increase the length of time people live. Because of the uncertainty in the clinical evidence, the estimates of cost effectiveness are very uncertain. Therefore niraparib cannot be recommended for routine use in the NHS.";2018;;;"High value";"Ovarian cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5764;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The effects of pharmacist-led drug reconciliation after hospital discharge are unclear, although it can identify and resolve existing discrepancies";"The COVID-19 pandemic is placing a strain on health systems and healthcare workers. Existing research on how pharmacists might help with the communication of medication information and reconciliation following a person?s discharge from hospital may provide information to help policy makers with this. Community based pharmacists can identify and resolve discrepancies when completing medication reconciliation after hospital discharge. Whether medication reconciliation interventions by pharmacists reduces workload is uncertain. The effects of medication reconciliation interventions by pharmacists on hospital readmission rate, emergency department attendance and primary care workload are uncertain.";2018;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4485;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of milnacipran and venlafaxine has shown more risks than benefits in treating depression";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4997;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with obstructive jaundice and suspected pancreatic cancer, offer a pancreatic protocol CT scan before draining the bile duct.";"If the diagnosis is still unclear, offer fluorodeoxyglucose-positron emission tomography/CT (FDG?PET/CT) and/or endoscopic ultrasound (EUS) with EUS?guided tissue sampling. Take a biliary brushing for cytology if endoscopic retrograde cholangiopancreatography (ERCP) is being used to relieve the biliary obstruction and there is no tissue diagnosis.";2018;;;"High value";"Pancreatic cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6533;33;"Choosing Wisely � : Things we do for no reason";"Young K., et al.";English;"Contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus are not recommended";"Contact precautions (CP) for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) infections are common in several hospitals. CP pose a significant burden to health systems, with an estimated 20%-25% of hospitalized patients on CP for MRSA or VRE alone. CP are becoming increasingly more prevalent with state laws and the Veterans Affairs (VA) hospital system requiring active surveillance cultures (ASC) and subsequent CP when ASC are positive. RECOMMENDATIONS: ? Discontinue the use of CP for MRSA and VRE in hospitals with low endemic rates and high hand hygiene compliance. ? Improve horizontal preventions by promoting hand hygiene, antimicrobial stewardship, and considering CHG bathing for all patients. ? Create a systematic approach to discontinuing CP and compare transmission of MRSA and VRE rates through microbiology surveillance before and after discontinuation. ";2018;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4486;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of tianeptine has shown more risks than benefits in treating depression";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4998;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended the use of MiraQ system in the NHS for assessing graft flow during coronary artery bypass graft (CABG) surgery. ";"The evidence suggests that intraoperative transit time flow measurement is effective in detecting imperfections that may be corrected by graft revision. This may reduce the incidence of graft occlusion and may reduce perioperative morbidity and mortality.";2018;;;"High value";"Cardiovascular conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6790;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"Antipsychotics are not recommended in people with Lewy body dementia because they can cause serious side effects.";"This guideline covers diagnosing and managing dementia (including Alzheimer?s disease). It aims to improve care by making recommendations on training staff and helping carers to support people living with dementia. People living with dementia can sometimes become distressed, aggressive or very agitated, and can have hallucinations or delusions. Antipsychotic medicines can help with this, but there are pros and cons to taking them. We?ve produced this patient decision aid to help healthcare professionals discuss antipsychotic medicines with people living with dementia and their families and carers, so they can decide together if these are the right choice.";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4487;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of dapoxetine has shown more risks than benefits when used for sexual dissatisfaction related to premature ejaculation";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4488;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of etifoxine has shown more risks than benefits in treating anxiety";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5000;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is not recommended to exclude a diagnosis of peripheral arterial disease in people with diabetes based on a normal or raised ankle brachial pressure index alone.";"For further information please visit de website. ";2018;;;"Low value";"Peripheral circulatory conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6792;36;"Choosing Wisely UK";"Royal College of Psychiatrists";English;"It is not recommended to prescribe valproate for mental disorders in women who are planning or may become pregnant, except when there is resistance to treatment and/or very high-risk clinical situations.";"Data from the Clinical Practice Research Datalink suggest that 35,000 women ages 14 to 45 per year received sodium valproate between 2010 and 2012, the majority for epilepsy. Of these, at least 375 per year had a prescription for sodium valproate during pregnancy. The Cochrane review published in November 2014 evaluated 22 prospective cohort studies and 6 registry studies. They conclude that children exposed to valproate in utero were at increased risk of lower neurodevelopmental scores compared with the general study population, both in infancy and at school age. Specifically, children exposed to valproate in utero are at high risk of severe developmental disorders (up to 30-40% of cases) and/or congenital malformations (in approximately 10% of cases). It is not possible to establish a threshold dose below which there is no risk of developmental disorders. If a woman with epilepsy or bipolar disorder receiving valproate therapy plans pregnancy or becomes pregnant, alternative treatments should be considered. But if treatment with valproate is continued during pregnancy: 1. The lowest effective dose should be used and the daily dose should be divided into several small doses to be taken throughout the day. 2. Start a specialized prenatal follow-up 3. folate supplementation before pregnancy may decrease the risk of neural tube defects common to all pregnancies; however, the available evidence does not suggest that it prevents birth defects or malformations due to valproate exposure.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4489;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of bupropion, an amphetamine, has shown more risks than benefits when used as a pharmacological treatment in smoking cessation";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5001;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is not recommended to use pulse oximetry for diagnosing peripheral arterial disease in people with diabetes.";"For futre information please visit the website.";2018;;;"Low value";"Peripheral circulatory conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6793;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"It is recommended to consider prescribing regular analgesia such as paracetamol if there is a clinical suspicion that pain is a relevant trigger of agitation in patients with dementia.";"50% of people with dementia are estimated to experience regular pain. Despite this, current assessment and treatment of pain in this patient group are inadequate. In addition to the discomfort and distress caused by pain, it is frequently the underlying cause of behavioural symptoms, which can lead to inappropriate. We should consider prescribing regular analgesia such as paracetamol if there is a clinical suspicion that pain is a relevant trigger.";2018;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 4490;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the sympathomimetic vasoconstrictors ephedrine, naphazoline, oxymetazoline, phenylephrine, pseudoephedrine and tuaminoheptane has shown more risks than benefits when used as decongestants.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4491;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the ambroxol and bromhexine has shown more risks than benefits when used as mucolytics";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5003;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of aortic valve reconstruction with processed bovine pericardium is inadequate in quantity and quality. Therefore, this procedure should only be used in the context of research.";"Further research should address patient selection and report long-term outcomes, particularly the durability of the valve.";2018;;;"Low value";"Structural heart defects";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6795;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"Anticholinergic drugs are not recommended in the elderly because they can be detrimental to cognition in later life and have other serious side effects.";"It has been estimated that 20?50% of older people have been prescribed at least one medication with anticholinergic activity. Careful consideration of the risks to patients, including the use of an anticholinergic burden scale, should be undertaken prior to initiation.";2018;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4492;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the pholcodine has shown more risks than benefits when used as antitussive";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5004;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of percutaneous balloon valvuloplasty for fetal critical aortic stenosis is limited in quantity and the results are inconsistent. Therefore, this procedure should only be used in the context of research.";"NICE encourages the peer-reviewed publication of all further research. Further research could be in the form of controlled trials, analysis of registry data or other observational studies. It should address patient selection, timing of the intervention and the natural history of the disease.";2018;;;"Low value";"Structural heart defects";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5516;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";English;"It is not recommended to use physical airway examination tests for the detection of airway difficulties in apparently normal adult patients during anaesthesia or acute conditions.";"The unanticipated difficult airway is a potentially life?threatening event during anaesthesia or acute conditions. An unsuccessfully managed upper airway is associated with serious morbidity and mortality Several bedside screening tests are used in clinical practice to identify those at high risk of difficult airway. Their accuracy and benefit however, remains unclear. The tests evaluated in this review included the Mallampati test, the modified Mallampati test, the Wilson risk score, the thyromental distance, the sternomental distance, the mouth opening test, the upper lip bite test, or any combination of these. The objective condition was the difficult airway, with one of the following reference standards: difficult ventilation with a face mask, difficult laryngoscopy, difficult tracheal intubation, and failed intubation All investigated index tests were found to have relatively low sensitivities, with high variability. In contrast, specificities were consistently and markedly higher than sensitivities in all tests. ";2018;;;"Low value";"management of patients";"Link to the recommendation on the website of the initiative" 4493;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of tixocortol, a corticosteroid, has shown more risks than benefits when used for sore throat.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5005;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of sutureless aortic valve replacement for aortic stenosis is adequate to support the use of this procedure, provided that standard arrangements are in place for clinical governance, consent and audit.";"Patient selection should be done by a multidisciplinary team, including cardiologists and cardiac surgeons. Specific training is important for this procedure and surgeons should do their initial procedures with an experienced mentor.";2018;;;"High value";"Structural heart defects";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5517;35;"Evidencias COVID-19";" Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The current, limited evidence suggests that the routine use of haloperidol for preventing intensive care unit (ICU) delirium is not an effective strategy.";"The current, limited evidence suggests that the routine use of haloperidol for preventing intensive care unit (ICU) delirium is not an effective strategy. The quality of the evidence for dexmedetomidine versus lorazepam was low, and very low for dexmedetomidine versus haloperidol. We found very low?quality evidence that a regimen of no sedation versus standard sedation increased the incidence of agitated delirium, while decreasing the number of ventilator?free days and length of ICU and hospital stay. The quality of the evidence for the remaining sedation interventions, physical and cognitive therapy interventions, and nursing care interventions ranged from moderate to very low and none of the interventions prevented delirium or improved or worsened any outcomes.";2018;;;"Low value";"Management of patient";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6797;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"It is not recommended to deny patients access to a service, research or treatment solely on the basis of their age";"Older people in care homes typically have greater and more complex health needs than those living in the community, and these needs can affect their wellbeing if they are not addressed. Many care home residents experience problems accessing NHS primary and secondary healthcare services, including GPs. It is important that care homes have good links with GPs and referral arrangements, so that services can be accessed easily and without delay when they are needed. This is essential to prevent unmet healthcare needs from having a negative impact on mental wellbeing.";2018;;;"Low value";Management;"Link to the recommendation on the website of the initiative" 4494;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of mannitol inhalation powder, has shown more risks than benefits when used as mucolytic for patients with cystic fibrosis.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6798;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"It is recommended that the management of older adults with mental problems should be guided by specialists in old age, who are capable of handling the complex needs of this population.";"The number of specialist schemes are relatively limited and most older people with mental health needs use mainstream services. The full range of community care services should be available to older people with mental health needs without discrimination. It is essential, therefore, that all service providers understand mental health issues, and ensure their staff are specifically trained to provide an appropriate service.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative" 4495;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of nintedanib, a tyrosine kinase inhibitor, has shown more risks than benefits when used for the treatment of idiopathic pulmonary fibrosis";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6799;36;"Choosing Wisely UK";"Royal College of Psychiatrists ";English;"It is not recommended to use cognitive tests alone to diagnose dementia. ";"Dementia is a term used to describe a variety of cognitive and behavioral symptoms that can include memory loss, reasoning and communication problems, and personality changes, and a reduction in a person's ability to perform daily activities, such as go shopping, wash, dress and cook It is a progressive condition: symptoms will gradually worsen. It will vary from person to person and everyone will experience dementia differently. People can often have some of the same general symptoms, but the degree to which these affect each person will vary. Cognitive tests alone do not diagnose dementia. Do not rule out dementia solely because the person has a normal score on a cognitive instrument. The first and central thing is to make a correct history, accompanied by testimonials from people who know the patient well.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4496;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"El uso de roflumilast, un inhibidor de la fosfodiesterasa tipo 4 con efectos antiinflamatorios, ha mostrado m�s riesgos que beneficios cuando se usa para el tratamiento de la enfermedad pulmonar obstructiva cr�nica grave (EPOC)";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";"For further information please visit the website of the initiative (link below)";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5008;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Endoscopic bipolar radiofrequency ablation is recommended for the treatment of biliary obstruction caused by cancer in the context of research.";"Current evidence on endoscopic bipolar radiofrequency ablation for treating biliary obstruction caused by cancer shows there are serious but well recognised safety concerns. Evidence on efficacy is limited in quality and quantity. Therefore, this procedure should only be used in the context of research, which should include randomised controlled trials. Further research should address: patient selection, relief of biliary obstruction, quality of life and survival.";2018;;;"High value";"Complications of cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6800;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"It is recommended that care for frail older adults with complex needs who require hospitalization be managed in a specialist ward setting for older people.";"Research commissioned by the Department of Health and non governmental reports have confirmed various aspects of discrimination, infringement of human rights, unmet need or neglect of older people. Deep-rooted cultural attitudes to ageing are particularly evident in mental health. An arbitrary age is not a satisfactory criterion to determine the service a person receives. Services must recognise the equal value of all people and be based on need not on age. Age is a continuous variable and there is no point at which populations become discretely separate. A needs-based service will still require the development of comprehensive specialist-based mental health services for older people.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative" 4497;14;"Prescrire bilan. Towards better patient care: drugs to avoid";"Prescrire bilan. Towards better patient care: drugs to avoid";English;"The use of oral selexipag, a prostacyclin receptor agonist, has shown more risks than benefits when used for the treatment of pulmonary arterial hypertension.";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4498;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of Cox-2 inhibitors such as celecoxib, etoricoxib and parecoxib, has shown more risks than benefits when used for the treatment of rheumatologic pain ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6802;36;"Choosing Wisely UK";"Royal College of Psychiatrists ";English;"It is recommended to use of non-pharmacological treatments for the treatment of behavioral and psychological symptoms of dementia.";"As initial and ongoing management, offer psychosocial and environmental interventions to reduce distress in people living with dementia. If there are significant risks that make treatment with an antipsychotic necessary, this should be discussed with the patient and their family, and the lowest possible dose used. Only offer antipsychotics for people living with dementia who are either: 1. At risk of harming themselves or others or 2. Experiencing agitation, hallucinations or delusions that are causing them severe distress. Antipsychotics can worsen the motor features of the condition, and in some cases cause severe antipsychotic sensitivity reactions. When using antipsychotics: 1. Use the lowest effective dose and use them for the shortest possible time 2. Reassess the person at least every 6 weeks, to check whether they still need medication. ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4499;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use oral aceclofenac and oral diclofenac has shown more risks than benefits compared to other NSAIDs, when used for the treatment of rheumatologic pain ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6803;36;"Choosing Wisely UK";"Royal College of Psychiatrists";English;"It is recommended to review and change/add antidepressants in patients with little or no response within two months of starting treatment if a drug with the appropriate therapeutic dose was prescribed.";"Antidepressant drugs are designed to correct an imbalance of certain chemicals in the brain which may happen in people with depression. Taking antidepressant medicines may improve symptoms of depression and make people feel better. They are more effective in people with severe depression than in those with mild to moderate depression. Symptoms should improve within two to four weeks of starting treatment. If there is no improvement after 6 weeks, a review of the proposed treatment should be considered. When someone starts antidepressant treatment, their GP will ask to see them after two weeks to see how they are getting on. After that, they may see their GP every two to four weeks in the first three months. If they respond well totreatment, they may see their GP at longer intervals for the rest of their treatment.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4500;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of ketoprofen gel has shown more risks than benefits compared to other NSAIDs, when used for the treatment of rheumatologic pain ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4501;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of piroxicam, when used systemically, has shown more risks than benefits compared to other NSAIDs, when used for the treatment of rheumatologic pain ";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4757;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule).";"Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. They also increase length of stay and misdiagnosis. There is strong evidence that physicians should not order CT head scans for patients with minor head injury unless validated clinical decision rules are used to make imaging decisions (i.e., Canadian CT head rule for adults, and CATCH or PECARN rules for children). Despite their validity, these rules are never 100% sensitive and are meant to assist and not replace, clinical judgement.";2018;;;"Low value";-;"Link to the recommendation on the website. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4502;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of diacerein has shown more risks than benefits when used for the treatment of osteoarthritis";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6806;36;"Choosing Wisely UK";"Royal College of Psychiatrists (2018)";English;"It is not recommended to use physical restraints in older adults in hospital settings with delirium except as a last resort.";"There is little evidence to support the effectiveness of physical restraints to manage people with delirium who exhibit behaviours that risk injury. Physical restraints can lead to serious injury or death and may worsen agitation and delirium. Restraints should therefore be used as a last resort and should be discontinued at the earliest possible time, particularly given that effective non-pharmacological alternatives are available.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4503;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of glucosamine has shown more risks than benefits when used for the treatment of osteoarthritis";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4504;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of capsaicin in patch form, has shown more risks than benefits when used for the treatment for neuropathic pain";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5272;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use ultrasound for routine monitoring of disease activity in adults with RA. ";"Randomised controlled evidence did not support using ultrasound for routine monitoring of RA. However, in the committee's experience ultrasound can be useful for monitoring when clinical examination is inconclusive or is inconsistent with other signs of disease activity (for example, pain or markers of inflammation). The committee decided to make a research recommendation to inform future guidance about using ultrasound in these situations. ";2018;;;"Low value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6808;36;"Choosing Wisely UK";"Royal College of Psychiatrists";English;"It is recommended make sure there is a clear plan to review the use, reduce or discontinue the treatment with benzodiazepines or antipsychotic drugs initiated during an acute hospital admission in elderly patients.";"If benzodiazepines or antipsychotics drugs have been initiated during an acute care hospital admission, make sure there is a clear plan to review their use, ideally tapering and discontinuing prior to discharge. Both benzodiazepines and antipsychotics have serious side effects in the elderly, in particular, addiction, falls, worsening cognition, infections, stroke and death.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4505;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of denosumab has shown more risks than benefits when used in the prevention of osteoporotic fractures";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6809;36;"Choosing Wisely UK";"Royal College of Radiologists (2018)";English;"Magnetic resonance imaging is not recommended in the diagnosis of chronic knee pain.";"Typically, radiography is the initial imaging study used to evaluate chronic pain in a native knee. When pain persists but the initial radiographs are normal or demonstrate a joint effusion, MRI is usually considered the next imaging study. However, the use of MRI may be premature and unnecessary in some patients, as it is estimated that approximately 20% of patients with chronic knee pain have had an MRI performed without recent (within the prior year) radiographs. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4506;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of methocarbamol has shown more risks than benefits when used as muscle relaxant";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4762;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis.";"Respiratory distress from bronchospasm/wheezing is a common presentation in both children (i.e., bronchiolitis) and adults (i.e., bronchitis/asthma) seen in the emergency department. Most patients with symptoms do not have bacterial infections that require antibiotic treatment or influence outcomes (i.e., hospitalization). Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash, diarrhea and other side-effects) and has the potential to increase patients? risk of antibiotic induced diarrhea, including infections with C. Difficile. These prescriptions also increase overall antibiotic resistance in the community, and limit the effectiveness of standard antibiotics in the treatment of legitimate bacterial infections. There is strong applied research evidence to recommend that physicians should not prescribe antibiotics in children (i.e., bronchiolitis) and adults (i.e., bronchitis and asthma) with wheezing presentations.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5018;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Strimvelis is recommended, within its marketing authorisation, as an option for treating adenosine deaminase deficiency?severe combined immunodeficiency (ADA?SCID) when no suitable human leukocyte antigen-matched related stem cell donor is available. ";"ADA?SCID is a rare and serious condition that is fatal if untreated, and which severely affects the quality of life of people with the condition and their families. Treatment for ADA?SCID includes haematopoietic stem cell transplants (HSCTs). Clinical trial evidence shows that Strimvelis is effective in treating ADA?SCID. Compared with HSCTs, results suggest the main benefits are that more people live after Strimvelis than after a transplant and fewer people develop graft-versus-host disease. However, the exact size of the clinical benefits are uncertain because the trials have been small and uncontrolled, and the evidence for HSCTs is limited. There are also several important uncertainties in the cost-effectiveness results associated with Strimvelis. However, there are health-related and wider benefits not included in the economic analysis but which are important to consider. Taking these into account, and considering the additional weight that can be assigned to the benefits when the estimated health gain is large, the plausible cost-effectiveness estimates for Strimvelis are within the range that NICE normally considers acceptable for highly specialised technologies. The cost of Strimvelis is high and there are some uncertainties in the evidence. However, Strimvelis is likely to provide important benefits for people with ADA?SCID, at a cost that provides value for money in the context of a highly specialised service.";2018;;;"High value";"Failure to thrive";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4507;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of quinine has shown more risks than benefits when used for the treatment of cramps";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6811;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health";English;"Is recommended the repeat prescription of 12-month oral contraceptives instead of 3-month or 6-month supplies in women without medical problems";"This guidance provides evidence-based recommendations and good practice points for health professionals on the use of combined hormonal contraceptives (i.e. the combined oral contraceptive pill, transdermal patch and combined vaginal ring) currently available in the UK. It is intended for any health care professional or health service providing contraception or conception advice in the UK.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4508;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of Colchimax� (colchicine + opium powder + tiemonium) has shown more risks than benefits when used for the treatment of gout attacks";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6812;36;"Choosing Wisely UK";"Royal College of Radiologists (2018)";English;"It is recommended that Morton?s neuroma diagnosis is essentially a clinical diagnosis. ";"Further investigations are generally unnecessary. According to the NICE guideline and several clinical trials, no correlation was found between the size of MN on US and the positive clinical tests. If the diagnosis of forefoot pain is uncertain, use XR to assess forefoot bones, joints and alignment. In experienced hands, US with dynamic assessment can confirm a diagnosis of Morton?s neuroma and guide injection treatment if required. It is helpful when clinical suspicion is high and conservative measures have failed. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4509;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The use of the prednisolone + dipropylene glycol salicylate combination, for cutaneous application, has shown more risks than benefits when used for the treatment of painful sprains or tendinopathy";"For further information please visit the website of the initiative (link below)";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5021;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tofacitinib is recommended, within its marketing authorisation, as an option for treating moderately to severely active ulcerative colitis in adults when conventional therapy or a biological agent cannot be tolerated or the disease has responded inadequately or lost response to treatment. It is recommended only if the company provides tofacitinib with the discount agreed in the commercial arrangem";"Clinical trial evidence shows that tofacitinib is more effective than placebo for treating moderately to severely active ulcerative colitis. An indirect comparison suggests that for people who have not had a TNF-alpha inhibitor, tofacitinib is more effective than adalimumab and golimumab as maintenance treatment. For people who have had a TNF-alpha inhibitor, tofacitinib is more effective than adalimumab as induction treatment. No other statistically significant differences between tofacitinib and biological therapies were identified. Based on the health-related benefits and costs compared with conventional therapy and biologicals, tofacitinib is recommended as a cost-effective treatment for moderately to severely active ulcerative colitis in adults whose disease has responded inadequately to, or who cannot tolerate, conventional or biological therapy.";2018;;;"High value";"Ulcerative colitis";"https://www.nice.org.uk/guidance/ta547/chapter/1-Recommendations" 5789;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"School closings recommended during influenza outbreaks";"During the COVID-19 pandemic, schools in some countries have been closed to reduce the risk of transmission of the virus. Existing research from other large outbreaks of a respiratory virus may provide information to help policy makers make decisions about this. In this systematic review, the authors searched for articles quantifying the effects of school closures during influenza epidemics, using either mathematical models or data from within an established epidemic. They restricted their searches to studies available in English and did the search in March 2017. They identified 31 studies from 12 countries. Implementing school closure before or after an influenza epidemic reaches its peak, reduced the overall epidemic. School closure reduced and delayed the influenza epidemic peak, especially if implemented earlier. The longer the duration of school closure, the more the influenza epidemic peak was delayed. The optimum duration of school closure during an influenza epidemic is uncertain.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4510;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Non-operative treatment with antibiotics is recommended as the initial treatment strategy for children with uncomplicated appendicitis. Such an approach would reduce risks associated with surgery and general anesthesia. ";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4511;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"The use of amitriptyline and topiramate as preventive medications for pediatric migraine is not recommended as is not more effective than placebo. Greater reliance on non-pharmacologic treatment strategies for children experiencing migraine swould limit the harm of serious medication adverse effects.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4767;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"It s not recommended to order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators.";"Adults with non-specific lumbosacral (low back) pain, in the absence of significant trauma (i.e., car crash, acute axial loading, acute hyperflexion, etc.), commonly present to the emergency department. The evaluation of patients presenting with nontraumatic low back pain should include a complete focused history and physical examination to identify ?red flags? that may indicate significant pathology. These may include, but are not limited to: features of cauda equina syndrome, weight loss, history of cancer, fever, night sweats, chronic use of systemic corticosteroids, chronic use of illicit intravenous drugs, patients with first episode of low back pain over 50 years of age and especially if over 65, abnormal reflexes, loss of motor strength or loss of sensation in the legs. In the absence of red flags, physicians should not order radiological images for patients presenting with non-specific low back pain. Imaging of the lower spine for symptomatic low back pain does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 6815;36;"Choosing Wisely UK";"Royal College of Radiologists (2018)";English;"Ultrasonic is recommended as the investigation of choice in the assessment of patients with rotator cuff and surrounding soft tissues. ";"It may be used to guide injection. It is reserved for cases with unresponsive to first line treatment and clinically guided injection. It is indicated preoperatively if the surgeon requires assessment if rotator cuff integrity. The etiology of traumatic shoulder pain can often be made based on clinical examination, radiographs, and mechanism of injury. Traumatic shoulder injuries can generally be separated into injuries requiring acute surgical management and injuries in which conservative management can be attempted prior to considering surgical treatment. Unstable or significantly displaced fractures and joint instability are injuries most likely requiring acute surgical treatment. Most soft-tissue injuries (such as labral tears and rotator cuff tears) can undergo a period of conservative management prior to considering surgery.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4512;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"The use of prophylactic antibiotics is not recommended for recurrent UTI with the goal of preventing renal scarring in children because it has more risks than benefits when used.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5280;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended to sensitize health and social assistance personnel, as well as to give information about vaccination programs. ";" These recommendations are aimed at the following population groups: educators, health professionals and pharmacists, social workers and caregivers of the elderly or people with risk factors.";2018;;;"High value";Influenza;"https://www.nice.org.uk/guidance/ng103" 4513;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Narrow-spectrum antibiotics (eg, penicillin, amoxicillin) are recommended as the mainstays for antibiotic treatment of acute otitis media, acute sinusitis, and group A streptococcal pharyngitis in children. Broad-spectrum antibiotics do not confer additional treatment benefit and may be associated with more adverse events.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4514;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Safely reduction of exposure to curative but toxic agents is recommended in the treatment of childhood cancer as they have been associated with decreased long-term harm from treatment.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5794;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended to minimize overcrowding, achieve effective coordination among stakeholders; provide health information and guarantee human resources, physical infrastructure, and health financing for the prevention and control of communicable diseases in migrant detention centers";"The COVID-19 pandemic is particularly concerning for people living in overcrowded settings. Migrant holding centres face many challenges in the prevention and control of communicable diseases. In this scoping review, the authors searched for studies to 1) identify challenges for prevention and control of communicable diseases in migrant centres and similar institutional settings, and 2) describe suitable approaches to assess strengths and weaknesses in addressing communicable diseases in migrant centres. They restricted their search to articles published in English, French and Italian between 2000 and 2015 and did their most recent search in December 2015. They included 43 articles from journals and 54 reports from the grey literature. Critical interventions for communicable disease prevention and control include living conditions, notably minimising overcrowding; effective coordination among various stakeholders; health information, especially related to early detection and reporting; human resources; physical infrastructure; and health financing.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6306;29;"Choosing Wisely Australia";"Australasian Faculty of Rehabilitation Medicine";English;"Do not prescribe spinal orthotics or bed rest for patients with non-specific low back pain. ";"There is insufficient and conflicting evidence on the effectiveness of spinal orthotics and other forms of lumbar support for treating or preventing low back pain, either as an intervention in its own right or as a supplement to other interventions. While there is no evidence that short term bed rest is harmful, long periods of bed rest can lead to complications such as muscular atrophy. The only randomised control trial to assess optimal periods of bed rest suggests two days is as effective as any longer period but the evidence is of low quality. There is evidence to support other approaches, such as advice to stay active and exercise which help with pain relief and improved function. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6818;36;"Choosing Wisely UK";"Royal College of Radiologists (2018)";English;"Imaging is not recommended for patients with Parkinson?s disease diagnosis routinely.";"In spite of the recommendation, MRI is useful for differentiating PD from vascular parkinsonism and atypical parkinsonism syndromes in the differential diagnosis of parkinsonian syndromes (progressive supranuclear palsy, multiple system atrophy and corticobasal degeneration). CT is the alternative when MRI is contraindicated. Nuclear medicine imaging with dopamine transporter is recommended in difficult cases to differentiate true PD and the parkinsonian syndromes from essential tremor and other movement disorders.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4515;6;"Less Is More Collection - JAMA Network";" Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"The use of laryngeal mask airway is recommended to reduce the risk of serious adverse events, including laryngospasm and bronchospasm, compared with use of an endotracheal tube, among infants undergoing general anesthesia.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4516;6;"Less Is More Collection - JAMA Network";"Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Surfactant administration via a thin catheter without endotracheal intubation (less invasive surfactant administration) is recommeded to be the preferred technique for delivering surfactant in preterm infants with respiratory distress syndrome in the intensive care unit.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6820;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health";English;"It is recommended that professional help be sought only when the dangling strings of the copper intrauterine device or hormonal intrauterine system cannot be felt by teaching patients how to feel these strings";"The recommendation does not have more information, evidence, or additional references.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4517;6;"Less Is More Collection - JAMA Network";"Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Tight glycemic control is not recommended when treating children with critical illness and hyperglycemia, because it was not shown to be beneficial and led to increased risk of severe hypoglycemia and health care?associated infections. ";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4773;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Order neck radiographs is not recommended in patients who have a negative examination using the Canadian C-spine rules.";"Neck pain resulting from trauma (such as a fall or car crash) is a common reason for people to present to the emergency department. Very few patients have a cervical spinal injury that can be detected on radiographs (?X-rays?). History, physical examination and the application of clinical decision rules (i.e., the Canadian C-spine rule) can identify alert and stable trauma patients who do not have cervical spinal injuries and therefore do not need radiography. The Canadian C-spine rule has been validated and implemented successfully in Canadian centres, and physicians should not order imaging unless this rule suggests otherwise. Unnecessary radiography delays care, may cause increased pain and adverse outcomes (from prolonged spinal board immobilization), and exposes the patient to ionizing radiation without any possible benefit. This strategy will reduce the proportion of alert patients who require imaging.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa.
" 5797;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Interventions to support the self-care of children and young people with long-term conditions are recommended since they have statistically significant benefits, although minimal, in their quality of life and in visits to the emergency department";"In this systematic review, the authors searched for comparative effectiveness studies of self-care support delivered to children and young people (aged <18 years) with a long-term physical or mental condition. They did not restrict their searches by date or language of publication and did the search in March 2015. They included 97 studies reporting on 114 interventions, with 37 trials rated as being at low risk of bias. Among the interventions, the authors categorized 4% as pure self-care, 23% as facilitated self-care, 65% as intensively facilitated self-care and 8% as ?case management?. The effects on hospital admissions and the total costs of medical care of these supportive interventions are not clear. The optimal models of self-care support for children and youth with long-term conditions are also unclear due to the size and nature of the available evidence. Equally uncertain are the effects of different types of self-care support for these children and youth in a variety of long-term conditions.";2018;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6309;29;"Choosing Wisely Australia";"Australasian Faculty of Rehabilitation Medicine";English;"Do not use Mini Mental State Examination as the only tool to assess cognitive deficit in acquired brain injury";"Numerous studies suggest that the Montreal Cognitive Assessment (MoCA) is one of the most effective means of assessing cognitive deficits in acquired brain injury (for instance after transient ischemic attack and stroke) and is to be preferred to the Mini Mental State Evaluation (MMSE). MMSE may under-detect cognitive impairment in acquired brain injury; it is more appropriate for assessing dementia.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4518;6;"Less Is More Collection - JAMA Network";"Coon E. JAMA Pediatrics. 2019;173(4):379-384";English;"Enteral DHA supplementation is not recommended to reduce bronchopulmonary dysplasia risk in preterm infants born at less than 29 weeks? gestation, in fact it may increase it.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5030;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Embolization of the superior rectal artery is not recommended for the treatment of hemorrhoids. Current evidence on the safety and efficacy of superior rectal artery embolisation for haemorrhoids is inadequate in quality and quantity. Therefore, this procedure should only be used in the context of research.";"Further research should report details of patient selection, and follow?up efficacy (including symptom relief), need for subsequent treatments, quality of life and safety outcomes for at least 1 year.";2018;;;"Low value";"Haemorrhoids and other anal conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5798;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Peer support, well-designed organizational structures, and employee reward systems are recommended to balance the negative impact of adverse work factors on the well-being of emergency department professionals";"The COVID-19 pandemic is a placing a strain on healthcare workers. Existing research on the effects of work factors in emergency department (ED) on healthcare workers? well-being may provide useful information for policy makers. In this systematic review, the authors searched for research into the quantitative associations between psychosocial work factors and the mental well-being of ED providers. They restricted their searches to articles published in English or German and did the search in December 2017. They included 37 cross-sectional surveys and 2 prospective studies. The majority of the studies were assessed to be of weak to moderate methodological quality, with considerable risk of bias.";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4519;6;"Less Is More Collection - JAMA Network";"Divyajot S.JAMA Intern Med. 2018;178(1):116-122.";English;"Red blood cell transfusion is not recommended in hemodynamically stable adult hospitalized patients with a Hb level of 7 g/dL or more. This population includes critically ill patients.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4520;6;"Less Is More Collection - JAMA Network";"Divyajot S.JAMA Intern Med. 2018;178(1):116-122.";English;"Red blood cell transfusion is not recommended in patients undergoing orthopedic or cardiac surgery or in patients with underlying cardiovascular disease with a Hb level of 8 g/dL or more.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4776;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Prescribe antibiotics after incision and drainage of uncomplicated skin abscesses is not recommended unless extensive cellulitis exists.";"Abscesses are walled off collections of pus in soft tissue, with Staphylococcus aureus (both sensitive and resistant to methicillin) being the microbe most frequently involved. Most uncomplicated abscesses should undergo incision in an acute care setting such as the emergency department, using local analgesia or procedural sedation, complete drainage and appropriate follow-up. Antibiotics may be considered when patients are immunocompromised, systemically ill, or exhibit extensive surrounding cellulitis or lymphangitis. There is some evidence to suggest that antibiotics in addition to incision and drainage of uncomplicated abscesses may confer some benefit in a small number of patients. However, we encourage physicians to discuss the use of antibiotics in uncomplicated abscesses with patients as the benefits conferred by antibiotics may not outweigh the risks associated with their use (i.e. nausea, diarrhea, and allergic reactions).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 6824;36;"Choosing Wisely UK";"Royal College of Radiologists (2018)";English;"Routine follow up imaging is not recommended in rheumatoid arthritis.";"According to the iREFER guidelines available, it is better to individualise every case to determine what is best for patients. As soon as possible after establishing a diagnosis of RA (canviar a Reumathoide Artritis), it is necessary to measure anticyclic citrullinated peptide antibodies and X-ray the hands and feet to establish whether erosions are present, but only if they were not performed or measured to inform diagnosis. XR (X-ray) may be required by specialists to assist management decisions; e.g. for instituting and modifying drug treatment and referral for joint replacement. Routine follow up is otherwise not appropriate.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4521;6;"Less Is More Collection - JAMA Network";"Divyajot S.JAMA Intern Med. 2018;178(1):116-122.";English;"Single-unit RBC transfusions followed by reassessment are recommended as the standard of care for patients who are hemodynamically stable and not actively bleeding.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6825;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health (2018)";English;"It is recommended the realization of routine cervical smears for women if they must be done at the time they attend for other sexual health problems.";"Cervical screening checks a sample of cells from your cervix for certain types of human papillomavirus (HPV). These types of HPV can cause abnormal changes to the cells in your cervix and are called ""high risk"" types of HPV. If these types of HPV are found during screening (an HPV positive result), the sample of cells is then checked for abnormal changes. If abnormal cells are not treated, they may turn into cervical cancer.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4522;6;"Less Is More Collection - JAMA Network";" Johansen M.JAMA Intern Med. 2018;178(2):292-294. ";English;"The use of gabapentinoids (gabapentin and pregabalin) is not recommended as it has shown more risks than benefits for the treatment of partial seizures and postherpetic neuralgia, particularly for those individuals who are long-term opioid users.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5034;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cabozantinib is recommended, within its marketing authorisation, as an option for treating progressive medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease, only if the company provides cabozantinib with the discount agreed in the patient access scheme.";"Cabozantinib and vandetanib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Both drugs are currently available through the Cancer Drugs Fund for progressive and symptomatic disease. Best supportive care is the only other available option for people who cannot have cabozantinib or vandetanib. Clinical trial evidence suggests that cabozantinib is effective in delaying disease progression compared with best supportive care, but may not prolong survival. Without reliable comparative data, it was considered that cabozantinib and vandetanib are likely to be similarly effective. ";2018;;;"High value";"Thyroid cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4523;6;"Less Is More Collection - JAMA Network";"Reinhardt S. JAMA Intern Med. 2018;178(2):212-219.";English;"Non-invasive testing with coronary computed tomographic angiography or stress testingin are not recommended for patients who come to the emergency department with acute chest pain, negative biomarkers, and a nonischemic ECG result, as they lead to longer length of stay, more downstream testing, more radiation exposure, and greater cost, without an improvement in clinical outcomes.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5035;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lenvatinib and sorafenib are recommended as options for treating progressive, locally advanced or metastatic differentiated thyroid cancer (papillary, follicular or H�rthle cell) in adults whose disease does not respond to radioactive iodine, only if: they have not had a tyrosine kinase inhibitor before or they have had to stop taking a tyrosine kinase inhibitor within 3 months of starting it be";"This recommendation is not intended to affect treatment with lenvatinib or sorafenib that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Lenvatinib and sorafenib (tyrosine kinase inhibitors) are the only treatment options for progressive, locally advanced or metastatic differentiated thyroid cancer after surgery and radioactive iodine. For people who cannot have lenvatinib or sorafenib, best supportive care is the only option. Clinical trial evidence shows that lenvatinib and sorafenib are both effective in delaying disease progression, but there is a higher response rate (that is, more tumours shrink) with lenvatinib and it may delay progression for longer. Clinical expert advice is that this response is associated with an improvement in symptoms, which is valued by patients. Lenvatinib and sorafenib also increase the length of time people live, but it is uncertain by how long.";2018;;;"High value";"Thyroid cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5291;1;"NICE ";"National Institute for Health and Care Excellence (NICE)";Spanish;"Microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma is is not recommended unless when used with special arrangements for clinical governance, consent, and audit or research. ";"Evidence on the safety and efficacy of this procedure is limited in quantity and quality. Clinicians wishing to do microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear information to support shared decision-making. In addition, the use of NICE's information for the public is recommended. - Audit and review clinical outcomes of all patients having microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma. NICE has identified relevant audit criteria and has developed an audit tool. NICE encourages further research into microinvasive subconjunctival insertion of a trans-scleral gelatin stent for primary open-angle glaucoma, including randomised studies. Further research should include details of patient selection and long-term outcomes.";2018;;;"Low value";"Eye Conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4524;6;"Less Is More Collection - JAMA Network";"Daniel M. JAMA Intern Med. 2018;178(2):271-276.";English;"Successful interventions are recommended to reduce inappropriate antimicrobial use in asymptomatic bacteriuria, particularly in low-risk populations (ie, excluding pregnant women and patients undergoing invasive urologic procedures), and improves patient outcomes and experience while reducing costs.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5036;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vandetanib is not recommended, within its marketing authorisation, for treating aggressive and symptomatic medullary thyroid cancer in adults with unresectable, locally advanced or metastatic disease. This recommendation is not intended to affect treatment with vandetanib that was started in the NHS before this guidance was published. People having treatment outside this recommendation m";"Vandetanib and cabozantinib are the only systemic treatment options for unresectable, locally advanced or metastatic medullary thyroid cancer. Best supportive care is the only other available option for people who cannot have vandetanib or cabozantinib. Clinical trial evidence suggests that vandetanib may delay disease progression compared with best supportive care, but the benefit is uncertain. The evidence about whether vandetanib increases the overall length of time people live is unreliable. Clinical experts consider that vandetanib and cabozantinib are similarly effective, so more robust data from a cabozantinib trial are used because of the uncertainties in the evidence. Cost-effectiveness estimates for vandetanib compared with either best supportive care or cabozantinib are much higher than what NICE normally considers an acceptable use of NHS resources. Vandetanib does not meet NICE's end-of-life or Cancer Drugs Fund criteria. Therefore, it cannot be recommended as a cost-effective use of NHS resources.";2018;;;"Low value";"Thyroid cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4525;6;"Less Is More Collection - JAMA Network";"Costantino G. JAMA Intern Med. 2018;178(3):356-362.";English;"It is discourage the adoption of a routine protocol for excluding pulmonary embolism in all patients presenting to the emergency department with syncope. The unnecessary exposure to radiation and the risk of contrast allergy is significant. In addition, evaluation could lead to false-positive results and overtreatment, thereby increasing adverse events and health care costs.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4781;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"It is not recommended to order CT head scans in adult patients with simple syncope in the absence of high-risk predictors.";"Patients commonly present to the emergency department with syncope. Syncope is a transient loss of consciousness followed by a spontaneous return to baseline neurologic function that does not require resuscitation. The evaluation of syncope should include a thorough history and physical exam to identify high-risk clinical predictors for CT head abnormalities. These highrisk predictors include, but are not limited to: trauma above the clavicles, headache, persistent neurologic deficit, age over 65, patients taking anticoagulants, or known malignancies. Many patients with syncope receive a CT scan of the head; however, in the absence of these predictors, a CT head is unlikely to aid in the management of syncope patients. CT scans can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. Unwarranted imaging also increases length of stay and misdiagnosis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 6829;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health (2018)";English;"It is recommended that women requesting intrauterine contraception be able to attend a single consultation and an insertion appointment as long as they are well informed of the procedure and the risks-benefits.";"Women requesting intrauterine contraception can attend a single consultation and insertion appointment provided they have access to high-quality local information about the procedure and its risks and benefits. For example, online resources can be used for women's information with a check list.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative" 4526;6;"Less Is More Collection - JAMA Network";"Caverly T. JAMA Intern Med. 2018;178(3):426-428. ";English;"It is recommended to risk-stratify patients for lung cancer screening due to the high rate of false-positive results, and provide support for personalized, risk-based harm-benefit estimates for all eligible persons during lung cancer screening decision-making. ";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4527;6;"Less Is More Collection - JAMA Network";"Chong J. JAMA Intern Med. 2018;178(3):412-413. ";English;"Using multimodal interventions that include indication-based ordering, automatic discontinuation, routine review of use and appropriateness, and education is recommended as it can lead to significant reduction in inappropriate telemetry use, and subsequently significant cost savings.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4528;6;"Less Is More Collection - JAMA Network";"Ko L. JAMA Intern Med. 2018;178(7):994-996.";English;"Radiologic imaging and blood cultures are not recommended for evaluation and treatment of cellulitis as they have low clinical usefulness. In addition, they portend significant cost to the health care system. Imaging and blood cultures should be pursued only in patients who are severely immunocompromised or experiencing systemic toxic effects.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5296;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ocrelizumab is recommended as an option for treating relapsing?remitting multiple sclerosis in adults with active disease defined by clinical or imaging features, only if: alemtuzumab is contraindicated or otherwise unsuitable and the company provides ocrelizumab according to the commercial arrangement.";"This recommendation is not intended to affect treatment with ocrelizumab that was started in the NHS before this guidance was published. People having treatment outside this recommendation may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Current NHS treatments for relapsing?remitting multiple sclerosis include alemtuzumab, beta interferons, cladribine, dimethyl fumarate, fingolimod, glatiramer acetate, natalizumab and teriflunomide. Clinical trial results show that ocrelizumab reduces the number of relapses and slows disability progression compared with interferon beta?1a for people with relapsing?remitting multiple sclerosis. There is no evidence directly comparing ocrelizumab with other treatments. Indirect analyses suggest that ocrelizumab reduces the number of relapses compared with interferon beta?1b, glatiramer acetate, dimethyl fumarate, fingolimod and teriflunomide, and is as effective as alemtuzumab and natalizumab. These analyses suggest that ocrelizumab slows disease progression in the total relapsing?remitting multiple sclerosis population compared with some treatments but not others. Also, it is uncertain whether ocrelizumab slows disease progression in the subgroups of highly active and rapidly evolving severe disease.";2018;;;"High value";"Multiple sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4529;6;"Less Is More Collection - JAMA Network";"King L. JAMA Intern Med. 2018;178(7):992-994. ";English;"Shorter durations (3-7 days) of antibiotic therapy for sinusitisas is recommended as it has been shown to be associated with similar outcomes and fewer drug-related adverse events compared with longer durations (6-10 days).";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5297;1;"NICE ";" National Institute for Health and Clinical Excellence (NICE)";English;"Interferon beta?1a is recommended as an option for treating multiple sclerosis, only if: the person has relapsing?remitting multiple sclerosis and the companies provide it according to commercial arrangements.";"Interferon beta?1b (Extavia) is recommended as an option for treating multiple sclerosis, only if: the person has relapsing?remitting multiple sclerosis and has had 2 or more relapses within the last 2 years or the person has secondary progressive multiple sclerosis with continuing relapses and the company provides it according to the commercial arrangement. Glatiramer acetate is recommended as an option for treating multiple sclerosis, only if: the person has relapsing?remitting multiple sclerosis and the company provides it according to the commercial arrangement. Interferon beta?1b (Betaferon) is not recommended within its marketing authorisation as an option for treating multiple sclerosis. These recommendations are not intended to affect treatment with a beta interferon or glatiramer acetate that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. For children and young people, this decision should be made jointly by them, their clinician, and their parents or carers. Evidence from clinical trials and the Department of Health's Risk Sharing Scheme shows that glatiramer acetate and the beta interferons are effective for treating multiple sclerosis. It also shows that all the treatments work similarly in slowing progression of disability and in reducing the number of multiple sclerosis-related relapses.";2018;;;"High value";"Multiple sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4530;6;"Less Is More Collection - JAMA Network";"Grant P. JAMA Intern Med. 2018;178(8):1122-1124. ";English;"The use of venous thromboembolism prophylaxis strategies it is not recommended for hospitalized patients, particulary those with low risk. Pharmacologic overprophylaxis could lead to major bleeding, patient discomfort, potential risk of falls and impaired mobility with mechanical prophylaxis, more costs, and risk for heparin-induced thrombocytopenia.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4786;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"It is not recommended to order CT pulmonary angiograms or VQ scans in patients with suspected pulmonary embolism until risk stratification with a clinical decision rule has been applied and when indicated d-dimer biomarker results are obtained.";"Many adults present to the emergency department with chest pain and/or shortness of breath. The majority of adult patients with these symptoms do not have a pulmonary embolism (PE) that requires investigation with a CT pulmonary angiogram (CTPA) or ventilation perfusion (VQ) lung scan. CTPAs or VQ scans expose patients to ionizing radiation that has the potential to increase patients? lifetime risk of cancer. CTPAs also place patients at risk for potential allergic reaction and acute kidney injury from the intravenous contrast required for the CTs. Imaging also increases length of stay and may contribute to misdiagnosis. Evidence demonstrate that physicians should not order CTPAs or VQ scans to diagnose PE until risk stratification with a clinical decision rule (Wells score, PERC rule) has been applied and d-dimer biomarker results are obtained for those patients where it is indicated. For high-risk populations in which the clinical decision rules have not been validated (i.e., pregnancy, hypercoagulability disorders), physicians are urged to exert their clinical judgment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4275;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)";English;"Inhaled corticosteroids are not recommended as routine treatment for patients with FEV > 60% and < 2 acute exacerbations in the previous year or in patients without an overlapping COPD?asthma phenotype.";"Patients with stable COPD.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4531;6;"Less Is More Collection - JAMA Network";"Raslan I. JAMA Intern Med. 2018;178(9):1272-1274.";English;"It is recommended clinical surveillance over therapeutic anticoagulation for the treatment of subsegmental pulmonary embolisms (SSPEs)";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4276;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)";English;"Spirometry is recommended as part of the diagnostic work-up in patients with a past history of smoking and symptoms of COPD.";"Patients with stable COPD.";2018;;;"High value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4532;6;"Less Is More Collection - JAMA Network";"Brenner A. JAMA Intern Med. 2018;178(10):1311-1316.";English;"It is recommended to keep in mind that in practice, shared decision-making in lung cancer screening does not follow the guidelines of clinical practice guidelines.";"For further information please visit the website of the initiative (link below) ";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4277;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is recommended to not assume that patients correctly administer the inhaled medication in the absence of adequate confirmation.";"Patients with stable COPD.";2018;;;"High value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4533;6;"Less Is More Collection - JAMA Network";"Howard D. JAMA Intern Med. 2018;178(11):1557-1558";English;"Knee arthroscopy, compared with medical management, does not result in clinically significant benefits for patients with osteoarthritis, meniscal tears, and knee pain.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4789;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"It is not recommended to routinely use antibiotics in adults and children with uncomplicated sore throats";"Adults and children frequently present to the emergency department with sore throats (pharyngitis). The vast majority of cases of pharyngitis are caused by self-limiting viral infections that do not respond to antibiotics. The benefit of antibiotics for the approximately 10% of cases in adults (25% in children), caused by bacteria (principally Group A Streptococcus (GAS)) is modest at best, although is associated with fewer complications and a slightly shorter course of illness. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community. Evidence suggests that antibiotics should only be used in patients with intermediate and high clinical prediction scores for GAS (CENTOR or FeverPAIN score) AND confirmatory testing (throat cultures or rapid testing) that are positive for GAS, especially in children.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4278;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to initiate treatment without previously confirming the diagnosis by spirometry in patients with satble COPD. ";"Patients with stable COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4534;6;"Less Is More Collection - JAMA Network";"Gerlach L. JAMA Intern Med. 2018;178(11):1560-1562.";English;"It is recommended for new benzodiazepine users, prescribers should ?begin with the end in mind? and immediately engage patients in discussion regarding the expected length of treatment, particularly when prescribed for insomnia among older adults.";"For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5302;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Age-related macular degeneration";"Do not refer to late AMD (wet inactive) as 'dry AMD'. Do not refer people with asymptomatic early AMD to hospital eye services for further diagnostic tests. Do not offer fundus fluorescein angiography (FFA) to people with suspected late AMD (wet active) if clinical examination and OCT exclude neovascularisation. Do not offer photodynamic therapy alone for late AMD (wet active). Do not offer photodynamic therapy as an adjunct to anti-VEGF as first-line treatment for late AMD (wet active). Do not offer intravitreal corticosteroids as an adjunct to anti-VEGF for late AMD (wet active). Do not offer thermal laser therapy (for example, argon, diode) for treating drusen in people with early AMD. Do not routinely monitor people with early AMD or late AMD (dry) through hospital eye services.";2018;;;"Low value";"Eye conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4279;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to change inhaled treatment without first assessing treatment compliance on patients with stable COPD. ";"Patients with stable COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4535;6;"Less Is More Collection - JAMA Network";"Reeve E. JAMA Intern Med. 2018;178(12):1673-1680. ";English;"It is recommended that physicians consider deprescribing as part of comprehensive, patient-centered care. ";"A majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking. For further information please visit the website of the initiative (link below) ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4791;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"It is not recommended to order ankle and/or foot X-rays in patients who have a negative examination using the Ottawa ankle rules";"Foot and ankle injuries in children and adults are very common presentations to emergency departments. The Ottawa Ankle Rules (OAR) have been validated in both children (greater than 2 years old) and adult populations, and have been shown to reduce the number of X-rays performed without adversely affecting patient care. In alert, cooperative and sensate patients with blunt ankle and/or foot trauma within the previous ten days and who are not distracted by other injuries, only those who fulfill the OAR should undergo ankle and/or foot X-rays. Imaging of the ankle and/or foot in patients who are negative for the OAR does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4280;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to perform pulmonary function testing systematically at each follow-up visit if there is no change in symptoms, in the number of previous acute exacerbations, or in treatment, on patients with stable COPD.";"Patients with stable COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4792;19;"Choosing Wisely Canada";"Canadian Headache Society";English;"It is not recommended to order neuroimaging or sinus imaging in patients who have a normal clinical examination, who meet diagnostic criteria for migraine, and have no ?red flags? for a secondary headache disorder.";"Red flags for a secondary headache include thunderclap onset, fever and meningismus, papilloedema, unexplained focal neurological signs, unusual headache attack precipitants, and headache onset after age 50. The yield of neuroimaging in patients with typical recurrent migraine attacks is very low. Any imaging study, particularly MRI, can identify incidental findings of no clinical significance which may lead to patient anxiety and further unnecessary investigation. For patients with typical migraine and a normal clinical examination who desire reassurance, careful explanation of the diagnosis and patient education may be more advisable.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4281;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)";English;"It is not recommended to prescribe antibiotic treatment in all cases of acute exacerbation in patients with exacerbated COPD.";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4793;19;"Choosing Wisely Canada";"Canadian Headache Society";English;"It is not recommended to prescribe opioid analgesics or combination analgesics containing opioids or barbiturates as first line therapy for the treatment of migraine.";"Non-steroidal anti-inflammatory drugs and triptans are recommended first line treatments for acute migraine therapy. Opioids may produce increased sensitivity to pain and increase the risk that intermittent headache attacks will become more frequent and escalate to a chronic daily headache syndrome (medication overuse headache), particularly when opioids are used on 10 days a month or more. Opioids may impair alertness and produce dependence or addiction syndromes.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5305;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Transcutaneous neuromuscular electrical stimulation is recommended for adults with dysphagia after a stroke, only when used with special arrangements for clinical governance, consent, and audit or research. The evidence on efficacy suggests a potential benefit, but is limited in quality and quantity. ";"Current evidence on transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia in adults shows there are no major safety concerns. For adults with dysphagia not caused by a stroke, there is insufficient evidence on efficacy to support the use of this procedure. Therefore, this procedure should only be used in the context of research. Clinicians wishing to do transcutaneous neuromuscular electrical stimulation for adults with oropharyngeal dysphagia after a stroke should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended. - Audit and review clinical outcomes of all patients having transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion). Further research on transcutaneous neuromuscular electrical stimulation for oropharyngeal dysphagia in adults should address patient selection, variations in technique, the need for retreatments and long-term outcomes.";2018;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4282;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)";English;"It is not recommended to prescribe nebulized medication in all cases of acute exacerbation in patients with exacerbated COPD. ";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4794;19;"Choosing Wisely Canada";"Canadian Headache Society";English;"It is not recommended to prescribe acute medications or recommend an over-the-counter analgesic for patients with frequent migraine attacks without monitoring frequency of acute medication use with a headache diary.";"All acute medications used for migraine attacks, when used too frequently, increase the risk of medication overuse headache with progression to a chronic daily headache syndrome. Use of opioids, triptans, ergotamines, or combination analgesics of any kind on 10 days a month or more, and use of NSAIDs or acetaminophen on 15 days a month or more places patients at risk for medication overuse headache. Patients with migraine should be educated with regard to these risks.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5306;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the efficacy and safety of intranasal phototherapy for allergic rhinitis is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.";"Further research should include: details of patient selection including medication use; underlying medical conditions; the intensity, duration and wavelength of light used; patient-reported outcomes; comparison with existing treatments; and the effects of repeated long-term use. NICE may update the guidance if further evidence is published.";2018;;;"Low value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4283;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to administer high-flow oxygen if oxygen saturation is >90% or if PaO2 is > or = 60 mmHg in patients with exacerbated COPD.";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4795;19;"Choosing Wisely Canada";"Canadian Headache Society";English;"It is recommended to consider the behavioural components of migraine treatment, including lifestyle issues like regular and adequate meals and sleep, and management of specific triggers including stress, when managing migraine. ";"Lifestyle issues and specific trigger management can contribute considerably to successful migraine control. Patient education regarding these factors may reduce the need for expensive medications and reduce indirect costs related to disability. Training in relaxation and other stress management techniques should be considered. Training in other skills like pacing activities to help patients manage their schedules and stress levels well, and how to take acute medications appropriately are also important.";2018;;;"High value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative " 5051;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Leadless cardiac pacemaker implantation is not recommended for patients with bradyarrhythmias. ";"Evidence on the safety of leadless cardiac pacemaker implantation for bradyarrhythmias shows that there are serious but well-recognised complications. The evidence on efficacy is inadequate in quantity and quality: - For people who can have conventional cardiac pacemaker implantation, leadless pacemakers should only be used in the context of research. - For people in whom a conventional cardiac pacemaker implantation is contraindicated following a careful risk assessment by a multidisciplinary team, leadless cardiac pacemakers should only be used with special arrangements for clinical governance, consent and audit or research. Clinicians wishing to do leadless cardiac pacemaker implantation for bradyarrhythmias in people who cannot have conventional cardiac pacemaker implantation should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy compared with conventional pacemaker implantation, and provide them with clear written information. In addition, the use of NICE's information for the public is recommended. Further research in people who could have conventional cardiac pacemaker implantation should report the patient selection criteria and compare leadless pacemakers with conventional pacemakers. Follow?up should be for at least 5 years and outcomes should include adverse events, symptom relief, quality of life and device durability in the long?term. Clinicians should enter details about all patients having leadless cardiac pacemaker implantation for bradyarrhythmias onto the National Institute for Cardiovascular Outcomes Research database and review local clinical outcomes. The procedure should only be done in specialist centres by clinicians with specific training on, and supervised experience in, inserting the device. Centres where this procedure is done should have both cardiac and vascular surgical support for emergency treatment of complications. NICE advises clinicians to follow the Medicines and Healthcare products Regulatory Agency's (MHRA) Expert Advisory Group recommendations on leadless cardiac pacemaker therapy.";2018;;;"Low value";"Heart rhythm conditions";"Link to the recommendation on the website of the initiative" 5307;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Otitis media (acute): antimicrobial prescribing";"General advice to be given: - The usual course of acute otitis media (about 3 days, can be up to 1 week) - Managing symptoms, including pain, with self-care (see the recommendations on self-care). It is recommended that when no antibiotic prescription is given, as well as the general advice, in children and young people who may be less likely to benefit from antibiotics, give advice about: - An antibiotic not being needed - Seeking medical help if symptoms worsen rapidly or significantly, do not start to improve after 3 days, or the child or young person becomes systemically very unwell. It is recommended that when a back-up antibiotic prescription is given, as well as the general advice in children and young people who may be less likely to benefit from antibiotics, give advice about: - An antibiotic not being needed immediately - Using the back-up prescription if symptoms do not start to improve within 3 days or if they worsen rapidly or significantly at any time - Seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell. It is recommended that when an immediate antibiotic prescription is given in children and young people who may be more likely to benefit from antibiotics (those of any age with otorrhoea or those under 2 years with infection in both ears), as well as the general advice,give advice about seeking medical help if symptoms worsen rapidly or significantly, or the child or young person becomes systemically very unwell. It is recommended to offer an immediate antibiotic prescription with advice or further appropriate investigation and managemen to children and young people who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high-risk of complications. It is recommended to refer children and young people to hospital if they have acute otitis media associated with: - A severe systemic infection (see the NICE guideline on sepsis) - Acute complications, including mastoiditis, meningitis, intracranial abscess, sinus thrombosis or facial nerve paralysis. It is recommended in all children and young people with acute otitis media - To offer regular doses of paracetamol or ibuprofen for pain, using the right dose for the age or weight of the child at the right time, and maximum doses for severe pain. - To explain that evidence suggests decongestants or antihistamines do not help symptoms. To see recommendations on the choice of antibiotic, go to link. ";2018;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4284;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to prescribe home oxygen therapy following an acute exacerbation if PaO2 is = or > 60 mmHg in patients with exacerbated COPD.";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4796;19;"Choosing Wisely Canada";"Canadian Hematology Society";English;"It is not recommended to give IVIG as first line treatment for patients with asymptomatic immune thrombocytopenia (ITP).";"Treatment for ITP is recommended for a platelet count less than 30x10^9/L. Corticosteroids are considered first-line treatment, with the addition of intravenous IgG reserved for severe ITP and bleeding, when a rapid rise in platelets is required, or when corticosteroids are contraindicated. There is no evidence of benefit of intravenous IgG in combination with corticosteroids for first-line treatment of asymptomatic ITP. Unnecessary intravenous IgG infusions can result in multiple adverse effects, including acute hemolytic or anaphylactic reactions, infections, thromboembolic events, and aseptic meningitis.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5308;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sore throat (acute): antimicrobial prescribing";"It is recommended to give general advice about: - The usual course of acute sore throat (can last around 1 week) - Managing symptoms, including pain, fever and dehydration, with self-care (see the recommendations on self-care). It is recommended to reassess at any time if symptoms worsen rapidly or significantly, taking account of: - Alternative diagnoses such as scarlet fever or glandular fever - Any symptoms or signs suggesting a more serious illness or condition - Previous antibiotic use, which may lead to resistant organisms. In people who are unlikely to benefit from an antibiotic (FeverPAIN score of 0 or 1, or Centor score of 0, 1 or 2) it is recommended TO: - Do not offer an antibiotic prescription. - As well as the general advice, give advice about: -- An antibiotic not being needed -- Seeking medical help if symptoms worsen rapidly or significantly, do not start to improve after 1 week, or the person becomes systemically very unwell. In people who may be more likely to benefit from an antibiotic (FeverPAIN score of 2 or 3) it is recommended to: - Consider no antibiotic prescription with advice or a back-up antibiotic prescription, taking account of: -- Evidence that antibiotics make little difference to how long symptoms last (on average, they shorten symptoms by about 16 hours). -- Evidence that most people feel better after 1 week, with or without antibiotics -- The unlikely event of complications if antibiotics are withheld -- Possible adverse effects, particularly diarrhoea and nausea. - When a back-up antibiotic prescription is given, as well as the general advice, give advice about: -- An antibiotic not being needed immediately -- Using the back-up prescription if symptoms do not start to improve within 3 to 5 days or if they worsen rapidly or significantly at any time -- Seeking medical help if symptoms worsen rapidly or significantly or the person becomes systemically very unwell. In people who are most likely to benefit from an antibiotic (FeverPAIN score of 4 or 5, or Centor score of 3 or 4) it is recommended to: - Consider an immediate antibiotic prescription, or a back-up antibiotic prescription with advice taking account of: -- The unlikely event of complications if antibiotics are withheld -- Possible adverse effects, particularly diarrhoea and nausea. - When an immediate antibiotic prescription is given, as well as the general advice, give advice about seeking medical help if symptoms worsen rapidly or significantly or the person becomes systemically very unwell. In people who are systemically very unwell, have symptoms and signs of a more serious illness or condition, or are at high-risk of complications, it is recommended to: - Offer an immediate antibiotic prescription with advice or further appropriate investigation and management. - Refer people to hospital if they have acute sore throat associated with any of the following: -- Severe systemic infection (see the NICE guideline on sepsis) -- Severe suppurative complications (such as quinsy [peri-tonsillar abscess] or cellulitis, parapharyngeal abscess or retropharyngeal abscess or Lemierre syndrome). In all people with acute sore throat, it is recommended to: - Consider paracetamol for pain or fever, or if preferred and suitable, ibuprofen. - Advise about the adequate intake of fluids. - Explain that some adults may wish to try medicated lozenges containing either a local anaesthetic, a non-steroidal anti-inflammatory drug (NSAID) or an antiseptic. However, they may only help to reduce pain by a small amount. - Be aware that no evidence was found on non-medicated lozenges, mouthwashes, or local anaesthetic mouth spray used on its own. For recommendations on choice of antibiotic go to link. ";2018;;;"High value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5820;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the effects of interventions to reduce the task load of emergency medical personnel and other shift workers";"The COVID-19 pandemic is placing a strain on healthcare workers. Existing research on interventions to reduce task load (defined as the perceived difficulty in accomplishing a task or subjective mental workload) in the emergency department might provide useful information for policy makers. In this systematic review, the authors searched for studies of the effect of task load interventions among emergency medical workers or other shift workers on fatigue and their sleep quality. They did not restrict their search by type of publication and did the search in September 2016. They included 5 observational studies, which they judged to be at serious or very serious risk of bias. What was found: Based on the studies included in this review, the effects of task load interventions on fatigue, fatigue-related risks and sleep quality for emergency medical workers and other shift workers are uncertain.";2018;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4285;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to prescribe corticosteroid therapy for periods of > 14 days or with progressive reduction in therapy in patients with exacerbated COPD.";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4797;19;"Choosing Wisely Canada";"Canadian Hematology Society";English;"During interruption of warfarin anticoagulation for procedures, it is not recommended to ?bridge? with full-dose low molecular weight heparin (LMWH) or unfractionated heparin (UFH) unless the risk of thrombosis is high.";"Patients on warfarin with a low-risk for thrombotic events do not require bridging anticoagulation. If interruption is necessary, warfarin can be stopped 5 days prior to a planned procedure and resumed when it is felt to be safe to do so afterwards. Bridging with LMWH or UFH has been shown to cause excess bleeding when compared with no bridging and may ultimately delay resumption of warfarin. High-risk patients (e.g. mechanical mitral valve, venous thromboembolism within the last 3 months or atrial fibrillation with recent stroke/TIA) should be considered for bridging if the risk of thrombosis is higher than the risk of peri-procedural bleeding.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5309;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hearing loss in adults: assessment and management";"Do not offer adults manual syringing to remove earwax.";2018;;;"Low value";"Ear, nose and throat conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4286;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to perform spirometry in patients with known COPD when exacerbated COPD episodes occur. ";"Patients with exacerbated COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4798;19;"Choosing Wisely Canada";"Canadian Hematology Society";English;"It is not recommended to order thrombophilia testing in women with early pregnancy loss.";"Early pregnancy losses are common amongst healthy women. Current guidelines do not support the routine screening of women with pregnancy loss for inherited thrombophilias. Moreover, there are recommendations against instituting thromboprophylaxis in women with inherited thrombophilias wishing to achieve a successful term pregnancy. By performing testing for inherited thrombophilias, patients may be unnecessarily exposed to the harms of thromboprophylaxis, inappropriately labeled with a disease-state, and may unnecessarily modify future plans for travel, pregnancy or surgery based on detection of an ?asymptomatic? thrombophilia. Further, patients with negative testing may receive false reassurance.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4287;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to discontinue taking inhaled medication because an improvement in clinical symptoms has taken place in patients with COPD. ";"Self-care in patients with COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4799;19;"Choosing Wisely Canada";"Canadian Hematology Society";English;"It is not recommended to request a fine-needle aspirate (FNA) for the evaluation of suspected lymphoma.";"The diagnosis of lymphoma requires specimens with intact cellular architecture for accurate histopathologic and immunophenotypic classification. FNA is associated with a low sensitivity and potentially results in delays in lymphoma diagnosis. Although excisional biopsy is the gold standard for lymphoma diagnosis, depending on the lymph node location, excisional biopsy may be associated with complications and the need for general anesthesia. At a minimum, an imagingguided core biopsy should be obtained to improve the accuracy and timeliness of lymphoma diagnosis.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5311;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety of subcutaneous automated low-flow pump implantation for refractory ascites shows there are serious but well-recognised safety concerns, including device failure and acute kidney injury. Evidence on efficacy is limited in quantity. ";"Clinicians wishing to do subcutaneous automated low-flow pump implantation for refractory ascites should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients understand the procedure's safety and efficacy, as well as any uncertainties about these. Provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended. - Audit and review clinical outcomes of all patients having subcutaneous automated low-flow pump implantation for refractory ascites. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).";2018;;;"Low value";" Alcohol-use disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4288;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to use the inhaler incorrectly in patients with COPD. ";"Self-care in patients with COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4800;19;"Choosing Wisely Canada";"Canadian Hematology Society";English;"It is not recommended to transfuse patients based solely on an arbitrary hemoglobin threshold.";"Decisions to transfuse should be based on assessment of an individual patient including their underlying cause of anemia. There is high quality evidence that demonstrates a lack of benefit and, in some cases, harm to patients transfused to achieve an arbitrary transfusion threshold. If necessary, transfuse only the minimum number of units required instead of a liberal transfusion strategy. Risks of red blood cell transfusions include allergy, fever, infections, volume overload and hemolysis.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4289;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to stop walking due to feelings of dyspnea in patients with CPOD. ";"Self-care in patients with COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4801;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"The use of antibiotics in adults and children with uncomplicated acute otitis media is not recommended. ";"Both adults and children commonly present to the emergency department with symptoms of a middle ear infection, or acute otitis media (AOM). The symptoms of AOM include fever, earache, discharge from ear, and/or decreased hearing. Evidence suggests that adults and children with uncomplicated AOM do not need antibiotics. Treatment should focus on analgesia and the use of antibiotics should be limited to complicated or severe cases. A watch and wait approach (analgesia and observation for 48 to 72 hours) should be considered for healthy, non-toxic appearing children older than six months of age with no craniofacial abnormalities, mild disease (mild otalgia, temperature < 39�C without antipyretics), and who have reliable medical follow-up. Antibiotics should be considered if the child?s illness does not improve during the observation period, and for those children who are < 24 months of age with infection in both ears, and in those with AOM and ear discharge. Similarly, antibiotics should not be used for the initial treatment of uncomplicated AOM in adults. Delayed antibiotics are an effective alternative to immediate antibiotics to reduce antibiotic use. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5825;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - optimizando la salud en el espacio de trabajo en casa";Spanish;"There is uncertainty as to whether the use of progressive lens glasses with a screen filter is better than progressive lens glasses without a filter";"There is low to very low quality evidence that providing computer users with progressive computer glasses does not lead to a considerable decrease in problems with the eyes or headaches compared to other computer glasses. Progressive computer glasses might be slightly better than progressive glasses for daily use in the short term but not in the intermediate term and there is no data on long?term follow?up. The quality of the evidence is low or very low and therefore we are uncertain about this conclusion. Larger studies with several hundreds of participants are needed with proper randomisation, validated outcome measurement methods, and longer follow?up of at least one year to improve the quality of the evidence.";2018;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4290;32;"Otros art�culos/Other articles on this topic";"Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid).";English;"It is not recommended to take unprescribed treatments in patients with COPD. ";"Self-care in patients with COPD.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5314;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Involving people living with dementia in decisions about their care.";"Involving people in decision-making - Encourage and enable people living with dementia to give their own views and opinions about their care. - If needed, use additional or modified ways of communicating (for example visual aids or simplified text). - Consider using a structured tool to assess the likes and dislikes, routines and personal history of a person living with dementia.";2018;;;"High value";Dementia;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4291;2;"Choosing Wisely�";"American Academy of Nursing";English;"It is not recommended to routinely use graduated compression stockings in surgical patients as mechanical prophylaxis for preventing venous thromboembolism (VTE) after surgery, but do consider using intermittent pneumatic compression devices.";"Thromboembolic disease is a significant cause of complications and mortality in hospitalized patients and a growing public health issue. Although anyone can develop a VTE, research shows that half of the VTE events in the outpatient setting are directly linked to a recent hospitalization. Many of these events can be prevented through pharmacological and/or mechanical VTE prophylaxis. Current guidelines that recommend mechanical devices demonstrate a preference for intermittent pneumatic compression-pc (IPC) devices with no recommendations for graduated compression stockings (GCS), except for women at high risk for VTE after cesarean delivery. These IPC devices minimize adverse effects to skin, promote patient comfort, and permit clinician assessment compared to graduated compression stockings.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5315;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The three acetylcholinesterase (AChE) inhibitors donepezil, galantamine and rivastigmine as monotherapies are recommended as options for managing mild to moderate Alzheimer's disease under all of the conditions specified in 1.5.5 and 1.5.6 of this guide. ";"If prescribing an AChE inhibitor (donepezil, galantamine or rivastigmine), treatment should normally be started with the drug with the lowest acquisition cost (taking into account required daily dose and the price per dose once shared care has started). However, an alternative AChE inhibitor could be prescribed if it is considered appropriate when taking into account adverse event profile, expectations about adherence, medical comorbidity, possibility of drug interactions and dosing profiles.";2018;;;"High value";Dementia;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4292;2;"Choosing Wisely�";"American Academy of Nursing";English;"It is not recommended to apply continuous cardiac-respiratory or pulse oximetry monitoring to children and adolescents admitted to the hospital unless condition warrants continuous monitoring based on objectively scored cardiovascular, respiratory, and behavior parameters.";"Nurses use continuous electrocardiography (ECG), respiratory, and pulse oximetry monitoring to track patient vital signs and trends, and to help identify signs of patient status deterioration. However, when pulse oximetry and physiologic monitoring are used inappropriately, significant cost burdens can affect the entire healthcare system. In addition, the high number of alarm alerts and level of noise created by these alarms leads to alarm fatigue. When high levels of false alarms occur in the work environment, clinically significant alarms may be masked by being silenced or unrecognized when clinicians become desensitized. In addition to alarm fatigue, continuous bedside monitoring of pediatric patients can provide a false sense of security that the patient is ?safer? and that the nurse will note status changes in a patient more easily when a bedside monitor is used. Continuous bedside monitoring should not be used in place of hourly safety checks. Focused nursing assessments using a standardized early warning tool should be used to monitor changes in a pediatric patient?s status to identify deteriorations. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5316;1;"NICE ";" National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended the creation of suicide prevention partnerships among the community.";"Local authorities should work with local organisations to: - Set up a multi-agency partnership for suicide prevention. This could consist of a core group and a wider network of representatives. - Identify clear leadership for the partnership. - Ensure the partnership has clear terms of reference, based on a shared understanding that suicide can be prevented. - Ensure the partnership has clear governance and accountability structures. Include oversight from local health and care planning groups, for example health and wellbeing boards.";2018;;;"High value";" Mental health services";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4293;2;"Choosing Wisely�";"American Academy of Nursing";English;"It is not recommended to routinely repeat labs hemoglobin and hematocrit in the hemodynamically normal pediatric patients with isolated blunt solid organ injury.";"Preset timed interval measurements of hemoglobin and hematocrit are no longer indicated as early detectors of instability. Clinical instability is defined by physiologic criteria such as age-specific tachycardia or hypotension, tachypnea, low urine output, altered mental status, or any significant clinical deterioration that warrants increased level of care and investigation. Therefore, the routine use of repeat laboratories studies in children with isolated solid organ injury who have physiologically normal vital signs for their age is not necessary.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5061;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Given the evidence that the benefits of one of the bisphosphonates (alendronate) may continue for several years after the end of treatment, the Committee recommends that research should be carried out to define the optimal duration of treatment with individual bisphosphonates.";"The Committee recommends research into the long-term effects of bisphosphonates on bone quality, given the inhibitory effects on bone resorption of these drugs.";2018;;;"High value";Osteoporosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4294;2;"Choosing Wisely�";"American Academy of Nursing";English;"It is not recommended to use physical or chemical restraints, outside of emergency situations, when caring for long-term care residents with dementia who display behavioral and psychological symptoms of distress; instead assess for unmet needs or environmental triggers and intervene using non-pharmacological approaches as the first approach to care whenever possible. ";"Behavioral and psychological symptoms of distress (BPSD) include aggression, agitation, wandering, disruptive vocalizations, anxiety, apathy, hallucinations, and depression. The majority of people living with dementia will experience these symptoms. They result in poor quality of life, more rapid cognitive and functional decline, high risk for abuse, caregiver burden, and tremendous cost to the US healthcare system. In fact, dementia care is among the most costly of diseases including diabetes, cancer and heart disease; and BPSD account for a staggering 30% of total dementia costs. Despite the high human and dollar costs associated with these symptoms, their treatment continues to challenge practitioners and remains a top research priority in long-term care settings. Because BPSD are often triggered by a change in physical condition, an unmet need or an environment that exceeds the person?s stress threshold, it is important that these triggers be addressed as the first line of treatment rather than resorting to physical or chemical restraint, which carry a risk for adverse effects.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5062;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Given the evidence that the benefits of one of the bisphosphonates (alendronate) may continue for several years after the end of treatment, the Committee recommends that research should be carried out to define the optimal duration of treatment with individual bisphosphonates. ";"The Committee recommends research into the long-term effects of bisphosphonates on bone quality, given the inhibitory effects on bone resorption of these drugs.";2018;;;"High value";Osteoporosis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4295;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t remove hair at the surgical site including the hair on the patient?s head, but if hair must be removed it should be clipped not shaved. ";"Removing hair at the surgical site has long been believed to be associated with an increased rate of surgical site infections because of razor-induced microtrauma. Specifically, shaving the patient?s head prior to neurosurgery can disturb the natural protective effects of hair and skin flora, also causing micro-abrasions to the scalp that can increase the risk of infection. Postoperative wound infections increase the costs and the length of hospital stay. In any type of surgery there are times when hair removal should be considered. For example, during emergent craniotomies or any time a surgeon deems hair removal necessary for the surgical procedure. When hair removal is necessary, hair at the surgical site should be removed by clipping or depilatory methods. A razor should not be used. In a landmark nonexperimental study of 23,649 surgical wounds, Cruse (1973) found a 2.3% infection rate for surgical sites shaved with a razor, 1.7% for sites that were clipped, and 0.9% when no hair removal was performed. Yet shaving hair at the surgical site continues to be practiced. In addition, most patients dread the thought of having the hair on their head removed, and hair shaving can negatively affect their body image.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4296;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis. ";"Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be appropriate in patients with a complication of acute rhinosinusitis, patients with comorbidities that predispose them to complications and patients in whom an alternative diagnosis is suspected.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5320;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Leadless cardiac pacemaker implantation is not recommended for bradyarrhythmias. ";"Evidence on the safety of leadless cardiac pacemaker implantation for bradyarrhythmias shows that there are serious but well-recognised complications. The evidence on efficacy is inadequate in quantity and quality: - For people who can have conventional cardiac pacemaker implantation, leadless pacemakers should only be used in the context of research. - For people in whom a conventional cardiac pacemaker implantation is contraindicated following a careful risk assessment by a multidisciplinary team, leadless cardiac pacemakers should only be used with special arrangements for clinical governance, consent and audit or research. Clinicians wishing to do leadless cardiac pacemaker implantation for bradyarrhythmias in people who cannot have conventional cardiac pacemaker implantation should: - Inform the clinical governance leads in their NHS trusts. - Ensure that patients and their carers understand the uncertainty about the procedure's safety and efficacy compared with conventional pacemaker implantation, and provide them with clear written information. - Enter details about all patients having leadless cardiac pacemaker implantation for bradyarrhythmias onto the National Institute for Cardiovascular Outcomes Research database and review local clinical outcomes. The procedure should only be done in specialist centres by clinicians with specific training on, and supervised experience in, inserting the device. Centres where this procedure is done should have both cardiac and vascular surgical support for emergency treatment of complications. Further research in people who could have conventional cardiac pacemaker implantation should report the patient selection criteria and compare leadless pacemakers with conventional pacemakers. Follow?up should be for at least 5 years and outcomes should include adverse events, symptom relief, quality of life and device durability in the long?term.";2018;;;"Low value";"Heart rhythm conditions";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4297;2;"Choosing Wisely�";"American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America";English;"Do not order a screening hip ultrasound to rule out developmental hip dysplasia or developmental hip dislocation if the baby has no risk factors and has a clinically stable hip examination. ";"Hip dysplasia/dislocation is relatively rare, with incidence of approximately 7 per 1,000 births. Studies have shown that universal screening programs for developmental hip instability using ultrasounds to assess otherwise normal appearing hips have a nearly negligible positive yield. There is a substantial false positive rate, with an associated increase in treatment rate, suggesting that babies without hip pathology are being treated. When there are no physical findings or underlying risk factors for hip dysplasia/dislocation in a newborn, a hip ultrasound is costly, time-intensive and the findings may be misleading to parents and physicians. This recommendation is in accordance with the 2016 AAP clinical report regarding the use of ultrasound in early detection of developmental dysplasia of the hip (see reference: ?Evaluation and Referral for Developmental Dysplasia of the Hips in Infants?).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6345;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Do not prescribe combination therapy (inhaled corticosteroids with long-acting beta2 agonist) as initial therapy in mild to moderate asthma before a trial of inhaled corticosteroids alone. ";"Even for children with persistent asthma, the most recent evidence suggests that adding long-acting beta2 agonists to inhaled corticosteroids does not result in a statistically significant reduction in exacerbations. However, there is some evidence that LABA/ICS combination therapy increases the risk of hospital admissions and severe asthma-associated adverse events, particularly among asthmatic children aged 4 to 11 years old. Due to the limited paediatric evidence on the safety and efficacy of long-acting beta2 agonists, the use of ICS alone is therefore recommended for the initial preventative therapy and the only therapy for children with mild to moderate asthma.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4298;2;"Choosing Wisely�";"American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America";English;"Do not order radiographs or advise bracing or surgery for a child less than 8 years of age with simple in-toeing gait.";"Mild in-toeing is usually a physiologic phenomenon reflecting ongoing maturation of the skeleton. Metatarsus adductus, femoral anteversion, and tibial torsion all contribute to in-toeing and tend to improve with growth. Simply monitoring gait for continued improvement at normal well child examination intervals is adequate until the age of 7?8 unless there is severe tripping and falling or asymmetry. It is not possible to alter the natural evolution using physical therapy, bracing or shoe inserts.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4299;2;"Choosing Wisely�";"American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America";English;"Do not order custom orthotics or shoe inserts for a child with minimally symptomatic or asymptomatic flat feet. ";"Flexible flat feet are normal physiologic variants commonly found in children and adults. Unlike a painful or rigid flatfoot that requires further workup, if an arch is present when standing on tiptoe, the foot can be managed with observation or over-the-counter orthotics. The use of custom orthotic devices to provide support for the foot does not aid in the development of the arch.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5323;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When evaluating post-traumatic stress disorder, it is recommended that you ask people specific questions about the new experience, avoidance, hyperactivation, dissociation, negative mood disturbances, and associated thinking and functional control, as well as ask people with specific symptoms and if they have experienced 1 or more traumatic events.";"Assessment and coordination of care - For people with clinically important symptoms of PTSD presenting in primary care, GPs should take responsibility for assessment and initial coordination of care. This includes determining the need for emergency physical or mental health assessment. [2005, amended 2018] - Assessment of people with PTSD should be comprehensive, including an assessment of physical, psychological and social needs and a risk assessment. [2005, amended 2018] - Where management is shared between primary and secondary care, healthcare professionals should agree who is responsible for monitoring people with PTSD. Put this agreement in writing (if appropriate, using the Care Program Approach) and involve the person and, if appropriate, their family or carers.";2018;;;"High value";Anxiety;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4300;2;"Choosing Wisely�";"American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America";English;"Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory and plain radiographic examinations have been completed. ";"History, physical examination, and appropriate radiographs remain the primary diagnostic modalities in pediatric orthopaedics, as they are both diagnostic and prognostic for the great majority of pediatric musculoskeletal conditions. Examples of such conditions would include, but not be limited to, the work up of injury or pain (spine, knees and ankles), possible infection, and deformity. MRI examinations and other advanced imaging studies are costly, frequently require sedation in the young child (5 years old or less), and may not result in appropriate interpretation if clinical correlations cannot be made. Many conditions require specific MRI sequences or protocols best ordered by the specialist who will be treating the patient. Inappropriately obtained MRIs may need to be repeated in those circumstances. Additionally, a significant dose of radiation is delivered to the patient during a CT scan, so their utility in a specific case would be best confirmed prior to ordering. Therefore, in those conditions where advanced imaging is indicated, it has greater value when it is used to answer a specific question that arises from a thorough clinical and appropriate radiographic evaluation. Additionally, if you believe findings warrant additional advanced imaging, discuss with the consulting orthopaedic surgeon to make sure the optimal studies are ordered.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4812;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.";"Once target control is achieved and the results of self-monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming this state. There are many exceptions, such as acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 6348;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia ";English;"Do not recommend complementary medicines or therapies unless there is credible evidence of efficacy and the benefit of use outweighs the risk. ";"Complementary medicines may also be called 'traditional' or 'alternative' medicines and include items such as vitamins, minerals, herbal products, aromatherapy and homoeopathic products. Many of the products available in pharmacies, supermarkets or health food outlets have limited evidence of efficacy. There is some evidence of efficacy for some complementary medicines, however this may be formulation and dose dependent, and health practitioners are encouraged to seek this information before recommending such products.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4301;2;"Choosing Wisely�";"American Academy of Pediatrics and the Pediatric Orthopaedic Society of North America";English;"Do not order follow-up X-rays for buckle (or torus) fractures if they are no longer tender or painful. ";"Buckle (torus) fractures are very common injuries in young children, especially in the distal radius. The fracture is one of compression, where the metaphyseal bone impacts on itself, and actually becomes denser. These fractures are inherently stable and do not necessarily require a formal cast, unless severe pain or fracture instability necessitates a cast for 4 weeks. Instead immobilization with a simple wrist brace or removable splint is often preferable. The mild cortical angular deformity reliably remodels over time and requires no intervention or monitoring. If the fracture is non-tender to palpation at 4 weeks post-injury, no follow-up radiograph is required, and full activities may be resumed.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5069;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pertuzumab, in combination with trastuzumab and docetaxel, is recommended, within its marketing authorisation, for treating HER2?positive metastatic or locally recurrent unresectable breast cancer, in adults who have not had previous anti?HER2 therapy or chemotherapy for their metastatic disease, only if the company provides pertuzumab within the agreed commercial access arrangement.";"This recommendation is for a drug that has been available on the Cancer Drugs Fund for several years and the committee recognised this as an exceptional circumstance. In this context, the committee considered it reasonable to apply flexibility in its interpretation of the criteria for special consideration as a life-extending treatment for people with a short life expectancy, but noted that the weight applied to the quality-adjusted life years gained would not be at the maximum allocated in other, more regular, circumstances where the end of life criteria have been applied. With this in mind, the committee accepted that the incremental cost-effectiveness ratio, taking into account the commercial access arrangement, provides for an acceptable use of NHS resources.";2018;;;"High value";"breast cancer ";"http://https://www.nice.org.uk/guidance/ta509/chapter/1-Recommendations" 5837;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Notification of mental health services to survivors after a disaster is recommended";"Existing research on the mental health impacts of humanitarian disasters, including pandemic illnesses, might provide useful information for policy makers. In this integrative review, the authors searched for articles about notification methods for psychiatric mental health services for adult survivors of disasters caused by natural hazards. They restricted their search to studies published in English between 2011 and 2016. They included 18 studies, many of which related to Hurricane Katrina. Mental healthcare providers might have a significant impact on disaster recovery by developing communication plans within the disaster response. ";2018;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6349;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Do not prescribe antibiotics for exacerbation of asthma. ";"The most recent Global Initiative for Asthma (GINA) report does not recommend a role for antibiotics in management of asthma exacerbation unless there is strong evidence of lung infection, such as fever and purulent sputum or radiographic evidence of pneumonia. This is supported by recent trials involving azithromycin (a commonly prescribed antibiotic for management of asthma), which found that this drug had no statistically significant impacts on severity of symptoms during an exacerbation. One small randomised controlled trial (RCT) in young children with recurrent asthma-like symptoms showed that azithromycin reduced the duration of asthma-like symptoms. No RCT has been conducted in children who have a diagnosis of asthma to determine if the rate of severe asthma exacerbation or the severity of asthma symptoms or duration of an asthma exacerbation is reduced by azithromycin. A potential role for azithromycin in reducing the duration of an episode of asthma-like symptoms in children less than 3 years of age requires further investigation. Antibiotic treatment in addition to its lack of efficacy also increases the risk of bacteria resistance for those on long term treatment regimes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4302;2;"Choosing Wisely�";"American Gastroenterological Association";English;"Do not repeat colorectal cancer screening (by any method) in average risk individuals for 10 years after a high-quality colonoscopy that does not detect neoplasia.";"A screening colonoscopy every 10 years is the recommended interval for adults without increased risk for colorectal cancer, beginning no later than age 50. Published studies indicate the risk of cancer is low for 10 years after a high-quality colonoscopy fails to detect neoplasia in this population. Therefore, following a high-quality colonoscopy that does not detect neoplasia, the next interval for any colorectal screening should be 10 years following that normal colonoscopy.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5070;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Eribulin is not recommended for treating locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen.";"People with advanced breast cancer who have had 1 chemotherapy regimen are usually then offered an anthracycline, a taxane or capecitabine, depending on what they have had already. The clinical trial results for eribulin showed that it did not increase progression-free survival, but there was an average overall survival increase of 4.6 months compared with capecitabine. Since treatment is changed when the disease progresses, and eribulin would have been stopped at that stage, it is not clear whether the increase in overall survival is because of eribulin, or related to the treatments given after eribulin. Eribulin is already recommended after 2 previous chemotherapy treatments, and there are no trials which compare its effectiveness given after 1 or 2 previous treatments, so this remains uncertain. Eribulin meets NICE's criteria to be considered a life-extending treatment at the end of life. The estimates of cost effectiveness for eribulin range from �36,200 to �82,700 per quality-adjusted life year (QALY) gained. The most plausible estimate of cost effectiveness, based on a revised company model and the committee's preferred assumptions, is �69,800 per QALY gained. This is above what NICE normally considers to be acceptable for end-of-life treatments. Therefore, eribulin cannot be recommended as a cost-effective option for locally advanced or metastatic breast cancer in adults who have had only 1 chemotherapy regimen.";2018;;;"Low value";" Breast cancer ";"https://www.nice.org.uk/guidance/ta515/chapter/1-Recommendations" 4303;2;"Choosing Wisely�";"The American Occupational Therapy Association, Inc.";English;"Don?t provide intervention activities that are non-purposeful (e.g., cones, pegs, shoulder arc, arm bike). ";"Purposeful activities?tasks that are part of daily routines and hold meaning, relevance, and perceived utility such as personal care, home management, school, and work?are a core premise of occupational therapy. Research shows that using purposeful activity (occupation) in interventions is an intrinsic motivator for patients. Such activities can increase attention, endurance, motor performance, pain tolerance, and engagement, resulting in better patient outcomes. Purposeful activities build on a person?s ability and lead to achievement of personal and functional goals. Conversely, non-purposeful activities do not stimulate interest or motivation, resulting in reduced patient participation and suboptimal outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5071;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Avelumab is recommended as an option for treating metastatic Merkel cell carcinoma in adults, only if they have had 1 or more lines of chemotherapy for metastatic disease.";"Treatment options for metastatic Merkel cell carcinoma are limited. People are usually offered chemotherapy or best supportive care. Avelumab could potentially be used as a first-line treatment or after chemotherapy. Clinical trial evidence suggests that avelumab may improve overall survival compared with chemotherapy. But chemotherapy has not been compared directly with avelumab so the results are highly uncertain. The evidence on avelumab is promising, but the trial included only a small number of people and data are still being collected. Avelumab as a first-line or second-line treatment meets NICE's criteria to be considered a life-extending end-of-life treatment. Avelumab is recommended as a second-line treatment after chemotherapy because it is within the range NICE normally considers acceptable for end-of-life treatments. Avelumab has the potential to be cost effective as a first-line treatment, at the price agreed in the managed access agreement with NHS England. But more evidence is needed to address the clinical uncertainties. It is therefore recommended for use within the Cancer Drugs Fund as a first-line treatment while further data are collected.";2018;;;"High value";Metastases;"https://www.nice.org.uk/guidance/ta517" 6351;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Do not use oral beta2 agonists as bronchodilators in asthma, wheeze or bronchiolitis. ";"The weight of evidence does not support the use of oral beta2 agonists as bronchodilators in children with asthma, wheeze or bronchiolitis. In the case of asthma, oral beta2 agonists have not been shown to have a significant impact on symptom score or length of hospital stay for acute asthma in infancy when compared to placebo. For wheeze inhalation is the recommended route for delivering relievers for all children and adults. For bronchiolitis, according to the latest evidence, oral bronchodilators are no better than placebo at reducing the time to resolution of illness among infants treated at home or affecting the probability or rates of hospital admission after treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4304;2;"Choosing Wisely�";"The American Occupational Therapy Association, Inc.";English;"Don?t provide sensory-based interventions to individual children or youth without documented assessment results of difficulties processing or integrating sensory information. ";"Many children and youth are affected by challenges in processing and integrating sensations that negatively affect their ability to participate in meaningful and valued occupations. Processing and integrating sensations are complex and result in individualized patterns of dysfunction that must be addressed in personalized ways. Interventions that do not target the documented patterns of dysfunction can produce ineffective or negative results. Therefore, it is imperative to assess and document specific sensory difficulties before providing sensory-based interventions such as Ayres Sensory Integration�, weighted vests, listening programs, or sensory diets.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6352;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia";English;"It is not recommended initiate medications to treat symptoms, adverse events, or side effects (unless in an emergency) without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another treatment is warranted.";"The prescribing cascade occurs when a new medicine is prescribed to 'treat' a side effect from another drug. The cascade often occurs in the mistaken belief that the side effect is a sign or symptom of a new condition requiring treatment. Other times, it can be a belief that it is more important to continue therapy with the original drug and prescribe another medicine to manage the side effects. Pharmacists and prescribers need to be aware that a new sign or symptom may potentially be a side effect of a current medicine.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4305;2;"Choosing Wisely�";"The American Occupational Therapy Association, Inc.";English;"Don?t use physical agent modalities (PAMs) without providing purposeful and occupation-based intervention activities. ";"The exclusive use of PAMs (e.g., superficial thermal agents, deep thermal agents, electrotherapeutic agents, mechanical devices) as a therapeutic intervention without direct application to occupational performance is not considered occupational therapy. PAMs provided with a functional component can lead to more positive health outcomes. PAMs should be integrated into a broader occupational therapy program and intervention plan in preparation for or concurrently with purposeful activities or interventions that ultimately enhance engagement in occupation.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4817;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests unless there is a palpable abnormality of the thyroid gland.";"Thyroid ultrasound is used to identify and characterize thyroid nodules, and is not part of the routine evaluation of abnormal thyroid function tests (over- or underactive thyroid function) unless the patient also has a large goiter or a lumpy thyroid. Incidentally discovered thyroid nodules are common. Overzealous use of ultrasound will frequently identify nodules, which are unrelated to the abnormal thyroid function, and may divert the clinical evaluation to assess the nodules, rather than the thyroid dysfunction. Imaging may be needed in thyrotoxic patients; when needed, a thyroid scan, not an ultrasound, is used to assess the etiology of the thyrotoxicosis and the possibility of focal autonomy in a thyroid nodule.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5073;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab is recommended for use within the Cancer Drugs Fund as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy";"Treatment for previously treated locally advanced or metastatic urothelial carcinoma is docetaxel or paclitaxel. Clinical trial evidence shows that pembrolizumab significantly improves overall survival compared with these drugs. Pembrolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. The most plausible cost-effectiveness estimate is uncertain because it is not clear which overall survival extrapolation is most appropriate to use for the economic modelling. Based on the company's commercial offer as part of the managed access agreement proposal, and the preferred assumptions and extrapolations, the cost-effectiveness estimates using either the evidence review group's or company's preferred overall survival extrapolation are between �44,504 and �46,447 per quality-adjusted life year (QALY) gained. This is in line with what NICE normally considers acceptable for end-of-life treatments (less than �50,000 per QALY gained), although other plausible estimates are higher. However, the cost-effectiveness estimates assume that, despite a 2-year stopping rule, the effect of pembrolizumab continues for the duration of the model (a lifetime continued treatment effect) which is implausible. Accounting for this effect increases cost-effectiveness estimates, although it's not certain by how much; some plausible estimates are more than �50,000 per QALY gained. Pembrolizumab has plausible potential to be cost effective. Further data collection would reduce the uncertainty around overall survival and continued treatment effect. Therefore pembrolizumab can be recommended for use in the Cancer Drugs Fund. Pembrolizumab appears to be more effective for people with urothelial carcinoma expressing the PD-L1 protein than for people who do not express PD-L1. However, the cost-effectiveness results for this group are not reliable so no recommendations can be made.";2018;;;"High value";"Bladder cancer ";"https://www.nice.org.uk/guidance/ta519" 4306;2;"Choosing Wisely�";"The American Occupational Therapy Association, Inc.";English;"Don?t use pulleys for individuals with a hemiplegic shoulder. ";"Use of an overhead pulley for individuals with a hemiplegic shoulder resulting from a stroke or other clinical condition is considered too aggressive and should be avoided, as it presents the highest risk of the patient developing shoulder pain. Gentler and controlled range of motion exercises and activities are preferred.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5074;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Atezolizumab is recommended as an option for treating locally advanced or metastatic non-small-cell lung cancer (NSCLC) in adults who have had chemotherapy (and targeted treatment if they have an EGFR- or ALK?positive tumour";"Treatments for NSCLC after chemotherapy include docetaxel alone, pembrolizumab (for tumours expressing the PD?L1 protein) and nintedanib plus docetaxel for adenocarcinoma. Clinical trial evidence shows that people having atezolizumab live longer than those having docetaxel alone. There is no evidence directly comparing atezolizumab with pembrolizumab. But indirect analyses show that for people with PD?L1?positive disease, there may be no difference in survival benefit for atezolizumab compared with pembrolizumab. Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life compared with docetaxel alone, but not compared with pembrolizumab. The most plausible cost-effectiveness estimates for atezolizumab, compared with docetaxel (for PD?L1?negative disease) and with pembrolizumab (for PD?L1?positive disease), are within the range NICE considers an acceptable use of NHS resources. Therefore it can be recommended after chemotherapy for locally advanced or metastatic NSCLC.";2018;;;"High value";"Lung cancer ";"https://www.nice.org.uk/guidance/ta520" 5842;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Social distancing is recommended in the workplace to reduce flu transmission";"In this systematic review, the authors searched for research on workplace social distancing interventions for the prevention of influenza transmission. They restricted their searches to articles published in English since 2000 and did the search in May 2017. They included 3 epidemiological studies and 12 modelling studies. Within the studies included in this review, workplace social distancing measures (working from home where possible, extended weekends or rotating workforce schedules) reduced influenza transmission, both in the workplace and the wider population. Adding other nonpharmaceutical and pharmaceutical measures increased the effectiveness of workplace social distancing. The effects of workplace social distancing in lower income countries are uncertain.";2018;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4307;2;"Choosing Wisely�";"The American Occupational Therapy Association, Inc.";English;"Don?t provide cognitive-based interventions (e.g., paper-and-pencil tasks, table-top tasks, cognitive training software) without direct application to occupational performance. ";"To improve occupational performance, cognitive-based interventions should be embedded in an occupation relevant to the patient. Examples of cognitive-based interventions include awareness approaches, strategy training, task training, environmental modifications, and assistive technology. The use of cognitive-based interventions not based on occupational performance will result in suboptimal patient outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6355;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"For children with bronchiolitis without other co-morbidities, do not delay discharge from an inpatient admission based on oxygen saturations alone if saturations are ?90%. ";"Clinical guidelines and recent evidence indicate that oxygen supplementation need only be commenced for children with uncomplicated bronchiolitis (i.e. bronchitis without other co-morbidities) if oxygen saturation levels fall below percentage levels around the early 90s. While one guideline cites 92% as the minimum acceptable level, other research shows that management of infants with bronchiolitis to an oxygen saturation target of 90% or higher is as safe and clinically effective as one of 94% or higher. On the balance of evidence, we recommend that children with bronchiolitis without other co-morbidities can be safely discharged if oxygen saturation levels are 90% or higher.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4308;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not place a central venous catheter if peripheral vein access is a safe and effective option.";"For most adult patients and donors, peripheral venous access is the safest, quickest and most easily achievable route for performing a limited number of apheresis procedures. Avoiding a central venous catheter reduces the risk of harm.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4820;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t use Free T4 or T3 to screen for hypothyroidism or to monitor and adjust levothyroxine (T4) dose in patients with known primary hypothyroidism, unless the patient has suspected or known pituitary or hypothalamic disease.";"T4 is converted into T3 at the cellular level in virtually all organs. Intracellular T3 levels regulate pituitary secretion and blood levels of TSH, as well as the effects of thyroid hormone in multiple organs. Therefore, in most people a normal TSH indicates either normal endogenous thyroid function or an adequate T4 replacement dose. TSH only becomes unreliable in patients with suspected or known pituitary or hypothalamic disease when TSH cannot respond physiologically to altered levels of T4 or T3. Patients should have access to additional testing, as required.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5076;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Atezolizumab is recommended as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy. ";"These recommendations only cover people with locally advanced or metastatic urothelial carcinoma who have had platinum-containing chemotherapy. There is separate guidance on atezolizumab for untreated disease for people who cannot have cisplatin. Treatment options for people whose disease has progressed after platinum-containing chemotherapy include docetaxel, paclitaxel or best supportive care. Evidence from 2 clinical trials, one of which compares atezolizumab directly with chemotherapy, suggests that atezolizumab is an effective treatment. According to clinical experts, the trial results compare favourably with their experience of current treatments for the disease. Atezolizumab meets NICE's criteria to be considered a life-extending treatment at the end of life. Although there are uncertainties in the economic model, the most plausible cost-effectiveness estimates for atezolizumab compared with taxanes are within the range NICE considers an acceptable use of NHS resources. Therefore, atezolizumab can be recommended as an option for treating locally advanced or metastatic urothelial carcinoma in adults who have had platinum-containing chemotherapy.";2018;;;"High value";" Bladder cancer ";"https://www.nice.org.uk/guidance/ta525" 6356;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia";English;"Promoting or supplying homeopathic products is not recommended as there is no reliable evidence of their efficacy";"Homeopathic products are widely available to consumers from a variety of platforms including the internet, supermarkets, and health stores. Many consumers are not aware that there is no reliable evidence to support the use of homeopathic products to treat or prevent ailments. There may be a public perception that these products have health benefits. Consumers may put their health at risk if they choose homeopathic products and reject or delay treatments for which there is good evidence for safety and effectiveness. Many products are being sold with little or no information. All health professionals, particularly pharmacists and doctors, have a critical role to educate consumers so they can make informed decisions about how best to manage their health using evidence based medicine.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4309;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not routinely use plasma as replacement fluid for therapeutic plasma exchange unless there is a clear indication to replete a plasma component. ";"Plasma is a limited resource with added concern for potential transmission of infectious agents and transfusion reactions. Albumin is an effective replacement fluid for therapeutic plasma exchange and is a safe alternative to plasma when a pathogenic protein or solute is removed without the need to replete any plasma component.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5077;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nivolumab is not recommended, within its marketing authorisation, for treating locally advanced unresectable or metastatic urothelial carcinoma in adults who have had platinum-containing therapy.";"Treatment options for people with locally advanced unresectable or metastatic urothelial carcinoma who have had platinum-containing therapy are limited. They are usually offered docetaxel, paclitaxel and best supportive care. Nivolumab has been studied in a clinical trial, but it has not been directly compared with other treatments. So it is not clear how effective nivolumab is compared with current clinical practice. Nivolumab meets NICE's criteria to be considered a life-extending treatment at the end of life. The committee agreed that the assumptions incorporated in the evidence review group's (ERG's) revised base case were mostly consistent with its preferred assumptions. The committee agreed that the most plausible incremental cost-effectiveness ratios (ICERs) were somewhere between the ERG's estimates of �58,791 per quality-adjusted life year (QALY) gained (compared with paclitaxel) and �78,869 per QALY gained (compared with docetaxel), above what NICE normally considers to be acceptable for end-of-life treatments. There was substantial uncertainty because the model used a simulated treatment comparison, so the ICER could be considerably higher. Therefore nivolumab could not be recommended for routine use in the NHS for locally advanced, unresectable or metastatic urothelial cancer after platinum-containing chemotherapy. Because neither data collection from clinical practice or the ongoing trials would resolve the identified uncertainty, nivolumab is not suitable for use within the Cancer Drugs Fund for people with unresectable or metastatic urothelial cancer after platinum-containing therapy.";2018;;;"Low value";"Bladder cancer ";"https://www.nice.org.uk/guidance/ta530" 4310;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not continue simple transfusions in patients with stroke from sickle cell disease who have iron overload, if red blood cell exchange is available. ";"Stroke is a common cause of serious morbidity in children and mortality in adults with sickle cell disease. Exchange transfusion is a more effective method than simple transfusions to prevent both recurrent strokes and the complications of iron overload.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5078;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Offer standard structural MRI (defined as T2 weighted, FLAIR, DWI series and T1 pre- and post-contrast volume) as the initial diagnostic test for suspected glioma, unless MRI is contraindicated.";"The evidence indicated that standard structural MRI is useful in distinguishing high-grade from low-grade glioma. The committee noted that this knowledge will inform management. Based on their experience, the committee recommended a protocol that they defined as a minimum standard for imaging acquisition. No evidence was found on more advanced MRI techniques. However, the committee agreed that in their experience such techniques can be useful for assessing malignant features of a tumour ? in particular, for ensuring that high-grade tumours are not misdiagnosed as low-grade tumours, which could have serious consequences for people who receive suboptimal management as a result. However the committee explained that a specialist multidisciplinary team would be needed to interpret features of the scan and decide management, even if advanced techniques were used.";2018;;;"High value";"Brain cancer ";"https://www.nice.org.uk/guidance/ng99" 6358;29;"Choosing Wisely Australia";"The Thoracic Society of Australia and New Zealand";English;"Do not delay immunisation/s based on presence of mild respiratory symptoms in the absence of fever. ";"Major guidelines on immunisation/vaccination do not cite the presence of minor or moderate acute illness (including mild respiratory symptoms), whether with or without fever, as a contraindication for immunisation. Australian immunisation guidelines explicitly state that ?mild illness without fever? is not a contraindication while US guidelines state that mild acute illness ?with or without fever? are ?commonly misperceived? as contraindications. Failure to immunise children with minor illnesses can reduce the effectiveness of immunisation campaigns. Given these considerations we adopt the conservative formulation that at least in the absence of fever, immunisation should not be delayed due to the mere presence of mild respiratory symptoms.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4311;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not routinely monitor coagulation tests during a course of therapeutic plasma exchange, unless the procedure is performed daily. ";"For most indications, therapeutic plasma exchange can be performed on an intermittent schedule using clotting factor deficient replacement fluid without the need for routine monitoring of the patient?s hemostasis status. Daily treatments significantly reduce clotting factors; therefore, coagulation testing may be appropriate.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4823;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency.";"Many of the symptoms attributed to male hypogonadism are commonly seen in normal male aging or in the presence of comorbid conditions. Testosterone therapy has the potential for serious side effects and represents a significant expense. It is therefore important to confirm the clinical suspicion of hypogonadism with biochemical testing. Current guidelines recommend the use of a total testosterone level obtained in the morning. A low level should be confirmed on a different day, again measuring the total testosterone. In some situations, a free or bioavailable testosterone may be of additional value.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5079;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab is recommended as an option for untreated PD?L1-positive metastatic non-small-cell lung cancer (NSCLC) in adults whose tumours express PD?L1 (with at least a 50% tumour proportion score) and have no epidermal growth factor receptor- or anaplastic lymphoma kinase-positive mutations";"People with untreated metastatic PD?L1-positive NSCLC are usually offered platinum-based chemotherapy (docetaxel, gemcitabine, paclitaxel, vinorelbine or pemetrexed, with a platinum-based drug). Clinical trial evidence shows that pembrolizumab increases the length of time people live by nearly 16 months compared with chemotherapy. Although there is uncertainty about the long-term treatment benefit of pembrolizumab after treatment is stopped, there was sufficient evidence of an important extension-to-life benefit in people with untreated stage 4 metastatic PD?L1-positive NSCLC compared with standard care. The most plausible cost-effectiveness estimate for pembrolizumab compared with chemotherapy is within the range NICE normally considers acceptable for an end-of-life treatment. Therefore it can be recommended as an option for untreated metastatic PD?L1-positive (with at least a 50% tumour proportion score) NSCLC if treatment is stopped after 2 years.";2018;;;"High value";"Lung cancer ";"https://www.nice.org.uk/guidance/ta531" 4312;2;"Choosing Wisely�";"American Society for Apheresis";English;"Do not routinely continue a series of apheresis procedures without a predefined objective goal, and stop the series if it is apparent that the goal cannot be reached or adverse effects outweigh potential benefits. ";"Apheresis procedures are performed sequentially until a predefined objective goal is reached. When the goal is either achieved or is determined to be unreachable the burden and potential adverse effects of performing additional procedures outweighs the potential benefits.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5080;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pembrolizumab is recommended for use within the Cancer Drugs Fund as an option for untreated locally advanced or metastatic urothelial carcinoma in adults when cisplatin-containing chemotherapy is unsuitable";"Current treatment for untreated locally advanced or metastatic urothelial carcinoma when cisplatin-containing chemotherapy is unsuitable is carboplatin plus gemcitabine. Atezolizumab is also an option, but only within the Cancer Drugs Fund, because of uncertainty about its clinical effectiveness. Pembrolizumab has been studied in a single-arm clinical trial (KEYNOTE?052). It appears to be effective but it's difficult to establish the size of the clinical benefit because it has not been directly compared with other treatments in a clinical trial. Also, the long-term benefits of pembrolizumab are uncertain because the trial is ongoing. These issues mean that the estimates of cost effectiveness are also very uncertain. Pembrolizumab meets NICE's criteria to be considered a life-extending end-of-life treatment. It has the potential to be cost effective, but more evidence is needed to address the clinical uncertainties. Longer follow?up data from KEYNOTE?052 and collecting further data from people taking part in KEYNOTE?361, which directly compares pembrolizumab with other treatments, would help to address some of the uncertainties. Pembrolizumab can therefore be recommended for use within the Cancer Drugs Fund while further data are collected.";2018;;;"High value";"Bladder cancer ";"https://www.nice.org.uk/guidance/ta522" 6360;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia";English;"It is not recommended to dispense a repeat prescription for an antibiotic without first clarifying clinical appropriateness.";"Inappropriate use of antibiotics could result in infection progression, leading to increased patient morbidity and mortality, as well as contributing to antibiotic resistance. In some chronic conditions, such as COPD, repeated antibiotics form part of a management plan. However, in other cases patients commonly request dispensing of repeat antibiotic prescriptions without consultation with their treating doctor, and sometimes well after the original prescription was written. If a repeat prescription for an antibiotic is requested to be dispensed, consider the clinical appropriateness of the request.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/" 4313;2;"Choosing Wisely�";"American Soc. for Blood and Marrow Transplantation & the Canadian Blood and Marrow Transplant Group";English;"Don?t routinely use peripheral blood stem cells for patients with aplastic anemia when a suitable bone marrow donor is available due to a higher risk of graft-versus-host disease. ";"Mientras que el injerto m�s r�pido con c�lulas madre de sangre perif�rica movilizadas con filgrastim da como resultado una recuperaci�n m�s r�pida de los recuentos de sangre perif�rica en comparaci�n con la m�dula �sea en pacientes con anemia apl�sica, la mayor tasa de enfermedad de injerto contra hu�sped puede ser perjudicial.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4569;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Pediatr�a";Spanish;"It is not recommended the realization of food allergens panels (in which a common long group of allergens is tested) in a clinical suspicion of food allergy.";"The results, regardless of the medical history of the type of food that triggers the food allergy, mislead the overdiagnosis of food allergy, the unnecessary elimination of food from the diet, potential nutritional deficiencies and the decrease in the child's quality of life and the family; also, to an increase in the costs of the use and in an erroneous interpretation of the panels.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5081;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lutetium (177Lu) oxodotreotide is recommended, within its marketing authorisation, as an option for treating unresectable or metastatic, progressive, well-differentiated (grade 1 or grade 2), somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumours (NETs) in adults. It is recommended only if the company provides it according to the commercial arrangement.";"NETs can affect the pancreas and gastrointestinal tissue and are difficult to diagnose and treat. Current treatment options include everolimus, sunitinib and best supportive care. Clinical trial evidence shows that lutetium (177Lu) oxodotreotide (referred to as lutetium) is effective for treating somatostatin receptor-positive gastrointestinal and pancreatic NETs. Indirect comparison with everolimus, sunitinib and best supportive care suggests lutetium is effective for treating gastrointestinal and pancreatic NETs in people with progressive disease. For treating pancreatic NETs, lutetium meets NICE's end-of-life criteria. Compared with everolimus, sunitinib and best supportive care, the cost-effectiveness estimates are within the range NICE normally considers acceptable. So lutetium can be recommended for treating pancreatic NETs. For treating gastrointestinal NETs, lutetium does not meet the end-of-life criteria because life expectancy for this form of the disease is between 5 and 6 years. But it can be recommended because the most plausible cost-effectiveness estimate is within what NICE normally considers acceptable and treatment options for gastrointestinal NETs are limited.";2018;;;"High value";Metastases;"https://www.nice.org.uk/guidance/ta539" 4314;2;"Choosing Wisely�";"American Soc. for Blood and Marrow Transplantation & the Canadian Blood and Marrow Transplant Group";English;"Don?t use greater than 2 mg/kg/day of methylprednisolone (or equivalent) for the initial treatment of graft-versus-host disease. ";"Published studies have shown no advantage to using methylprednisolone-equivalent doses higher than 2 mg/kg/day in acute graft-versus-host disease. In addition, using higher doses increases risks of corticosteroid related toxicity. Furthermore, at least in patients with grade I-II acute graft-versus-host disease, initial therapy with lower-dose corticosteroids at 1 mg/kg/day may be equivalent.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4570;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"Do not request studies to determine the serum concentration of vitamin D in healthy people without risk of hypovitaminosis D";"There is no evidence of the benefits of measuring serum levels of 25 (OH) D in asymptomatic population. It can be useful in population at risk. Likewise, the health benefits of vitamin D supplementation in the general population have not been proven.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4826;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t routinely test for Anti-Thyroid Peroxidase Antibodies (anti ? TPO).";"Positive anti-TPO titres are not unusual in the ?normal? population. Their presence in the context of thyroid disease only assists in indicating that the pathogenesis is probably autoimmune. As thyroid autoimmunity is a chronic condition, once diagnosed there is rarely a need to re-measure anti-TPO titres. In euthyroid pregnant patients deemed at high risk of developing thyroid disease, anti-TPO antibodies may influence the frequency of surveillance for hypothyroidism during the pregnancy. It is uncommon that measurement of anti-TPO antibodies influences patient management.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5082;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Padeliporfin is not recommended, within its marketing authorisation, for untreated, unilateral, low-risk prostate cancer in adults.";"Current treatments for low-risk prostate cancer include active surveillance and, for people whose disease has progressed (usually beyond low-risk disease), radical therapies such as surgery and radiotherapy. Focal therapies such as cryotherapy and high-intensity focused ultrasound can also be used, but are not routinely available. Professional organisations and NHS England say that there is a growing trend for people with low-risk disease to have active surveillance rather than radical therapy. This is because long-term studies show that people with low-risk disease live as long whichever they have, but radical therapies are associated with long-term, severe side effects. Also, improvements in diagnostic tests mean that low-risk disease can be more accurately identified. The company proposes padeliporfin as an option for people with low-risk disease who choose not to have active surveillance and so would otherwise have radical therapies. There is no clinical evidence on how effective padeliporfin is at slowing the disease compared with radical therapies. Also, there is no evidence to support the company's assumption that the length of time people live with padeliporfin is the same as with radical therapies. Clinical trial evidence comparing padeliporfin with active surveillance does show that, at 2 years, it is more effective at slowing prostate cancer. However, it is unclear whether the benefit seen at 2 years leads to people living longer. Also, it is unclear whether some of the people in the trial would have had intermediate-risk prostate cancer. Professional organisations and NHS England do not support using padeliporfin for low-risk prostate cancer because, like radical therapies, it is associated with long-term side effects, without supporting evidence of long-term clinical benefit. The company's cost-effectiveness analyses compare padeliporfin with radical therapies. However, because there is no clinical-effectiveness evidence comparing padeliporfin and radical therapies, it is not possible to consider these analyses. Therefore, padeliporfin cannot be recommended for untreated, unilateral, low-risk prostate cancer.";2018;;;"Low value";Metastases;"https://www.nice.org.uk/guidance/ta546" 4315;2;"Choosing Wisely�";"American Soc. for Blood and Marrow Transplantation & the Canadian Blood and Marrow Transplant Group";English;"Don?t routinely use two cord blood units for standard umbilical cord blood transplantation when a single unit of adequate size is available, recognizing that higher cell doses are preferred when using units with greater HLA mismatch. ";"Randomized trials demonstrate similar clinical outcomes after single-unit and double-unit umbilical cord blood transplantation, including comparable rates of relapse, engraftment failure, overall survival, and transplantation related mortality. Moreover, graft-versus-host disease may be more frequent after double-cord blood transplantation.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4571;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"Phosphomycin tromethamine in a single dose of 3 g is recommended for the treatment of uncomplicated acute cystitis.";"It would not be indicated in this case the treatment with fosfomycin trometamol 3 g in two doses as it increases the risk of side effects, there is no evidence of its benefit and increases the cost of treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4316;2;"Choosing Wisely�";"American Soc. for Blood and Marrow Transplantation & the Canadian Blood and Marrow Transplant Group";English;"Don?t routinely use peripheral blood stem cells for matched unrelated donor transplantation using myeloablative conditioning and standard graft-versus-host disease prevention regimens when a suitable bone marrow donor is available. ";"Patients undergoing myeloablative matched unrelated donor hematopoietic cell transplantation with standard graft-versus-host disease prophylaxis (calcineurin inhibitor and methotrexate) with a peripheral blood stem cell graft experience more symptomatic chronic graft-versus-host disease than those receiving bone marrow, without affecting relapse rates or overall survival. Peripheral blood stem cells may be considered in cases with substantial recipient/donor size discrepancy, donor preference, and for malignant diseases with high risk for graft failure.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4572;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"Do not routinely recommend in type 2 diabetic patients (not treated with insulin or sulfonylureas), capillary glycemic self-analysis, as there is insufficient evidence of its benefit.";-;2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5852;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - optimizando la salud en el espacio de trabajo en casa";Spanish;"Cool-white light is recommended as a source of workplace lighting to improve alertness and mood in daytime workers";"There is very low?quality evidence based on one RCT that individually applied blue?enriched light improves both alertness and mood. There is low?quality evidence based on one RCT that individually administered bright light during the afternoon is as effective as morning exposure for improving alertness and mood in subsyndromal seasonal affective disorder. ";2018;;;"High value";Prevenci�n;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6364;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia";English;"It is not recommended to prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements";"The use of medications for older people can improve symptom control and reduce disease progression. However, the use of five or more medications is independently associated with poor clinical outcomes including increased hospital admissions, falls and premature mortality. Deprescribing (which is the process of discontinuing or reducing medications) is an intervention to improve the quality use of medicines. Deprescribing is an intervention to manage polypharmacy that requires balancing the potential benefit and harm of each medication then systematically withdrawing medications that are no longer needed or clinically indicated or are inappropriate for that individual at that time. There is a growing body of evidence to support deprescribing in older people.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4317;2;"Choosing Wisely�";"American Soc. for Blood and Marrow Transplantation & the Canadian Blood and Marrow Transplant Group";English;"Don?t routinely give immunoglobulin replacement to adult hematopoietic cell transplantation recipients in the absence of recurrent infections regardless of the IgG level. ";"Meta-analyses of controlled trials conclude that immunoglobulin replacement offers no advantage for infection prevention and overall survival, and may predispose to a higher risk of hepatic sinusoidal obstruction syndrome and venous thromboembolism, and impair the efficacy of post-transplant vaccinations. There may be subsets of patients where prophylactic immunoglobulin replacement may be considered, such as in umbilical cord blood transplant recipients, in children undergoing transplantation for inherited or acquired disorders associated with B-cell deficiency, and in chronic graftversus-host disease patients with recurrent sino-pulmonary infections.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4829;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do imaging for lower-back pain unless red flags are present.";"Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5341;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento con l�quidos y vasopresores)";Spanish;"Using colloids versus crystalloids probably makes little or no difference to mortality in critically ill people requiring fluid volume replacement. ";"Using starches, dextrans, albumin or fresh frozen plasma (moderate?certainty evidence), or gelatins (low?certainty evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and renal replacement therapy (moderate?certainty evidence), and albumin or fresh frozen plasma may make little or no difference to the need for renal replacement therapy (low?certainty evidence). Evidence for blood transfusions for dextrans, and albumin or fresh frozen plasma, is uncertain. Similarly, evidence for adverse events is uncertain. Certainty of evidence may improve with inclusion of ongoing studies. ";2018;;;"Low value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4318;2;"Choosing Wisely�";"The American Society of Breast Surgeons ? Benign Breast Disease";English;"Don?t routinely excise areas of psuedoangiomatous stromal hyperplasia (PASH) of the breast in patients who are not having symptoms from it. ";"PASH is a benign breast condition that can present as either an abnormality on imaging or a palpable mass. Unless the lesion is suspicious or a patient has symptoms, a diagnosis of PASH on needle biopsy does not necessitate surgical removal.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4319;2;"Choosing Wisely�";"The American Society of Breast Surgeons ? Benign Breast Disease";English;"Don?t routinely surgically excise biopsy proven fibroadenomas that are smaller than 2 centimeters in size. ";"Fibroadenomas are non-cancerous solid masses within the breast that should be removed only if they are large, bothersome to the patient, or increasing in size. If a needle biopsy shows that a mass less than 2 centimeters in size is a fibroadenoma, with no other concerning features, it does not have to be surgically removed.";2018;;;"Low value";.;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4831;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration.";"Bacterial infections of the respiratory tract, when they do occur, are generally a secondary problem caused by complications from viral infections such as influenza. While it is often difficult to distinguish bacterial from viral sinusitis, nearly all cases are viral. Though cases of bacterial sinusitis can benefit from antibiotics, evidence of such cases does not typically surface until after at least seven days of illness. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 6367;29;"Choosing Wisely Australia";"Pharmaceutical Society of Australia";English;"It is not recommended to continue benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium for more than three months without review. ";"The use of benzodiazepines, other sedative hypnotics or antipsychotics in older adults for insomnia, agitation or delirium is associated with a range of adverse effects including falls and impaired cognition. Non-pharmacological interventions can be an effective substitute and use of these medicines should be for the shortest duration possible. Reductions in the use of these medicines can be achieved following pharmacist review, interdisciplinary input, staff education and feedback from audits.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4320;2;"Choosing Wisely�";"The American Society of Breast Surgeons ? Benign Breast Disease";English;"Don?t routinely operate for a breast abscess without an initial attempt to percutaneously aspirate or drain it. ";"An abscess is an infection of the breast tissue, forming pockets of pus that can be painful. Many times these can be treated by placing a large needle in the pocket and draining the fluid instead of performing an operation where an incision is made and the fluid removed. The needle removal of the fluid forms less scar and sometimes avoids an operation.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4321;2;"Choosing Wisely�";"The American Society of Breast Surgeons ? Benign Breast Disease";English;"Don?t perform screening mammography in asymptomatic patients with normal exams who have less than 5-year life expectancy. ";"Mammography identifies breast cancers at early stages and has demonstrated benefits in reducing mortality and morbidity from a breast cancer diagnosis. There is minimal benefit of screening mammography in women with life expectancies of <5 years. Additionally, there is a risk of false positives and potential procedures that do not provide patients improved outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4833;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients.";"There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Chest X-rays for asymptomatic patients with no specific indications for the imaging have a trivial diagnostic yield, but a significant number of false positive reports. Potential harms of such routine screening exceed the potential benefit.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4322;2;"Choosing Wisely�";"The American Society of Breast Surgeons ? Benign Breast Disease";English;"Don?t routinely drain non-painful fluid-filled breast cysts. Breast cysts are common. ";"They are harmless fluid filled sacs. If an ultrasound (sonogram) confirms that a breast mass is a simple cyst, it does not need to be drained unless it is bothersome to the patient or if there are concerns it could be something other than a cyst or has complex characteristics.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4323;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a validated head injury clinical decision rule). ";"Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. They also increase length of stay and misdiagnosis. There is strong evidence that physicians should not order CT head scans for patients with minor head injury unless validated clinical decision rules suggest otherwise (i.e., Canadian CT head rule for adults, and CATCH or PECARN rules for children). Despite their validity, these rules are never 100% sensitive and are meant to assist and not replace, clinical judgement.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4835;19;"Choosing Wisely Canada";"The Canadian Association of Hospital Dentists";English;"Don?t use opioids for post-operative dental pain until optimized dose of Nonsteroidal Anti-Inflammatory Drugs/Acetaminophen has been used.";"For post-operative dental pain, the dose and frequency of a non-opioid (ibuprofen and/or acetaminophen) analgesic should be optimized. If this is not sufficient for managing pain then an opioid may be considered. If an opioid analgesic is appropriate consider limiting the number of tablets dispensed.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5859;35;"Evidencias COVID-19";" Cochrane - Colecci�n Especial - optimizando la salud en el espacio de trabajo en casa";Spanish;"We found inconsistent evidence that the use of an arm support or an alternative mouse may or may not reduce the incidence of neck or shoulder musculoskeletal disorders";"For other physical ergonomic interventions there is no evidence of an effect. For organisational interventions, in the form of supplementary breaks, there is very low?quality evidence of an effect on upper limb discomfort. For training and multifaceted interventions there is no evidence of an effect on upper limb pain or discomfort. Further high?quality studies are needed to determine the effectiveness of these interventions among office workers. ";2018;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4324;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis. ";"Respiratory distress from bronchospasm/wheezing is a common presentation in both children (i.e., bronchiolitis) and adults (i.e., bronchitis/asthma) seen in the emergency department. Most patients with symptoms do not have bacterial infections that require antibiotic treatment or influence outcomes (i.e., hospitalization). Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash, diarrhea and other side-effects) and has the potential to increase patients? risk of antibiotic induced diarrhea, including infections with C. Difficile. These prescriptions also increase overall antibiotic resistance in the community, and limit the effectiveness of standard antibiotics in the treatment of legitimate bacterial infections. There is strong applied research evidence to recommend that physicians should not prescribe antibiotics in children (i.e., bronchiolitis) and adults (i.e., bronchitis and asthma) with wheezing presentations.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4325;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators. ";"Adults with non-specific lumbosacral (low back) pain, in the absence of significant trauma (i.e., car crash, acute axial loading, acute hyperflexion, etc.), commonly present to the emergency department. The evaluation of patients presenting with nontraumatic low back pain should include a complete focused history and physical examination to identify ?red flags? that may indicate significant pathology. These may include, but are not limited to: features of cauda equina syndrome, weight loss, history of cancer, fever, night sweats, chronic use of systemic corticosteroids, chronic use of illicit intravenous drugs, patients with first episode of low back pain over 50 years of age and especially if over 65, abnormal reflexes, loss of motor strength or loss of sensation in the legs. In the absence of red flags, physicians should not order radiological images for patients presenting with non-specific low back pain. Imaging of the lower spine for symptomatic low back pain does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4326;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules. ";"Neck pain resulting from trauma (such as a fall or car crash) is a common reason for people to present to the emergency department. Very few patients have a cervical spinal injury that can be detected on radiographs (?X-rays?). History, physical examination and the application of clinical decision rules (i.e., the Canadian C-spine rule) can identify alert and stable trauma patients who do not have cervical spinal injuries and therefore do not need radiography. The Canadian C-spine rule has been validated and implemented successfully in Canadian centres, and physicians should not order imaging unless this rule suggests otherwise. Unnecessary radiography delays care, may cause increased pain and adverse outcomes (from prolonged spinal board immobilization), and exposes the patient to ionizing radiation without any possible benefit. This strategy will reduce the proportion of alert patients who require imaging.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4838;19;"Choosing Wisely Canada";"The Canadian Association of Hospital Dentists";English;"Don?t prescribe antibiotics for irreversible pulpitis (toothache).";"Irreversible pulpitis or toothache occurs when the soft tissue and nerve inside the tooth (the dental pulp) becomes damaged as a result of decay, trauma or large fillings. The intense pain is caused by inflammation of the dental pulp and the tissue surrounding the root ? not by infection. Because this is not an infection, antibiotics do not relieve the pain and should not be used. Treatment for this condition is the removal of the damaged or diseased dental pulp, either through root canal therapy or extraction of the tooth. Inflammatory dental pain is best managed by non-steroidal inflammatory drugs.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5094;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for managing an acute exacerbation of bronchiectasis (non-cystic fibrosis)";"Be aware that an acute exacerbation of bronchiectasis is a sustained worsening of symptoms from a person's stable state. Obtain a sputum sample from people with an acute exacerbation of bronchiectasis and send for culture and susceptibility testing. Offer an antibiotic to people with an acute exacerbation of bronchiectasis. When results of sputum culture and susceptibility testing are available: - Review the choice of antibiotic and only change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving.";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4327;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists. ";"Abscesses are walled off collections of pus in soft tissue, with Staphylococcus aureus (both sensitive and resistant to methicillin) being the microbe most frequently involved. Most uncomplicated abscesses should undergo incision in the emergency department using local analgesia or procedural sedation, complete drainage and appropriate follow-up. Evidence suggests that antibiotics are not routinely required after abscess incision and drainage of an uncomplicated abscess. Physicians should not prescribe antibiotics for these patients, unless the patients are immunocompromised, systemically ill, or exhibit extensive surrounding cellulitis or lymphangitis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4328;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT head scans in adult patients with simple syncope in the absence of high-risk predictors. ";"Patients commonly present to the emergency department with syncope. Syncope is a transient loss of consciousness followed by a spontaneous return to baseline neurologic function that does not require resuscitation. The evaluation of syncope should include a thorough history and physical exam to identify high-risk clinical predictors for CT head abnormalities. These highrisk predictors include, but are not limited to: trauma above the clavicles, headache, persistent neurologic deficit, age over 65, patients taking anticoagulants, or known malignancies. Many patients with syncope receive a CT scan of the head; however, in the absence of these predictors, a CT head is unlikely to aid in the management of syncope patients. CT scans can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. Unwarranted imaging also increases length of stay and misdiagnosis.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5096;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for managing an acute exacerbation of COPD with antibiotics.";"An acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from a person's stable state A range of factors (including viral infections and smoking) can trigger an exacerbation Many exacerbations (including some severe exacerbations) are not caused by bacterial infections so will not respond to antibiotics Some people at risk of exacerbations may have antibiotics to keep at home as part of their exacerbation action plan (see the recommendations on choice of antibiotic).";2018;;;"High value";"Antibiotic use.";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4329;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT pulmonary angiograms or VQ scans in patients with suspected pulmonary embolism until risk stratification with decision rule has been applied and when indicated, D-dimer biomarker results are obtained. ";"Many adults present to the emergency department with chest pain and/or shortness of breath. The majority of adult patients with these symptoms do not have a pulmonary embolism (PE) that requires investigation with a CT pulmonary angiogram (CTPA) or ventilation perfusion (VQ) lung scan. CTPAs or VQ scans expose patients to ionizing radiation that has the potential to increase patients? lifetime risk of cancer. CTPAs also place patients at risk for potential allergic reaction and acute kidney injury from the intravenous contrast required for the CTs. Imaging also increases length of stay and may contribute to misdiagnosis. Evidence demonstrate that physicians should not order CTPAs or VQ scans to diagnose PE until risk stratification with a clinical decision rule (Wells score, PERC rule) has been applied and d-dimer biomarker results are obtained for those patients where it is indicated. For high-risk populations in which the clinical decision rules have not been validated (i.e., pregnancy, hypercoagulability disorders), physicians are urged to exert their clinical judgment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4841;19;"Choosing Wisely Canada";"The Canadian Association of Hospital Dentists";English;"Don?t routinely prescribe antibiotics for acute dental abscess without signs of systemic involvement.";"Acute dental abscess is a localized infection that occurs as the result of an untreated infection of the dental pulp. The abscess should be drained and the tooth treated with root canal therapy or extraction of the tooth. Antibiotics are of no additional benefit. In the event of systemic complications (e.g., fever, lymph node involvement or spreading infection), or for an immunocompromised patient, antibiotics may be prescribed in addition to drainage of the tooth.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5097;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recomendations for managing catheter-associated urinary tract infection.";"A catheter-associated urinary tract infection (UTI) is a symptomatic infection of the bladder or kidneys in a person with a urinary catheter. The longer a catheter is in place, the more likely bacteria will be found in the urine; after 1 month nearly all people have bacteriuria. Antibiotic treatment is not routinely needed for asymptomatic bacteriuria in people with a catheter. Give advice about managing symptoms with self-care.";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4330;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t routinely use antibiotics in adults and children with uncomplicated sore throats. ";"Adults and children frequently present to the emergency department with sore throats (pharyngitis). The vast majority of cases of pharyngitis are caused by self-limiting viral infections that do not respond to antibiotics. The benefit of antibiotics for the approximately 10% of cases in adults (25% in children), caused by bacteria (principally Group A Streptococcus (GAS)) is modest at best, although is associated with fewer complications and a slightly shorter course of illness. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community. Evidence suggests that antibiotics should only be used in patients with intermediate and high clinical prediction scores for GAS (CENTOR or FeverPAIN score) AND confirmatory testing (throat cultures or rapid testing) that are positive for GAS, especially in children.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5098;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for management of acute prostatitis.";"Is a bacterial infection of the prostate needing treatment with antibiotics. Is usually caused by bacteria entering the prostate from the urinary tract. Can occur spontaneously or after medical procedures such as prostate biopsy. Can last several weeks Can cause complications such as acute urinary retention and prostatic abscess. Offer an antibiotic (see the recommendations on choice of antibiotic) to people with acute prostatitis. Take account of: The severity of symptoms, the risk of developing complications or having treatment failure, particularly after medical procedures such as prostate biopsy, previous urine culture and susceptibility results, previous antibiotic use, which may have led to resistant bacteria. Obtain a midstream urine sample before antibiotics are taken and send for culture and susceptibility testing.";2018;;;"High value";"Antibiotics use.";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4331;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order ankle and/or foot X-rays in patients who have a negative examination using the Ottawa ankle rules. ";"Foot and ankle injuries in children and adults are very common presentations to emergency departments. The Ottawa Ankle Rules (OAR) have been validated in both children (greater than 2 years old) and adult populations, and have been shown to reduce the number of X-rays performed without adversely affecting patient care. In alert, cooperative and sensate patients with blunt ankle and/or foot trauma within the previous ten days and who are not distracted by other injuries, only those who fulfill the OAR should undergo ankle and/or foot X-rays. Imaging of the ankle and/or foot in patients who are negative for the OAR does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4843;19;"Choosing Wisely Canada";"The Canadian Association of Hospital Dentists";English;"Don?t give prophylactic antibiotics prior to dental procedures to patients with total joint replacement.";"Infections of orthopedic implants are uncommon events and are rarely caused by bacteria found in the mouth. Although dental procedures such as extractions cause transient bacteremia, most bacteremia of oral origin occurs with activities of daily living, including brushing, flossing and chewing. There is no reliable evidence that antibiotics prior to dental procedures prevents prosthetic joint infections. Patients should not be exposed to the adverse effects of antibiotics when there is no evidence of benefit.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5099;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for management of acute pyelonephritis";"Be aware that acute pyelonephritis is an infection of one or both kidneys usually caused by bacteria travelling up from the bladder. In people aged 16 years and over with acute pyelonephritis, obtain a midstream urine sample before antibiotics are taken and send for culture and susceptibility testing. In children and young people under 16 years with acute pyelonephritis, obtain a urine sample before antibiotics are taken and send for culture and susceptibility testing. Assess and manage children under 5 with acute pyelonephritis who present with fever. Offer an antibiotic to people with acute pyelonephritis. Take account of: - the severity of symptoms - the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract or immunosuppression - previous urine culture and susceptibility results - previous antibiotic use, which may have led to resistant bacteria.";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4332;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t use antibiotics in adults and children with uncomplicated acute otitis media. ";"Both adults and children commonly present to the emergency department with symptoms of a middle ear infection, or acute otitis media (AOM). The symptoms of AOM include fever, earache, discharge from ear, and/or decreased hearing. Evidence suggests that adults and children with uncomplicated AOM do not need antibiotics. Treatment should focus on analgesia and the use of antibiotics should be limited to complicated or severe cases. A watch and wait approach (analgesia and observation for 48 to 72 hours) should be considered for healthy, non-toxic appearing children older than six months of age with no craniofacial abnormalities, mild disease (mild otalgia, temperature < 39�C without antipyretics), and who have reliable medical follow-up. Antibiotics should be considered if the child?s illness does not improve during the observation period, and for those children who are < 24 months of age with infection in both ears, and in those with AOM and ear discharge. Similarly, antibiotics should not be used for the initial treatment of uncomplicated AOM in adults. Delayed antibiotics are an effective alternative to immediate antibiotics to reduce antibiotic use. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4844;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t screen women with Pap smears if under 21 years of age or over 69 years of age.";"? Don?t do screening Pap smears annually in women with previously normal results ? Don?t do Pap smears in women who have had a hysterectomy for non-malignant disease The potential harm from screening women younger than 21 years of age outweighs the benefits and there is little evidence to suggest the necessity of conducting this test annually when previous test results were normal. Women who have had a full hysterectomy for benign disorders no longer require this screening. Screening should stop at age 70 if three previous test results were normal.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5100;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendation for managinglower urinary tract infection.";"Be aware that lower urinary tract infection (UTI) is an infection of the bladder usually caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder. Give advice about managing symptoms with self-care to all people with lower UTI. Consider a back-up antibiotic prescription (to use if symptoms do not start to improve within 48 hours or worsen at any time) or an immediate antibiotic prescription for women with lower UTI who are not pregnant. Offer an immediate antibiotic prescription to pregnant women and men with lower UTI. Take account of: - previous urine culture and susceptibility results - previous antibiotic use, which may have led to resistant bacteria.";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4333;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do imaging for lower-back pain unless red flags are present. ";"Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4845;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do annual screening blood tests unless directly indicated by the risk profile of the patient.";"There is little evidence to indicate there is value in routine blood tests in asymptomatic patients; instead, this practice is more likely to produce false positive results that may lead to additional unnecessary testing. The decision to perform screening tests, and the selection of which tests to perform, should be done with careful consideration of the patient?s age, sex and any possible risk factors.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5101;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;" Recommendations for the prevention of recurrent urinary tract infections.";"Manage an acute UTI as outlined in the NICE guidelines on urinary tract infection (lower): antimicrobial prescribing or pyelonephritis (acute): antimicrobial prescribing. Be aware that recurrent UTI: includes lower UTI and upper UTI (acute pyelonephritis) - may be due to relapse (with the same strain of organism) or reinfection (with a different strain or species of organism) - is particularly common in women. Give advice to people with recurrent UTI about behavioural and personal hygiene measures and self?care treatments";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4334;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t use antibiotics for upper respiratory infections that are likely viral in origin, such as influenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration. ";"Bacterial infections of the respiratory tract, when they do occur, are generally a secondary problem caused by complications from viral infections such as influenza. While it is often difficult to distinguish bacterial from viral sinusitis, nearly all cases are viral. Though cases of bacterial sinusitis can benefit from antibiotics, evidence of such cases does not typically surface until after at least seven days of illness. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4846;19;"Choosing Wisely Canada";"The Canadian Association of Hospital Dentists";English;"Don?t give prophylactic antibiotics to patients with non-valvular cardiac or other indwelling devices.";"There is no convincing evidence that oral bacteria from dental procedures cause infections of the following devices at any time after implantation: pacemakers; implantable defibrillators; ventriculoatrial shunts; devices for patent ductus arteriosus, atrial septal defect, and ventricular septal defect occlusion; peripheral vascular stents; prosthetic vascular grafts; hemodialysis shunts; coronary artery stents; dacron parotid patches; chronic indwelling central venous catheters.";2018;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 5102;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for management of acute otitits media.";"All children and young people with acute otitis media. Be aware that: - acute otitis media is a self-limiting infection that mainly affects children - acute otitis media can be caused by viruses and bacteria, and it is difficult to distinguish between these (both are often present at the same time) - symptoms last for about 3 days, but can last for up to 1 week - most children and young people get better within 3 days without antibiotics - complications such as mastoiditis are rare. Give advice about: - the usual course of acute otitis media (about 3 days, can be up to 1 week). - managing symptoms, including pain, with self-care (see the recommendations on self-care).";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4335;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients. ";"There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Chest X-rays for asymptomatic patients with no specific indications for the imaging have a trivial diagnostic yield, but a significant number of false positive reports. Potential harms of such routine screening exceed the potential benefit.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4847;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t routinely measure Vitamin D in low risk adults.";"Because Canada is located above the 35� North latitude, the average Canadian?s exposure to sunlight is insufficient to maintain adequate Vitamin D levels, especially during the winter. Therefore, measuring serum 25-hydroxyvitamin D levels is not necessary because routine supplementation with Vitamin D is appropriate for the general population. An exception is made for measuring Vitamin D levels in patients with significant renal or metabolic disease.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5103;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is not recommended to adopting Neuropad to detect preclinical diabetic peripheral neuropathy. Neuropad detects sub-normal sweating in patients with diabetes but the clinical importance of this in current NHS care pathways is poorly defined. There is insufficient evidence to support the use of Neuropad in patients in whom 10 g monofilament testing for diabetic peripheral neuropathy is not possib";"Cost modelling is uncertain because of the limited clinical-effectiveness evidence. Using Neuropad instead of 10 g monofilament testing would likely increase costs because Neuropad has a lower specificity for detecting diabetic peripheral neuropathy. Further research is needed on the benefits and consequences of detecting preclinical diabetic peripheral neuropathy.";2018;;;"Low value";"Diabetic foot";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4336;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t screen women with Pap smears if under 21 years of age or over 69 years of age. ";"? Don?t do screening Pap smears annually in women with previously normal results. ? Don?t do Pap smears in women who have had a hysterectomy for non-malignant disease. The potential harm from screening women younger than 21 years of age outweighs the benefits and there is little evidence to suggest the necessity of conducting this test annually when previous test results were normal. Women who have had a full hysterectomy for benign disorders no longer require this screening. Screening should stop at age 70 if three previous test results were normal. ";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4848;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t routinely do screening mammography for average risk women aged 40 ? 49. Individual assessment of each woman?s preferences and risk should guide the discussion and decision regarding mammography screening in this age group.";"If, after this careful assessment and discussion, a woman?s breast cancer risk is not high, current evidence indicates that the benefit of screening mammography is small. Furthermore, for this age group there is a greater risk of false-positive screening results and consequently of undergoing unnecessary or harmful follow-up procedures. As always, clinicians need to be aware of changes in the balance of evidence on risk and benefit and support women in understanding this evidence. High quality materials to assist these discussions are available through the Canadian Task Force on Preventive Health Care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5104;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recomendation for managing acute sore throat.";"Be aware that: - acute sore throat (including pharyngitis and tonsillitis) is self?limiting and often triggered by a viral infection of the upper respiratory tract - symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus). Use FeverPAIN or Centor criteria to identify people who are more likely to benefit from an antibiotic. Give advice about: - the usual course of acute sore throat (can last around 1 week) - managing symptoms, including pain, fever and dehydration, with self-care. Reassess at any time if symptoms worsen rapidly or significantly, taking account of: - alternative diagnoses such as scarlet fever or glandular fever. - any symptoms or signs suggesting a more serious illness or condition. - previous antibiotic use, which may lead to resistant organisms.";2018;;;"High value";"Antibiotics use";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4337;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do annual screening blood tests unless directly indicated by the risk profile of the patient. ";"There is little evidence to indicate there is value in routine blood tests in asymptomatic patients; instead, this practice is more likely to produce false positive results that may lead to additional unnecessary testing. The decision to perform screening tests, and the selection of which tests to perform, should be done with careful consideration of the patient?s age, sex and any possible risk factors.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4849;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do annual physical exams on asymptomatic adults with no significant risk factors.";"A periodic physical examination has tremendous benefits; it allows physicians to check on their healthy patients while they remain healthy. However, the benefits of this check-up being done on an annual basis are questionable since many chronic illnesses that benefit from early detection take longer than a year to develop. Preventive health checks should instead be done at time intervals recommended by guidelines, such as those noted by the Canadian Task Force on the Periodic Health Examination.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5105;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Recommendations for awareness of Lyme disease";"Be aware that: - the bacteria that cause Lyme disease are transmitted by the bite of an infected tick - ticks are mainly found in grassy and wooded areas, including urban gardens and parks - tick bites may not always be noticed - infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete - particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas - Lyme disease may be more prevalent in parts of central, eastern and northern Europe (including Scandinavia) and parts of Asia, the US and Canada. Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission. Give people advice about: - where ticks are commonly found (such as grassy and wooded areas, including urban gardens and parks) - the importance of prompt, correct tick removal and how to do this (see the Public Health England website for information on removing ticks) - covering exposed skin and using insect repellents that protect against ticks - how to check themselves and their children for ticks on the skin - sources of information on Lyme disease, such as Public Health England, and organisations providing information and support, such as patient charities.";2018;;;"High value";"Bites and stings";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4338;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t routinely measure Vitamin D in low risk adults. ";"Because Canada is located above the 35� North latitude, the average Canadian?s exposure to sunlight is insufficient to maintain adequate Vitamin D levels, especially during the winter. Therefore, measuring serum 25-hydroxyvitamin D levels is not necessary because routine supplementation with Vitamin D is appropriate for the general population. An exception is made for measuring Vitamin D levels in patients with significant renal or metabolic disease.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4850;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t order DEXA (Dual-Energy X-ray Absorptiometry) screening for osteoporosis on low risk patients.";"While all patients aged 50 years and older should be evaluated for risk factors for osteoporosis using tools such as the osteoporosis self-assessment screening tool (OST), bone mineral density screening via DEXA is not warranted on women under 65 or men under 70 at low risk.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4339;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t routinely do screening mammography for average risk women aged 40 ? 49. Individual assessment of each woman?s preferences and risk should guide the discussion and decision regarding mammography screening in this age group. ";"If, after this careful assessment and discussion, a woman?s breast cancer risk is not high, current evidence indicates that the benefit of screening mammography is small. Furthermore, for this age group there is a greater risk of false-positive screening results and consequently of undergoing unnecessary or harmful follow-up procedures. As always, clinicians need to be aware of changes in the balance of evidence on risk and benefit and support women in understanding this evidence. High quality materials to assist these discussions are available through the Canadian Task Force on Preventive Health Care.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4851;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits.";"While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5363;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"No evidence was found that enteral feeding compared to parenteral feeding or compared to a combination of the routes was more or less likely to reduce the number of deaths in the hospital, over the course of 90 days and 180 days";"Evidence was found from three small studies that fewer patients died over the course of 30 days when feeding was provided by combined enteral and parenteral routes. No study reported the number of days without an ICU until day 28 (i.e., hospital stay in the ICU taking into account the expected loss of participants due to death) and one study reported that the feeding route did not affect the number of days without a respirator. No evidence was found that enteral feeding compared to parenteral feeding probably increased or decreased cases of aspiration (the entry of materials such as food from the digestive system into the lungs) or pneumonia (edema of the tissue of one or both lungs that due to it is usually due to a bacterial infection). Enteral nutrition can reduce sepsis (a life-threatening disorder that arises when the body's response to infection causes injury to its own tissues and organs), although the evidence came from studies in patients with different disorders (such as trauma, medical disorders, or postsurgical). Fewer participants were found to vomit on parenteral rather than enteral feeding, although there were a few studies reporting few events.";2018;;;Uncertain;"manejo de pacientes";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4340;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t do annual physical exams on asymptomatic adults with no significant risk factors. ";"A periodic physical examination has tremendous benefits; it allows physicians to check on their healthy patients while they remain healthy. However, the benefits of this check-up being done on an annual basis are questionable since many chronic illnesses that benefit from early detection take longer than a year to develop. Preventive health checks should instead be done at time intervals recommended by guidelines, such as those noted by the Canadian Task Force on the Periodic Health Examination.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4852;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t order thyroid function tests in asymptomatic patients.";"The primary rationale for screening asymptomatic patients is that the resulting treatment results in improved health outcomes when compared with patients who are not screened. There is insufficient evidence available indicating that screening for thyroid diseases will have these results.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4853;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t continue opioid analgesia beyond the immediate postoperative period or other episode of acute, severe pain.";"The immediate postoperative period or acute episodes of pain typically refers to a time period of three days or less, and rarely more than seven days. Prescribe the lowest effective dose and number of doses required to address the expected pain. This recommendation does not apply to individuals already on long term or chronic opioids or opioid agonist treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4342;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits. ";"While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4854;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t initiate opioids long-term for chronic pain until there has been a trial of available non-pharmacological treatments and adequate trials of non-opioid medications.";"Depending on the pain mechanism and patient co-morbidities, this can includeacetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclics and gabapentinoids. Other non-medication modalities for managing acute, subacute and chronic pain may include exercise, weight loss, cognitive-behavioural therapy, massage therapy, physical therapy and/or spinal manipulation therapy. An opioid trial should be guided by clear criteria for monitoring the success of an opioid trial and a plan for stopping opioids if criteria are not met.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 5110;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Se recomienda usar Brodalumab como una opci�n para tratar la psoriasis en placas en adultos, solo si: la enfermedad es grave, seg�n lo definido por un PASI total de 10 o m�s y un DLQI de m�s de 10 y la enfermedad no ha respondido a otros sist�micos terapias, incluyendo ciclosporina, metotrexato y PUVA, o estas opciones est�n contraindicadas o no se toleran.";"Stop brodalumab at 12 weeks if the psoriasis has not responded adequately, defined as: a 75% reduction in the PASI score (PASI 75) from when treatment started or a 50% reduction in the PASI score (PASI 50) and a 5?point reduction in DLQI from when treatment started. When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate. When using the DLQI, healthcare professionals should take into account any physical, psychological, sensory or learning disabilities, or communication difficulties that could affect the responses to the DLQI and make any adjustments they consider appropriate. These recommendations are not intended to affect treatment with brodalumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop";2018;;;"High value";" Psoriasis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4343;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t order thyroid function tests in asymptomatic patients. ";"The primary rationale for screening asymptomatic patients is that the resulting treatment results in improved health outcomes when compared with patients who are not screened. There is insufficient evidence available indicating that screening for thyroid diseases will have these results.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4855;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients.";"PPIs are effective drugs for the treatment of gastro-esophageal reflux disease (GERD). Patients should always be prescribed the lowest dose of drug that manages their symptoms. Even though GERD is often a chronic condition, over time the disease may not require acid suppression and it is important that patients do not take drugs that are no longer necessary. For this reason patients should try stopping their acid suppressive therapy at least once per year. Patients with Barrett?s esophagus, Los Angeles Grade D esophagitis, and gastrointestinal bleeding would be exempt from this.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4344;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t continue opioid analgesia beyond the immediate postoperative period or other episode of acute, severe pain. ";"The immediate postoperative period or acute episodes of pain typically refers to a time period of three days or less, and rarely more than seven days. Prescribe the lowest effective dose and number of doses required to address the expected pain. This recommendation does not apply to individuals already on long term or chronic opioids or opioid agonist treatment.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4856;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Avoid using an upper GI series to investigate dyspepsia.";"Upper GI series are often requested for the investigation of upper gastrointestinal symptoms. This investigation has a significant proportion of false positive and false negative results compared with endoscopy, and studies have consistently found that this is not a cost-effective approach compared to other strategies of managing dyspepsia.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative. Enlace a la recomendaci�n en la p�gina web de la iniciativa." 4345;19;"Choosing Wisely Canada";"College of Family Physicians of Canada";English;"Don?t initiate opioids long-term for chronic pain until there has been a trial of available non-pharmacological treatments and adequate trials of non-opioid medications. ";"Depending on the pain mechanism and patient co-morbidities, this can includeacetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclics and gabapentinoids. Other non-medication modalities for managing acute, subacute and chronic pain may include exercise, weight loss, cognitive-behavioural therapy, massage therapy, physical therapy and/or spinal manipulation therapy. An opioid trial should be guided by clear criteria for monitoring the success of an opioid trial and a plan for stopping opioids if criteria are not met.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5113;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Golimumab is recommended, within its marketing authorisation, as an option for treating severe non-radiographic axial spondyloarthritis in adults whose disease has responded inadequately to, or who cannot tolerate, nonsteroidal anti-inflammatory drugs.";"If patients and their clinicians consider golimumab to be one of a range of suitable treatments, including adalimumab, etanercept and certolizumab pegol, the least expensive (taking into account administration costs and patient access schemes) should be chosen. Assess the response to golimumab 12 weeks after the start of treatment. Continue treatment only if there is clear evidence of response, defined as: a reduction in the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score to 50% of the pre-treatment value or by 2 or more units and a reduction in the spinal pain visual analogue scale (VAS) score by 2 cm or more. When using BASDAI and spinal pain VAS scores, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the responses to the questionnaires, and make any adjustments they consider appropriate. NICE already recommends adalimumab, etanercept and certolizumab pegol for treating non-radiographic axial spondyloarthritis. An indirect comparison shows that golimumab provides similar overall health benefits to these drugs. The acquisition costs of golimumab are the same as or less than those of adalimumab and etanercept, and in the longer term, would be similar to those of certolizumab pegol. Because it is has similar overall health benefits and costs to adalimumab, etanercept and certolizumab pegol, golimumab is recommended for treating non-radiographic axial spondyloarthritis in the NHS.";2018;;;"High value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4346;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"Don?t routinely obtain neuro-imaging studies (CT, MRI, or carotid dopplers) in the evaluation of simple syncope in patients with a normal neurological examination. ";"Although an uncommon cause for syncope, providers must consider a neurological cause in every patient presenting with transient loss of consciousness. In the absence of signs or symptoms concerning for neurological causes of syncope (such as but not limited to focal neurological deficits), the utility of neuro-imaging studies are of limited benefit. Despite a lack of evidence for the diagnostic utility of neuroimaging in patients presenting with true syncope, providers continue to perform brain computed tomographic (CT) scans. Thus, inappropriate use of this diagnostic imaging modality carries high costs and subject patients to the risks of radiation exposure.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4347;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"Don?t place, or leave in place, urinary catheters without an acceptable indication (such as critical illness, obstruction, palliative care). ";"Use of urinary catheters without an acceptable indication of use increases the likelihood of infection leading to greater morbidity and health care costs. Catheter-associated bacteriuria often leads to inappropriate antimicrobial use and secondary complications including emergence of antimicrobial-resistant organisms and infection with clostridium difficile. A previous study showed that physicians are often unaware of urinary catheterization among their patients. Use of urinary catheters has found to be inappropriate in up to 50% of cases, with urinary incontinence listed as the most common reason for inappropriate and continued placement of urinary catheters. Clinical practice guidelines support the removal or avoidance of unnecessary urinary catheters in order to reduce the risk of catheter-associated urinary tract infections (CAUTIs).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4348;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"Don?t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure or stroke. ";"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 circulatory overload, and sepsis. Studies of transfusion strategies among multiple patient populations suggest that a restrictive approach is associated with improved outcomes.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4349;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"In the inpatient setting, don?t order repeated CBC and chemistry testing in the face of clinical and lab stability. ";"Repetitive inpatient blood testing occurs frequently and is associated with adverse consequences for the hospitalized patient such as iatrogenic anemia, and pain. A Canadian study showed significant hemoglobin reductions as a result of phlebotomy. Given that anemia in hospital patients is associated with increased length of stay, readmission rates and transfusion requirements, reducing unnecessary testing may improve outcomes. Studies support the safe reduction of repetitive laboratory testing without negative effects on adverse events, readmission rates, critical care utilization or mortality. Laboratory reduction interventions have also reported significant cost savings.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5117;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ixekizumab alone, or with methotrexate, is recommended as an option for treating active psoriatic arthritis in adults, only if:";"It is used as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis (recommendations 1.1 and 1.2) or The person has had a tumour necrosis factor (TNF)-alpha inhibitor but their disease has not responded within the first 12 weeks or has stopped responding after the first 12 weeks or TNF-alpha inhibitors are contraindicated but would otherwise be considered (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis). Ixekizumab is only recommended if the company provides it according to the commercial arrangement. Assess the response to ixekizumab after 16 weeks of treatment. Only continue treatment if there is clear evidence of response, defined as an improvement in at least 2 of the 4 Psoriatic Arthritis Response Criteria (PsARC), 1 of which must be joint tenderness or swelling score, with no worsening in any of the 4 criteria. People whose disease has a Psoriasis Area and Severity Index (PASI) 75 response but whose PsARC response does not justify continuing treatment should be assessed by a dermatologist, to determine whether continuing treatment is appropriate based on skin response (as described in NICE's technology appraisal guidance on etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis, recommendation 1.3). When using the PsARC, healthcare professionals should take into account any physical, sensory or learning disabilities or communication difficulties that could affect a person's responses to components of the PsARC and make any adjustments they consider appropriate. When using the PASI, healthcare professionals should take into account skin colour and how this could affect the PASI score, and make the clinical adjustments they consider appropriate. These recommendations are not intended to affect treatment with ixekizumab that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. Ixekizumab is a biological therapy, several of which are already recommended by NICE for treating psoriatic arthritis. Clinical trial evidence shows that ixekizumab is more effective than placebo at treating joint and skin symptoms. An indirect comparison suggests that ixekizumab is likely to be as effective at improving symptoms as some of the current treatments used in the NHS for psoriatic arthritis. The cost-effectiveness estimates show that for some groups of people with psoriatic arthritis, ixekizumab is the most cost-effective treatment option. For other groups, the difference in health benefits between ixekizumab and the most cost-effective treatment is very small. Overall, the cost effectiveness of ixekizumab is acceptable when it is used after 2 disease-modifying anti-rheumatic drugs, as the first biological therapy, or after treatment with a TNF?alpha inhibitor. Therefore, it can be recommended.";2018;;;"High value";Arthritis;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5885;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"All of the licensed forms of NRT (gum, transdermal patch, nasal spray, inhalator and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. ";"NRTs increase the rate of quitting by 50% to 60%, regardless of setting, and further research is very unlikely to change our confidence in the estimate of the effect. The relative effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT. NRT often causes minor irritation of the site through which it is administered, and in rare cases can cause non?ischaemic chest pain and palpitations.";2018;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4350;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"Don?t routinely perform preoperative testing (such as chest X-rays, echocardiograms, or cardiac stress tests) for patients undergoing low risk surgeries. ";"Routine preoperative tests for low risk surgeries results in unnecessary delays, potential distress for patients and significant cost for the health care system. Numerous studies and guidelines outline lack of evidence for benefit in routine preoperative testing (e.g., chest X-ray, echocardiogram) in low risk surgical patients. Economic analyses suggest significant potential cost savings from implementation of guidelines.";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4351;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine";English;"Don?t initiate therapy with opioids for patients with chronic non-cancer pain unless nonopioid pharmacotherapy and other non-pharmacological options have been optimized. ";"Several non-opioid therapies (including both drug and non-drug alternatives) may achieve a similar magnitude of improvement in pain and function more safely without the potentially serious side effects of opioid therapy (e.g. harms related to dependence, addiction and overdose).";2018;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4863;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2018;361:k2076";English;"The NICE guidance recommends prescribing a narrow spectrum antibiotic, with nitrofurantoin and trimethoprim as first choice options in non-pregnant women, depending on a patient?s kidney function and previous use.";"Very little evidence was found on the use of antibiotics in men with a lower UTI but, because of the potential risk of complications, the draft guidance suggests prescribing an antibiotic immediately and sending a midstream urine sample for culture and susceptibility testing.";2018;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4865;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2017;356:j713";English;"Do recommend performing interventions that provide advice or feedback to doctors to improve antibiotic prescribing practices.";"Reviewers searched the literature for studies investigating the effectiveness and safety of interventions designed to improve antibiotic prescribing in hospital inpatients. They included a total of 221 studies (58 randomised and 163 non-randomised), published before January 2015 and mostly carried out in Europe and North America.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4867;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2017;356:j772";English;"Do recommend adapting prescribing guidelines of tamoxifen for primary prevention of breast cancer.";"The online survey of 928 GPs in England, Northern Ireland, and Wales found that only half (51.7%) knew that tamoxifen can reduce breast cancer risk and that only a quarter were aware of the NICE guideline. The GPs were then informed about the NICE guidance, the eligibility criteria for tamoxifen, and the drug?s harms, benefits, and licensing status. They were also given one of four vignettes describing a hypothetical patient at increased risk of breast cancer.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4868;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2017;356:j869";English;"It is recommended that interventions to improve LDL cholesterol should ensure adherence and prescription of statins sufficiently potent and address side effects appropriately";"Researchers analysed the association between a range of medical and psychosocial factors and LDL cholesterol levels in 1095 consecutive patients admitted to two hospitals in Norway with a myocardial infarction and/or for a coronary revascularisation procedure. They collected data from hospital records, a comprehensive questionnaire, clinical examinations, and blood samples, two to 36 months after admission.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6406;31;"Smarter medicine";"Sociedad Profesional Suiza de Geriatr�a";English;"The use of first-line antipsychotics to treat behavioral and psychological symptoms of dementia in elderly patients is not recommended.";"People with dementia often exhibit aggression, resistance to attention, and other problem or disruptive behaviors. In such circumstances, antipsychotic medications are often prescribed, but they have limited and variable benefits while carrying risks, such as excessive sedation, cognitive impairment, and increased risk of falls, stroke, and heart failure. The use of these drugs in patients with dementia should be limited to cases where non-pharmacological measures have failed and the patients pose an imminent threat to themselves or others. Identifying and treating the causes of behavior change can avoid drug treatments.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3847;19;"Choosing Wisely Canada";"The Canadian Pediatric Neurosurgery Study Group";English;"Do not recommend ordering a CT to initially investigate macrocephaly (order an ultrasound or MRI).";"A common pediatric neurosurgery referral is a young child with a rapidly increasing head circumference crossing percentiles. The differential diagnosis is broad and includes benign expansion of the subarachnoid spaces (BESS), subdural collections, hydrocephalus, and neoplasm. When the fontanelle is open, the etiology can usually be diagnosed on head ultrasound, and this should therefore be the initial screening test of choice. In the absence of an open fontanelle, or if there are other signs and symptoms of acute raised intracranial pressure (vomiting, headache, irritability, drowsiness, full fontanelle, sun setting eyes), the etiology should be diagnosed with MRI, if available, in order to limit radiation exposure. There is growing evidence that exposure to radiation through CT imaging increases a child?s life long risk of cancer, and so all care should be taken to minimize this exposure as much as possible. Ultrasound (when fontanelle open), and/or MRI (when fontanelle closed), are therefore the screening tests of choice to investigate macrocephaly.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3848;19;"Choosing Wisely Canada";"The Canadian Pediatric Neurosurgery Study Group";English;"Do not recommend imaging a midline dimple related to the coccyx in an asymptomatic infant or child.";"Sacrococcygeal dimples (also called simple sacral dimples or sacrococcygeal pits) are common findings in newborns, with a prevalence of approximately 2 to 5%. They are not associated with any increased risk of occult spinal dysraphism (e.g., low lying conus, fatty filum, lipomyelomeningocele, split cord malformation, dermal sinus tract, etc.) compared with the general population of infants without sacrococcygeal dimples. There is therefore no need to investigate infants with this finding, with either ultrasound or MRI. Red flags for which investigating would be indicated include the presence of midline tuft of hair, sacral dimple or sinus tract above the gluteal cleft, hemangioma, dermal appendage, and/or a subcutaneous lump. The ideal choice for initial investigation (ultrasound or MRI) would depend on the specific cutaneous findings and clinical symptoms present.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6408;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"Systematic anti-ulcer prophylaxis is not recommended for intensive care patients. It is recommended to carry out an evaluation of the risk/benefit balance beforehand and to promote enteral nutrition.";"The expected positive effects of not systematically performing anti-ulcer prophylaxis in intensive medicine are the reduction in medication consumption and associated costs and the reduction in induced complications (pneumonia acquired in intensive care). Instead, it is recommended to carry out a prior evaluation of the risk/benefit balance and promote enteral nutrition. This measure is supported by: intervention studies, meta-analyses, recommendations from professional societies and groups of experts.";2017;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 3849;19;"Choosing Wisely Canada";"The Canadian Pediatric Neurosurgery Study Group";English;"Do not recommend using CT scans for routine imaging of children with hydrocephalus. Fast sequence non-sedated MRIs or ultrasounds provide adequate information to assess patients without exposing them to radiation or an anesthetic.";"Children with hydrocephalus, on average, obtain two head imaging assessments annually until the age of 20. Their lifetime increase risk of fatal cancer is estimated to be 1 excess case of fatal cancer per 97 patients if standard head CT is used, or 1 excess case of fatal cancer per 230 patients if low-dose head CT is used. Head ultrasound (in infants with open fontanelles), and rapid sequence MRI (in all other children) do not require ionizing radiation and adequately assess for radiographic change in ventricle size. A rapid sequence MRI can be obtained without sedation and in under 3 minutes. It is therefore recommended that ultrasound (in infants with open fontanelles), or rapid sequence MRI (in all other children) be used for surveillance imaging in hydrocephalus at minimum, and ideally in emergency assessments as well when available. In the emergent setting, or when MRI is not available, low-dose non-contrast CT is appropriate.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3850;19;"Choosing Wisely Canada";"The Canadian Pediatric Neurosurgery Study Group";English;"Don?t recommend helmets for mild to severe positional flattening.";"Positional flattening is very common, affecting up to 40% of infants since the Back to Sleep campaign began in 1992. There is now prospective, randomized control trial evidence that helmeting is no better at improving head shape in mild to severe positional flattening compared with physical therapy and providing general positioning recommendations such as maximizing tummy time while awake, and limiting time in swings and car seats. New guidelines from the Congress of Neurological Surgeons, following a systematic literature review including a review of the randomized trial mentioned above, consider helmeting as an option for severe cases of positional flattening. The prevalence of positional flattening in teens from the era following the Back to Sleep campaign but before helmets were widely used was less than 2%, suggesting that regardless of both the intervention used and the severity of the flattening, the vast majority of cases of positional flattening will cosmetically normalise. The cost of helmeting is also significant; a helmet costs thousands of dollars, and requires frequent adjustments over several months to adjust to an infant?s growing head. There are also risks associated with helmeting, including pressure sores and interference with parental attachment. With its associated high cost and only very weak evidence of benefit in treating positional flattening, there is no clear additional value in recommending helmets for infants with mild to severe positional flattening in addition to traditional positioning recommendations and physiotherapy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4874;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2017;359:j5374";English;"Do not recommend decompression surgery for reducing reduce symptoms in patients with subacromial shoulder pain";"Shoulder pain accounts for more than 2% of all primary care consultations in the UK, and more than two thirds of these cases involve subacromial pain. Arthroscopic decompression surgery is commonly used to treat this type of shoulder pain on the basis that removing bone spurs and soft tissue that narrow the subacromial space will reduce pain caused by arm movement. But its effectiveness is not clear. For further information please visit the website of the initiative (link below) ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3851;19;"Choosing Wisely Canada";"The Canadian Pediatric Neurosurgery Study Group";English;"Do not recommend doing routine surveillance imaging for incidentally discovered Chiari I malformation. ";"Chiari I malformation, defined as cerebellar tonsillar herniation greater than or equal to 5mm below the foramen magnum on MRI brain, is a frequent incidental finding in children, with an estimated prevalence of 1 to 3%. The vast majority of children with incidentally discovered, asymptomatic Chiari I malformations have no clinically significant progression of tonsillar descent on routine follow-up, and symptom development is often unassociated with radiographic change. Radiographic follow-up in the absence of new symptomatology is therefore unnecessary.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4876;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Iacobucci G. BMJ 2017;358:j4177";Spanish;"Do recommend cognitive behavioural therapy (CBT) to overcome health anxiety effectively";"UK researchers estimated that one in five people attending general hospital clinics has abnormal health anxiety, exacerbated by researching symptoms online. For further information please visit the website of the initiative (link below) ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6412;31;"Smarter medicine";"Sociedad Suiza de Medicina Intensiva";English;"The use of invasive equipment placed (catheters, probes, drains) is not recommended if no benefit is expected in the intensive care patient. It is recommended to reassess the relevance of keeping them and withdrawing them when they are not necessary.";"Invasive equipment in place (catheters, tubes, drains) should not be used if no benefit to the patient is expected. The correct course of action would be to reevaluate the relevance of maintaining them and withdrawing them when they are no longer necessary. The expected positive effects are the reduction of material consumption and associated costs and the reduction of associated complications (complications related to insertion, secondary infections, patient immobilization). The measures that support the evidence are: intervention studies, observational studies, meta-analyses and recommendations of professional societies.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4878;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2017;358:j4171";English;"Do recommend considering statin treatment for patients with LDL above 190 mg/dL regardless of other risk factors.";"The researchers analysed follow-up data from the West of Scotland Coronary Prevention Study (WOSCOPS)?a five year study in 1995 that provided the first evidence that treating men with high LDL levels with statins significantly reduced the risk of death from heart disease. For further information please visit the website of the initiative (link below)";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3858;19;"Choosing Wisely Canada";"Canadian Academy of Sport and Exercise Medicine";English;"Do not recommend ordering an MRI for suspected degenerative meniscal tears or osteoarthritis (OA).";"Degenerate meniscal tears and osteoarthritis (OA) are extremely common in the general population. Early degenerative changes in the meniscus can be found in many subjects under the age of 30. By 50 to 60 years of age, full degenerative meniscal tears are commonly found in 33-50% of subjects. Unless associated with the presence of osteoarthritis (OA), these degenerative meniscal tears are most often asymptomatic. Magnetic resonance imaging (MRI) is not recommended for degenerative meniscal tears unless there are mechanical symptoms (e.g., locking) or lack of improvement with conservative treatment (exercise/therapy, weight loss, bracing, topical or oral analgesia, intra-articular injections). MRI is not recommended for the diagnosis or management of OA. Weight-bearing X-rays should be ordered instead.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3859;19;"Choosing Wisely Canada";"Canadian Academy of Sport and Exercise Medicine";English;"Do not recommend prescribing opiates as first line treatment for tendinopathies. ";"Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Although acute inflammatory tendinopathies (i.e., tendinitis) exist, most patients seen in primary care will have chronic symptoms (tendinosis). Multimodality options (e.g., relative rest, activity modifications, physical or athletic therapy, etc.) should be considered as the first line treatment of tendinopathies. Opiates should not be used in the initial phase of treatment. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3860;19;"Choosing Wisely Canada";"Canadian Academy of Sport and Exercise Medicine";English;"Do not recommend ordering orthotics for asymptomatic children with pes planus (flat feet).";"Pes planus is common in children. Although it rarely leads to disability, it is still a major concern for parents and is a common cause of clinic visits for pediatric foot problems. Most pediatric pes planus cases are characterized by a normal arch during non-weight bearing, and a flattening of the arch on standing. They are often painless, non-problematic, and resolve by adolescence. The current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flexible pes planus.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4884;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ";English;"Study finds that statins for primary prevention in older people should not be recommended.";"Treating older people who have moderate hyperlipidaemia and hypertension with statins for primary prevention of cardiovascular disease does not reduce mortality or coronary heart disease events, results from a post-hoc analysis of a large randomised trial have shown. Therefore, treatment recommendations should be individualised for this population.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative " 3861;19;"Choosing Wisely Canada";"Canadian Academy of Sport and Exercise Medicine";English;"Do not recommend ordering an MRI as an initial investigation for suspected rotator cuff tendinopathy.";"Initial management of rotator cuff tendinopathy includes relative rest, modification of painful activities, and an exercise program guided by a physical therapist or athletic therapist to regain motion and strength. The addition of subacromial cortisone/local anesthetic injections may be helpful. Should conservative management fail to relieve pain and restore function of the shoulder, consider plain radiographs to rule out bony or joint pathology, and ultrasound to assess for rotator cuff and bursal pathology. MRI or MRA (MR arthrogram) should be considered if symptoms don?t resolve with conservative therapy and there is a concern of labral pathology.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4117;2;"Choosing Wisely�";"American Academy of Nursing";English;"Do not recommend routinely ordering a head CT to assess for shunt failure in children with hydrocephalus.";"Computerized tomography (CT) scans have been used for diagnostic imaging for more than 40 years, but it should not be assumed that a head CT is always needed in an evaluation for shunt failure. Because CT is the usual mode of imaging for children with hydrocephalus, these patients have a much higher cumulative radiation exposure than the average population. Children have an increased risk of cancer with exposure to higher cumulative radiation doses. CT scans should be performed only when warranted to reduce exposure to radiation and decrease the risk for radiation induced cancer. Consider using head ultrasounds when there is an open fontanel, or a rapid sequence magnetic resonance imaging (MRI) scan to reduce the amount of ionizing radiation exposure to pediatric patients with a ventricular shunt. A rapid sequence MRI is less expensive than a formal MRI and comparable in costs to CT scan. Because the rapid sequence MRI is quick, sedation is not needed, further reducing costs and medical risks of sedation. A CT scan can be used for emergencies and if the child has implanted metal or a device that is not compatible with an MRI.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4885;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2017;358:j4120";Spanish;"Prostate specific antigen (PSA) screening is associated with a reduction in the risk of death from prostate cancer by as much as a third";"The controversy about PSA based screening should no longer be whether it can do good but whether we can change our behaviour so that it does more good than harm. For further information please visit the website of the initiative (link below) ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3862;19;"Choosing Wisely Canada";"Canadian Academy of Sport and Exercise Medicine";English;"Do not recommend immobilizing ankle inversion sprains with no evidence of bony or syndesmotic injury.";"Ankle sprains are among the most common injuries seen in the ER or physician clinics. Ankle sprains cause a high incidence of absenteeism in professional and physical activities with important economic consequences. There is good evidence to show that functional bracing of the ankle instead of rigid immobilization is associated with improved and earlier functional improvement and an overall shorter recovery period. For ankle inversion sprains with no associated bony or syndesmotic injury, early mobilization using a functional ankle brace and physiotherapy/athletic therapy should be considered instead of rigid immobilization.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4118;2;"Choosing Wisely�";"American Academy of Nursing";English;"Do not recommend routinely ordering an EEG for a simple febrile seizure on neurologically healthy children.";"Febrile seizures are the most commonly occurring seizures in the first 60 months of life. Caregiver anxiety can often lead to requests for neurodiagnostic testing. Attention should be directed at finding the cause of fever and treating it. Electroencephalogram (EEG) tests are costly and can increase caregiver and child anxiety without changing the outcome or course of treatment. EEG has not been shown to predict recurrence of febrile seizures or future epilepsy in patients with simple febrile seizures. EEG can be ordered for children that present with afebrile seizures, complex febrile seizures and in children with neurological insult.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4119;2;"Choosing Wisely�";"American Academy of Nursing";English;"Do not recommend administering diazepam for muscle spasm following spine surgery in the elderly.";"Classic spine surgical treatment involves bilateral dissection of paraspinal muscles to expose the involved levels. Spasms of these muscles are common postoperatively. Treatment of these spasms should include both pharmacologic and non-pharmacologic interventions. Age-related changes in adults can affect both metabolism and drug elimination in the body, resulting in a prolonged half-life for medications. Among the benzodiazepines, diazepam is particularly problematic due to its long half-life and many active metabolites. Benzodiazepines can lead to over-sedation, potential for respiratory depression, increased risk of delirium, and extended in-hospital recovery time. Benzodiazepines have consistently been associated with falls in the aging population and should be avoided. Effective non-pharmacological interventions for use include heat, cold, repositioning, and massage.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4120;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don not recommend using lumbar puncture (LP) opening pressure as a reliable measure of intracranial pressure in children with severe chronic headache.";"There are many limitations with LP pressure measurement as it varies with patient position and level of the manometer. As a ?snapshot in time,? it cannot be correlated with symptoms over time, and anesthetic agents can cause false readings. An intracranial monitor (bolt) measures intracranial pressure (ICP) over time as the patient goes about daily activities. Medical and surgical treatment decisions are based on relieving intracranial pressure. Inaccurate pressure readings can lead to unnecessary surgeries such as cranial vault expansion, shunt revisions and placement of lumbar-peritoneal shunts as well as unnecessary medical treatments.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4121;2;"Choosing Wisely�";"American Academy of Nursing";English;"Do not recommend ordering ?formal? swallow evaluation in stroke patients unless they fail their initial swallow screen.";"Dysphagia (difficulty swallowing) is a common disorder in patients who have suffered a stroke, occurring in 50?60% of acute stroke patients. It is associated with an increased risk of aspiration, pneumonia, prolonged hospital stay, disability, and death. Swallow screening is critical in the rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Because formal swallowing evaluation is not warranted in all patients with acute stroke, the purpose of a swallowing screen is to identify those who do not need a formal evaluation and who can safely take food and medication by mouth. Formal swallowing evaluations can be done in patients who don?t pass the initial screening.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4122;2;"Choosing Wisely�";" American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Do not recommend using intravenous immunoglobulin (IVIG) in the treatment of idiopathic length dependent axonal polyneuropathy.";"IVIG is an expensive therapy with side effects that may include severe allergic reactions, headaches and blood clots. It is recommended for use in Guillain-Barre Syndrome, chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy, but not other polyneuropathies.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4123;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Do not recommend routinely using B vitamin supplements for the treatment of polyneuropathy or neuropathic pain unless a deficiency exists.";"There is no indication for supplementing with B vitamins in patients with polyneuropathy unless a deficiency has been detected or is highly likely secondary to other medical factors (e.g., gastric bypass surgery). In addition to being an unnecessary expense, excessive vitamin B-6 can lead to toxicity and cause worsening neuropathy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4124;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Do not recommend performing nerve conduction studies or electromyography for muscle pain in the absence of other abnormalities on examination or laboratory testing.";"Muscle pain or myalgias are common. The likelihood of finding a muscle disease in an individual with muscle pain who has a normal neurologic exam and laboratory tests is quite low.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4125;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Do not recommend choosing opioids or narcotics as the first choice of treatment for neuropathic pain.";"Opioids and narcotics include drugs such as hydrocodone, oxycodone, fentanyl and others. Risks related to the use of these drugs include uncontrollable sleepiness and slow or stopped breathing. They are a leading cause of addiction and avoidable death. Opioids may be less risky when used for a short time after some surgeries or when used for pain related to deadly cancers. There are many effective, safer options for neuropathic pain.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5661;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"It is not possible to draw any solid conclusions, despite the fact that the review indicates that interventions aimed at facilitating, supporting and maintaining self-care in patients with COPD and administered via smart technology significantly improved HRQL and activity levels up to six months in Comparison with interventions administered through personal support.";"Such improvement may not be sustained for an extended period. The only included study that measured outcomes up to 12 months highlighted the need to ensure sustained commitment to technology over time. Limited evidence indicates that the use of mobile and computer technology for self-care in COPD patients is not harmful and may be more beneficial for some patients than others, eg those who are interested in using the technology. they can get more benefit.";2017;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 4126;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Do not recommend having genetic testing for nerve and muscle diseases prior to having a discussion with your physician or a genetics professional.";"Genetic testing is now widely available and can be ordered directly by patients from home. Due to the potential implications of test results and the complexity of testing, patients are advised to speak with their physician or genetic counselor prior to having testing performed. Pre-testing counseling will help patients select appropriate testing, understand the limitations of testing, potential out-of-pocket costs and the effect that positive test results may have on the patient and their family.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5662;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"It is not possible to provide meaningful overall conclusions in shared decision making for asthma patients.";"Individual studies demonstrated some benefits of shared control decision-making in terms of quality of life; patient and parent satisfaction; adherence to prescribed medication; reduction in visits to asthma-related healthcare; and improvement in asthma control. Confidence in the findings of these individual studies varies from moderate to very low, and it is important to note that the studies did not measure or report adverse events.";2017;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 4127;2;"Choosing Wisely�";"American Chiropractic Association";English;"Do not recommend obtaining spinal imaging for patients with acute low-back pain during the six weeks after onset in the absence of red flags.";"In the absence of red flags, evidence-based guidelines do not support the routine use of spinal imaging for patients with acute back pain of less than six weeks duration. Red flags include history of cancer, fracture or suspected fracture based on clinical history, progressive neurologic symptoms and infection, as well as conditions that potentially preclude a dynamic thrust to the spine, such as osteopenia, osteoporosis, axial spondyloarthritis and tumors. Unnecessary imaging incurs monetary cost, exposes the patient to ionizing radiation, and can result in labeling patients with conditions that are not clinically meaningful, creating a false sense of vulnerability and disability. Indeed, several studies have shown that the routine use of radiographs in the care of low-back pain may result in worse outcomes than without their use.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5663;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There is insufficient evidence to draw conclusions about the effectiveness of text message-based interventions for drug adherence for secondary prevention of cardiovascular disease.";"High-quality randomized trials with sufficient statistical power are needed, particularly in low- and middle-income countries.";2017;;;Uncertain;"Prevention of patients";"Link to the recommendation on the website of the initiative" 4128;2;"Choosing Wisely�";"American Chiropractic Association";English;"Do not recommend performing repeat imaging to monitor patients? progress.";"With few exceptions (e.g., the long-term management of idiopathic scoliosis) radiographic findings should not be used as outcome measures for low-back pain. There is currently no data available to support a relationship between changes in alignment or other structural characteristics and patient improvement. This practice increases costs, exposes patients unnecessarily to ionizing radiation and may distract from more meaningful outcomes. Furthermore, there is no known correlation between performing routine or repeat imaging studies to monitor a patient?s condition and improved clinical outcomes or meaningful changes in patient management. Repeat imaging is appropriate only if strong clinical indications exist, such as a major change in diagnosis, documented worsening of symptoms or significant progression of disease. Failure to respond to treatment is not an indication for repeat imaging.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4129;2;"Choosing Wisely�";"American Chiropractic Association";English;"Do not recommend protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.";"Passive physical therapeutic modalities are defined as those interventions applied to a patient with no active participation on the part of the patient. These include heat, cold, electrical stimulation and ultrasound. These passive therapies can play an important role in facilitating patient participation in an active treatment program. However, the use of passive therapies untethered to the goal of increasing physical activity can be harmful, as it can lead to patient inactivity, prolonged recovery and increased costs. For any patient with a low-back pain disorder to achieve an optimal clinical outcome, an essential element is to restore, maintain or increase the level of physical activity. The evidence demonstrates that both general physical activity (e.g., walking, jogging, biking) and specific exercise regimens are effective in treating and preventing low-back pain and may lead to better outcomes when combined with spinal manipulation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4130;2;"Choosing Wisely�";"American Chiropractic Association";English;"Do not recommend providing long-term pain management without a psychosocial screening or assessment.";"There is a high probability that any person with a chronic pain syndrome has a concomitant psychological disorder, most notably depression and/or anxiety. The relationship between chronic pain and depression/anxiety is well established. The causal arrow between pain and these disorders can point in either direction and over time may form a positive feedback loop between these two elements. Screening tools are available that will aid in the detection of potential depression/anxiety, and, when indicated, a referral may be most appropriate for more extensive evaluation and treatment. In addition, lesser psychological factors such as catastrophizing and fear avoidance behavior may interfere with a patient?s recovery and should be recognized by the clinician. Recognizing indicators of patient psychosocial health behavioral factors can affect a patient?s recovery and/or compliance with treatment and may decrease the risk of developing chronic illness/pain. Tools such as StarTBack 9 screening tool, PHQ-9 depression scale and the Fear Avoidance Belief Questionnaire are examples.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4131;2;"Choosing Wisely�";"American Chiropractic Association";English;"Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.";"While there may be limited benefit in the short term, the prolonged use of lumbar supports is not supported by the literature for the treatment or prevention of low-back pain. Numerous systematic reviews have found limited to no value for their use in this context. The literature clearly demonstrates that such passive therapies are contrary to the currently accepted central principle of low-back pain care, which is that the patient must engage in an active rehabilitative regimen to achieve the best outcomes.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4132;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform routine electrocardiography (ECG) screening as part of pre-operative or pre-procedural evaluations for asymptomatic patients with low perioperative risk of death or myocardial infarction.";"Despite potential value in having a pre-operative ECG to identify unsuspected cardiac abnormalities or as a comparison after a perioperative event, the likelihood of benefit for patients at low risk of major cardiovascular events is very small. Low perioperative risk is defined as <1% probability of death or myocardial infarction in the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery, which also outline evidence-based methods for perioperative risk stratification. Unnecessary ECGs can lead to needless consults, delays and changes to operative plans, which may counterbalance any potential benefit for the patient. In the absence of scientific studies establishing the value of a pre-operative ECG in a low cardiovascular risk population, the routine ordering of pre-operative ECGs should be discouraged.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4133;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"Avoid routine use of pharmacologic DVT prophylaxis in elective foot and ankle surgery.";"The decision of whether to implement pharmacologic prophylaxis should take into account the risk of deep venous thromboembolism (DVT) in the absence of prophylaxis, and the potential adverse effects associated with the use of pharmacologic prophylaxis. Routine use may in fact be harmful, particularly in patients at lowest risk for DVT. The final decision regarding use of pharmacologic prophylaxis should be agreed upon by the physician and patient after a discussion of the potential benefits and harms as they relate to the individual.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4134;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"Don?t culture or treat clinically uninfected lower extremity wounds with systemic antibiotics.";"Uninfected wounds are contaminated with surface flora and will yield false positive culture results. Furthermore, wounds that are not clinically infected do not require antibiotics and the unnecessary prescription of antibiotics may have harmful side effects and lead to further antibiotic resistance.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4135;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"Avoid ordering MRI in patients with suspected acute Achilles tendon ruptures.";"MRI is expensive and can lead to treatment delays. History and physical exam findings can establish the diagnosis of acute Achilles tendon ruptures in nearly all instances. Physicians should reserve MRI for atypical presentations and subacute or neglected ruptures when preoperative planning is needed. When physicians prefer to use the rupture gap (i.e., apposition of tendon ends) as criteria for management (surgery versus conservative treatment), dynamic ultrasound can be easily substituted.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4136;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"Don?t use synthetic or donated grafts on diabetic foot wounds without first allowing for an adequate trial of standard wound care.";"Most diabetic foot wounds will heal when proper wound care is performed. The standard of care includes treating any infection present, ensuring there is adequate circulation for healing, taking pressure off the wound (offloading) and regular debridement. Synthetic or donated grafts are expensive and are ineffective without first performing the standard of care. If a wound being treated with standard care has not healed by at least 50 percent in four weeks, synthetic or donated grafts may then be necessary.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4137;2;"Choosing Wisely�";"American Podiatric Medical Association";English;"Don?t routinely use MRI to diagnose bone infection (osteomyelitis) in the foot. ";"When the diagnosis of osteomyelitis can be reliably established by clinical means and/or serial plain film radiographs, MRI is generally unnecessary. Furthermore, MRI is particularly poor at differentiating osteomyelitis from benign postoperative marrow edema and from marrow edema due to Charcot arthropathy. Use of MRI in these instances can lead to a false positive interpretation and potentially harmful overtreatment.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4138;2;"Choosing Wisely�";"American Society for Colposcopy and Cervical Pathology";English;"Don?t perform vaginal cytology (Pap test) or HPV screening in women who had hysterectomy (with removal of the cervix) for reasons other than high-grade cervical dysplasia (CIN 2/3) or cancer.";"Vaginal cancer after hysterectomy is very rare, less likely than breast cancer for men, for which screening is not recommended. Screening these women is more likely to discover benign changes that prompt invasive testing than to prevent cancer. Continued vaginal cytology (Pap testing) is recommended for women who had a hysterectomy for the indication of high-grade cervical dysplasia or cancer, as their risk of vaginal cancer remains elevated. Vaginal assessment may also be indicated in the presence of HPV-associated vulvar cancer.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4139;2;"Choosing Wisely�";"American Society for Colposcopy and Cervical Pathology";English;"Don?t perform cervical cytology (Pap tests) or HPV screening in immunocompetent women under age 21.";"Cervical cancer is rare in adolescents and screening does not appear to lower that risk. Screening adolescents for cervical cancer exposes them to the potential harms of tests, biopsies, and procedures, without proven benefit.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4140;2;"Choosing Wisely�";"American Society for Colposcopy and Cervical Pathology";English;"Don?t order screening tests for low-risk HPV types.";"There is no role for testing for low-risk HPV types for cervical cancer screening or patient follow-up for abnormal results. Identification of a low-risk HPV type does not change patient management or treatment. Low-risk HPV tests should not be performed.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4141;2;"Choosing Wisely�";"American Society for Colposcopy and Cervical Pathology";English;"Avoid treatment of CIN 1 in women under age 25.";"Regardless of prior cytology, treatment of cervical intraepithelial neoplasia grade 1 (CIN 1) in women aged 21?24 years is not recommended. CIN 1 is the histologic manifestation of HPV infection, and like HPV infection in young women regression rates are high. It is uncommon for these lesions to progress.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4142;2;"Choosing Wisely�";"American Society for Colposcopy and Cervical Pathology";English;"Don?t perform annual cervical cytology (Pap test) or annual HPV screening of immunocompetent women with a history of negative screening.";"There is a slight increase in cancer risk by increasing the interval between screens. However, this risk is balanced with potential harm from more colposcopy as a result of spurious HPV infection that, in most women, will clear spontaneously and is unlikely to progress to any clinically relevant cervical disease. Based on modeling studies of 3- or 5-year intervals, the screening intervals should be greater than a year, but the current evidence does not support a longer screening interval than 3 years for cervical cytology with HPV triage or for primary HPV screening with cytology triage.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4143;2;"Choosing Wisely�";"American Society of Health-System Pharmacists";English;"Do not initiate medications to treat symptoms, adverse events, or side effects without determining if an existing therapy or lack of adherence is the cause, and whether a dosage reduction, discontinuation of a medication, or another medication is warranted.";"New medications should not be initiated without taking into consideration patient compliance with their pre-existing medication and whether their current dose is effective at controlling/treating symptoms. Medications are often prescribed to treat symptoms that are really side effects of other medications without determining if the pre-existing medication is truly needed or could be discontinued.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6447;31;"Smarter medicine";"La Sociedad Suiza de Gastroenterolog�a";English;"It is recommended to adjust long-term antacid therapy (proton pump inhibitors or histamine 2 receptor antagonists) to the minimum effective dose necessary to achieve therapeutic goals.";"El principal identifiable risk associated with the reducci�n or suspension of the antiacid treatment is the empeoramiento de los s�ntomas. Hence it is deduced that the decision regarding the necessity (and dosificaci�n) of the treatment of maintenance is based on the impact of these residual s�ntomas in the quality of vida del paciente and that this treatment is not considered as a medium of control of the confinement.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative" 4144;2;"Choosing Wisely�";"American Society of Health-System Pharmacists";English;"Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be discontinued.";"Studies have shown that patients taking five or more medications often find it difficult to understand and adhere to complex medication regimens. A comprehensive review, including medical conditions, should be done at periodic intervals, at least annually, to determine if the medications are still needed and if any medications can be discontinued.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4145;2;"Choosing Wisely�";"American Society of Health-System Pharmacists";English;"Do not continue medications based solely on the medication history unless the history has been verified with the patient by a medication-use expert (e.g., a pharmacist) and the need for continued therapy has been established.";"The patient or caregiver should be the sole source of truth when taking the medication history. The patient or caregiver should be interviewed by someone with medication-use knowledge, ideally a pharmacist, and medications should be continued only if there is an associated patient indication. If a pharmacist is not available, then at a minimum, the healthcare worker taking the history should have access to robust drug information resources. The history should include the drug name, dose, units, frequency, and the last dose taken; and indication if available.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4146;2;"Choosing Wisely�";"American Society of Health-System Pharmacists";English;"Do not prescribe patients medications at discharge that they were on prior to admission without verifying that these medications are still needed and that the discharge medications will not result in duplication, drug interactions, or adverse events.";"Treatments and procedures during a hospitalization may impact a patient?s ongoing need for a medication they were receiving prior to admission. Care should be taken at discharge to consider each medication taken prior to hospitalization in light of the patient?s current state. Unnecessary medications should be discontinued, duplicate or overlapping therapies should be changed, and the specific changes should be clearly communicated to the patient. The Joint Commission recommends a thorough medication review at admission and discharge to prevent any unnecessary medications being continued.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4147;2;"Choosing Wisely�";"American Society of Health-System Pharmacists";English;"Do not prescribe or administer oral liquid medications using teaspoon or tablespoon for measurement; use only milliliters (mL) when measuring with an approved dosing device (e.g., medication cup or oral syringe).";"Serious medication errors, including patient deaths, have occurred because oral liquids are prescribed and/or administered using English measurement units such as the teaspoon or tablespoon. For medical professionals, best practice is using units and volume when prescribing a single-agent liquid medication, to be sure the dose is clear; but for administering, use only mL for measuring the amount. Safety organizations and agencies such as the Centers for Disease Control and Prevention (CDC) and the Institute for Safe Medication Practices (ISMP) have recommended using only the metric system units (e.g., mL) for measurement and using a measuring device that contains only metric markings. Prescribing using the metric system and dispensing with a metric measuring device will help avoid these preventable errors.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6451;31;"Smarter medicine";"La Sociedad Suiza de Gastroenterolog�a";English;"Repeat screening for colorectal cancer (regardless of method) is recommended in individuals at medium risk for at least 10 years after a negative total colonoscopy.";"The recommended interval between each screening colonoscopy in adults without an increased risk of colorectal cancer is ten years from the age of 50. Published studies indicate that the risk of cancer is low for ten years if a total colonoscopy did not detect neoplasia in this population. Thus, following a total colonoscopy having given a normal result, the time to be observed before a new colorectal screening should be ten years.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative" 4148;2;"Choosing Wisely�";"American Urological Association";English;"Don?t treat low-risk clinically localized prostate cancer (e.g., Gleason score is less than 7, PSA less than 10.0 ng/mL, and tumor stage T2 or less) without discussing active surveillance as part of the shared decision-making process.";"The ultimate choice of treatment should be based on shared decision making and individualized to the patient?s disease characteristics, his overall health, and his personal preferences. The disparity between prostate cancer incidence and mortality implies that many men may not benefit from definitive treatment of localized disease. For men with newly diagnosed low-risk prostate cancer, an active surveillance program represents a valid option that should be discussed. Active surveillance provides a monitored approach that can spare some men the potential risks of definitive treatment while selectively providing effective treatment for more aggressive cancers that warrant intervention.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4149;2;"Choosing Wisely�";"American Urological Association";English;"Don?t treat uncomplicated cystitis in women with fluoroquinolones if other oral antibiotic treatment options exist.";"Due to serious potential side effects associated with the use of fluoroquinolone antibiotics, these drugs should not be prescribed as first line therapy for uncomplicated cystitis in women. Their use should be reserved for situations where recommended first line antibiotic therapies, such as nitrofurantoin or sulfa-trimethoprim, are contraindicated.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4150;2;"Choosing Wisely�";"American Urological Association";English;"Don?t continue opioid analgesia beyond the immediate postoperative period; prescribe the lowest effective dose and number of doses required to address the expected pain.";"The use of opioid analgesia for pain is often appropriate in surgical patient care. However due to the emergence of opioid use disorder as a public health epidemic, the appropriate use of opioid therapy must begin with adherence to minimum prescribing in terms of dose, duration and quantity.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4151;2;"Choosing Wisely�";"American Urological Association";English;"Don?t obtain urine cytology or urine markers as a part of the routine evaluation of the asymptomatic patient with microhematuria.";"Insufficient evidence exists for the use of urine cytology and urine markers in the routine evaluation of the asymptomatic patient with microhematuria, including bladder tumor antigen (BTA) assays, nuclear matrix protein (NMP) assays, and fluorescent in situ hybridization (FISH) assays to detect chromosomal alterations. The psychological stress and unnecessary diagnostic procedures that could result from a false positive test outweigh the potential benefits to these patients.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4152;2;"Choosing Wisely�";"American Urological Association";English;"Don?t routinely use computed tomography (CT) to screen pediatric patients with suspected nephrolithiasis.";"Given the link between radiation exposure from computed tomography (CT) in children and increased cancer risk, imaging test selection should adhere to the principle of ALARA (as low as reasonably achievable) to minimize radiation exposure. Ultrasonography is sufficiently sensitive and specific as an initial imaging test in pediatric patients with suspected urolithiasis. When ultrasound results are negative or indeterminate despite strong clinical suspicion or when proceeding with preoperative planning, CT using a low-dose protocol is an appropriate next step.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5689;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"It is encouraged personalized digital interventions to reduce dangerous and harmful alcohol consumption in people residing in the community.";"Significant heterogeneity and the risk of completion and publication may mean that the reduction was less. Low-quality evidence from a few studies indicated that there may be little or no difference in the impact on alcohol consumption between digital and face-to-face interventions.";2017;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative" 6713;36;"Choosing Wisely UK";"Royal Pharmaceutical Society";English;"It is recommended to stop the inappropriate use of antipsychotics to manage behaviour that challenges in people with learning disabilities, dementia and other mental health conditions. ";"Compared to most other areas of work with learners, there is a broad evidence base to guide professionals who support people whose behavior is considered challenging. However, there is the application of best practice, as shown by the number of people who have to be referred to centers outside their area of residence when local services cannot help them. The purpose of this section is to identify some of the practice areas that have not been covered in this document, or that need to be investigated in the future in order to create a context for successful professional practice.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative" 5690;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is a lack of high-quality evidence to determine whether electronic assistive technology is effective in dementia patients in managing their memory problems.";"The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user?friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking.";2017;;;"Low value";"Management of patients";"Link to the recommendation on the website of the initiative" 4156;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that all women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 �g) of folic acid.";"Recommendation grade A ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6460;31;"Smarter medicine";"La Sociedad Suiza de Gastroenterolog�a.";English;"No follow-up examination for three years is recommended in a patient diagnosed with Barrett's esophagus and whose biopsy at the end of a second endoscopy confirmed the absence of dysplasia ";"In patients with Barrett's esophagus without dysplasia (cell changes), the risk of cancer is very low. In such cases, it is appropriate and prudent to examine the esophagus and check whether there is dysplasia or not. However, these check-ups should not occur more frequently than every three years, because if these cellular changes occur, they do so very slowly.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4157;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy";"Recommendation grade B ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4158;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status";"Recommendation grade B ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4159;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends vision screening at least once in all children ages 3 to 5 years to detect amblyopia or its risk factors.";"Recommendation grade B ";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4671;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Anatom�a Patol�gica (SEAP)";Spanish;"Do not ask for intraoperative studies if they are not going to involve an immediate change in the surgical attitude during the intervention.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa
" 6463;31;"Smarter medicine";"Sociedad Suiza de Gastroenterolog�a";English;"A repeat CT scan is not recommended unless there is a significant change in clinical findings or symptoms in a patient with functional abdominal pain syndrome (according to the Rome IV criteria).";"X-ray exposure leads to a mediocre improvement in cancer risk. Abdominal computed tomography is one of the examinations with relatively high X-ray exposure, equivalent to very high natural radiation. Because of this risk and its high cost, CT scanning should only be done if it is likely to provide useful information that could change patient management.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4160;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend one-time screening with ultrasound for abdominal aortic aneurysm for men aged 65 to 80.";"Pooled analyses from four population-based randomized controlled trials (RCTs) with men 65 to 80 years of age indicate that one-time screening for Abdominal Aortic Aneurysm (AAA) with ultrasound reduces the risk of AAA-related mortality, rupture and emergency repair. On the other hand, screening can also lead to identification of AAAs that would never rupture and increases the number of elective repairs which are conducted. The prevalence of AAA in screened populations has declined since these RCTs were conducted, which would reduce the absolute benefit of screening from that reported in the trials.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4161;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend not screening men older than 80 years of age for abdominal aortic aneurysm.";"Pooled analyses from four population-based randomized controlled trials (RCTs) with men 65 to 80 years of age indicate that one-time screening for Abdominal Aortic Aneurysm (AAA) with ultrasound reduces the risk of AAA-related mortality, rupture and emergency repair. On the other hand, screening can also lead to identification of AAAs that would never rupture and increases the number of elective repairs which are conducted. The prevalence of AAA in screened populations has declined since these RCTs were conducted, which would reduce the absolute benefit of screening from that reported in the trials.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4673;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Anatom�a Patol�gica (SEAP)";Spanish;"Do not manipulate nor open the surgical pieces without the supervision of a pathologist, since it is difficult to properly examine the piece and existing injuries.";-;2017;;;"Low value";-;"Link to the recommentadion on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4162;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend not screening women for abdominal aortic aneurysm.";"Pooled analyses from four population-based randomized controlled trials (RCTs) with men 65 to 80 years of age indicate that one-time screening for Abdominal Aortic Aneurysm (AAA) with ultrasound reduces the risk of AAA-related mortality, rupture and emergency repair. On the other hand, screening can also lead to identification of AAAs that would never rupture and increases the number of elective repairs which are conducted. The prevalence of AAA in screened populations has declined since these RCTs were conducted, which would reduce the absolute benefit of screening from that reported in the trials.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4674;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Anatom�a Patol�gica (SEAP)";Spanish;"Do not exhaust endoscopic material in patients diagnosed with tumor pathology if that is going to be the only sample available.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4163;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend against screening for HCV in adults who are not at elevated risk.";"This recommendation applies to asymptomatic adults who are not at elevated risk for hepatitis C.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4164;22;"The Canadian Task Force for Preventive Health Care Guidelines";"The Canadian Task Force for Preventive Health Care Guidelines";English;"We recommend an intervention asking children and youth or their parents about tobacco use and offering brief* information and advice to treat tobacco smoking for children and youth (5-18 years) who do not currently smoke tobacco, whether they have never smoked or are former smokers, at appropriate primary care visits**.";"* Contact time with primary care clinician of up to 5 minutes. Advice may include verbal communication about patient attitudes and beliefs, risks of smoking, and/or strategies for dealing with the influence of peers, sharing of printed or electronic material. **Appropriate primary care visits include scheduled health supervision visits, visits for immunizations or medication renewal, episodic care or acute illness, and other visits where the primary care practitioner deems it appropriate, conducted in primary health care or community settings.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4676;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Anatom�a Patol�gica (SEAP)";Spanish;"Do not base the diagnosis of lymphomas on molecular findings (monoclonal rearrangement) in the absence of clinical / histological / immunohistochemical correlation.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 6468;31;"Smarter medicine";"La Sociedad Profesional Suiza de Geriatr�a";English;"Percutaneous gastric tube feeding is not recommended in patients with severe dementia. It is recommended to offer assisted oral feeding insteadin patients with severe dementia.";"Helping an affected patient to feed by hand is at least as good a method as tube feeding in terms of prognosis for survival, aspiration pneumonia, functionality, and patient comfort. Nutrient intake should be based primarily on food. Tube feeding is associated with a risk of depression, increased use of physical and chemical restraints, and worsening of pressure ulcers.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4165;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend an intervention asking children and youth or their parents about tobacco use and offering brief* information and advice to treat tobacco smoking for children and youth (5-18 years) who have smoked tobacco within the past 30 days at appropriate primary care visits**. ";"* Contact time with primary care clinician of up to 5 minutes. Advice may include verbal communication about patient attitudes and beliefs, risks of smoking, and/or strategies for dealing with the influence of peers, sharing of printed or electronic material. **Appropriate primary care visits include scheduled health supervision visits, visits for immunizations or medication renewal, episodic care or acute illness, and other visits where the primary care practitioner deems it appropriate, conducted in primary health care or community settings.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4166;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The harm-benefit balance of Panitumumab is being re-evaluated for its use in colorectal cancers.";"The only drugs listed in our 2016 review of drugs to avoid that do not feature in this year?s review are panitumumab for colorectal cancers and varenicline for smoking cessation. This is because we are currently re-evaluating their harm-benefit balance in light of new data published in 2016.";2017;;;"Low value";-; 5702;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effectiveness of quality improvement (QI) initiatives in reducing avoidable hospital readmissions of patients ?within 30 days. ";"The COVID-19 pandemic is placing a strain on health services. Decreasing the rate of avoidable readmissions from skilled nursing facilities to acute care hospitals can reduce this strain and improve patient outcomes. In this systematic review, the authors searched for experimental research evaluating the effectiveness of quality improvement (QI) initiatives in reducing avoidable hospital readmissions of patients?within 30 days of their original discharge?to skilled nursing facilities (SNFs). They restricted their search to articles published in English between 2009 and 2016. Research concerning discharge from SNFs or hospital-to-home settings was excluded. They included 8 retrospective and 2 prospective quasi-experimental studies. ";2017;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4167;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The harm-benefit balance of varenicline is being re-evaluated for its use in smoking cessation.";"The only drugs listed in our 2016 review of drugs to avoid that do not feature in this year?s review are panitumumab for colorectal cancers and varenicline for smoking cessation. This is because we are currently re-evaluating their harm-benefit balance in light of new data published in 2016.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4168;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The adverse effects of ambroxol, such as hypersensitivity reactions and life-threatening cutaneous disorders make their harm-benefit balance unfavorable.";"The adverse effects of the mucolytics ambroxol and brom- hexine are better known now that they have been in use for a long time. The hypersensitivity reactions and life-threatening cutaneous disorders they cause make their harm-benefit balance unfavourable. Although these adverse effects are rare, they are unacceptable for drugs that have no efficacy beyond a placebo effect and that are indicated for minor ailments such as cough or sore throat.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4680;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Oncolog�a Radioter�pica (SEOR)";Spanish;"Conventional fractionations are not recommended in patients with early-stage non-small cell lung cancer not candidates for surgery.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4169;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The adverse effects of bromhexine, such as hypersensitivity reactions and life-threatening cutaneous disorders make their harm-benefit balance unfavorable.";"The adverse effects of the mucolytics ambroxol and bromhexine are better known now that they have been in use for a long time. The hypersensitivity reactions and life-threatening cutaneous disorders they cause make their harm-benefit balance unfavourable. Although these adverse effects are rare, they are unacceptable for drugs that have no efficacy beyond a placebo effect and that are indicated for minor ailments such as cough or sore throat.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4681;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Oncolog�a Radioter�pica (SEOR)";Spanish;"Do not perform postoperative radiotherapy routinely in patients with non-small cell lung cancer (NSCLC) in the early stage (N0-N1) with negative margins.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 5705;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Combined learning (which combines e-learning with face-to-face learning) is recommended to improve the knowledge and skills of health workers";"As knowledge about COVID-19 and how to deal with the pandemic spreads, it is important that healthcare workers are trained appropriately, which might require a shift from face-to-face learning to online e-learning during times of social distancing. In this Campbell systematic review, the authors searched for research assessing the effectiveness of e?learning for improving evidence?based health care knowledge and practice among healthcare workers. They did not restrict their search by language of publication and did the search in May 2016. They included 20 randomised trials and 4 non-randomised trials (total: 3825 participants). Participants included medical doctors, nurses, physiotherapists, physician assistants and athletic trainers at all levels of education";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4170;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Dronedarone is not recommended in atrial fibrillation";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4171;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Capsaicin is not recommended in neuropathic pain";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4172;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Nintedanib has an unfavourable harm-benefit balance for non-small cell lung cancer and for idiopathic pulmonary fibrosis";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4173;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Olaparib has an unfavourable harm-benefit balance for ovarian cancer. ";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4174;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Mepolizumab has an unfavourable harm-benefit balancefor asthma.";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4175;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Panobinostat has an unfavourable harm-benefit balance for multiple myeloma";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4687;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Oncolog�a Radioter�pica (SEOR)";Spanish;"Do not give adjuvant radiotherapy in low-grade astrocytoma / supratentorial oligodendrogiomas in adults with complete resection without high risk criteria.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4176;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Ciclosporin for eye drops has an unfavourable harm-benefit balance for dry eye disease";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5712;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is not recommended formulary restrictions to reduce costs and use of prescription drugs ";"The COVID-19 pandemic is placing a strain on healthcare services and resources. Existing research on the impact of formulary restrictions (restrictions to reduce costs and use of prescription drugs) for medications may provide information to help policy makers with this. In this systematic review, the authors searched for research on the effects of formulary restrictions. They restricted their search to articles published in English between 2005 and February 2017. They included 48 retrospective observational studies, 5 time-series analysis studies, 3 cross-sectional studies, 1 case-control study, 1 controlled before-after study and 1 randomised trial. Formulary coverage decisions may have unintended consequences on patient and payer outcomes, so there should be careful evaluation of restrictions before and after policy implementation, and it is uncertain which strategies might mitigate the unintended consequences. Formulary restrictions reduced drug utilization and associated drug costs, but some of these cost savings were offset by increased healthcare resource use and medical costs. Formulary restrictions were associated with reduced medication adherence and negative clinical outcomes in patients. ";2017;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4177;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Idebenone has an unfavourable harm-benefit balance for for Leber?s hereditary optic neuropathy";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4178;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Alemtuzumab is not recommended for the treatment of multiple sclerosis";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5714;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of general practitioner cooperatives to reduce non-urgent visits to emergency departments is recommended";"The COVID-19 pandemic has increased demand on hospital emergency departments. Research into alternative ways of managing less urgent cases (such as walk-in centers and General Practitioner cooperatives) may provide information that would help ease this demand. In this systematic review, the authors searched for research on the effects of walk-in centers and General Practitioner (GP) cooperatives on local ED attendances. They restricted their search to articles published in English between 2000 and 2014. They included 4 studies of walk-in centres (all done in the UK) and 7 studies of GP cooperatives (which were done in Australia (1 study), Ireland (1), The Netherlands (4) and Switzerland (1) GP cooperatives significantly reduced non-urgent ED attendances. The effects of walk-in centers on ED attendance are uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4179;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Alogliptin (alone or combined with metformin), canagliflozin, dapagliflozin and pioglitazone is not recommended for the treatment of type 2 diabetes";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5715;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The effects of walk-in centers on ED attendance are uncertain";"The COVID-19 pandemic has increased demand on hospital emergency departments. Research into alternative ways of managing less urgent cases (such as walk-in centers and General Practitioner cooperatives) may provide information that would help ease this demand. In this systematic review, the authors searched for research on the effects of walk-in centers and General Practitioner (GP) cooperatives on local ED attendances. They restricted their search to articles published in English between 2000 and 2014. They included 4 studies of walk-in centres (all done in the UK) and 7 studies of GP cooperatives (which were done in Australia (1 study), Ireland (1), The Netherlands (4) and Switzerland (1) GP cooperatives significantly reduced non-urgent ED attendances. The effects of walk-in centers on ED attendance are uncertain.";2017;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4180;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"The fixed-dose combinations of bupropion + naltrexone is not recommended for weight loss.";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5716;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"High-deductible health plans are recommended to reduce the cost and use of health care, including the use of necessary preventive services";"The COVID-19 pandemic is placing a strain on healthcare services and resources. Existing research on strategies intended to reduce healthcare costs may provide useful information for policy makers. In this systematic review, the authors searched for research on the impact of high-deductible health plans on healthcare use and costs. They restricted their search to articles published in English and did the search in January 2017. They included 28 studies comparing high-deductible plans to traditional health plans, with outcome measures including healthcare use and spending for any health care setting. High-deductible health plans were associated with lower healthcare costs due to a reduction in the use of health services, including the use of both appropriate and necessary care, and increased cost-sharing (out-of-pocket spending by patients). High-deductible health plans were associated with a significant reduction in the use of preventive services, medication adherence and office visits. The effects of high-deductible health plans on outcomes for low-income or chronically ill patients are uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4181;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Mannitol inhalation powder is not recommended for cystic fibrosis.";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4182;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Mifamurtide is not recommended for the treatment osteosarcoma.";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4694;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Oncolog�a Radioter�pica (SEOR)";Spanish;"Do not indicate rescue radiotherapy after Prostatectomy and PSA> 2 ng/ml without performing imaging tests that determine the location of recurrence.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4183;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Ranolazine is not recommended for the treatment of angina";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4184;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Vernakalant is not recommended for the treatment of atrial fibrillation";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4696;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Oncolog�a Radioter�pica (SEOR)";Spanish;"Do not routinely consider long fractionation schemes (>10 sessions) for palliative treatment of bone metastases.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4697;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"It's not recommended using peripheral blood stem cells for patients with aplastic anemia when a suitable bone marrow donor is available due to a higher risk of graft-versus-host disease.";"While faster engraftment with filgrastim-mobilized peripheral blood stem cells results in quicker recovery of peripheral blood counts compared to bone marrow in patients with aplastic anemia, the higher rate of graft-versus-host disease may be detrimental.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4698;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"Don?t use greater than 2 mg/kg/day of methylprednisolone (or equivalent) for the initial treatment of graft-versus-host disease.";"Published studies have shown no advantage to using methylprednisolone-equivalent doses higher than 2 mg/kg/ day in acute graft-versus-host disease. In addition, using higher doses increases risks of corticosteroid related toxicity. Furthermore, at least in patients with grade I-II acute graft-versus-host disease, initial therapy with lower-dose corticosteroids at 1 mg/kg/day may be equivalent.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4699;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"Don?t routinely use two cord blood units for standard umbilical cord blood transplantation when a single unit of adequate size is available, recognizing that higher cell doses are preferred when using units with greater HLA mismatch.";"Randomized trials demonstrate similar clinical outcomes after single-unit and double unit umbilical cord blood transplantation, including comparable rates of relapse, engraftment failure, overall survival, and transplantation related mortality. Moreover, graft-versus-host disease may be more frequent after double-cord blood transplantation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5467;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Vitamin D supplementation is safe, and protects against some acute respiratory tract infections.";"COVID-19 is an infection of the respiratory tract. It has been suggested that Vitamin D supplementation might prevent acute respiratory tract infection in other circumstances. The findings of research into this may be worth considering for COVID-19. In this systematic review, the authors collected data on each individual participant in randomised, placebo controlled trials of supplementation with vitamin D3 to evaluate its effects on the prevention of acute respiratory tract infection. They collected data from trials identified in a search in December 2015. They included 25 eligible studies (11,321 participants). Vitamin D supplementation is safe, and protects against some acute respiratory tract infections. People who were very vitamin D deficient and those not receiving bolus doses experienced the most benefit.";2017;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4700;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"Don?t routinely use peripheral blood stem cells for matched unrelated donor transplantation using myeloablative conditioning and standard graft-versus-host disease prevention regimens when a suitable bone marrow donor is available.";"Patients undergoing myeloablative matched unrelated donor hematopoietic cell transplantation with standard graft-versushost disease prophylaxis (calcineurin inhibitor and methotrexate) with a peripheral blood stem cell graft experience more symptomatic chronic graft-versus-host disease than those receiving bone marrow, without affecting relapse rates or overall survival. Peripheral blood stem cells may be considered in cases with substantial recipient/donor size discrepancy, donor preference, and for malignant diseases with high risk for graft failure.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5724;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Integrated care interventions are recommended for the health care of indigenous populations in North America";"In this systematic review, the authors searched for research into the effects of integrated care interventions for the health care of indigenous communities in North America. These interventions incorporated biological, psychological, social, cultural and spiritual factors into health care, and had health behavioral specialists working alongside primary care clinicians. The authors did their most recent search in 2016. They included 9 studies. Integrated care brought about better physical and mental health for indigenous people in North America, including reducing substance use and improving access to health care. Integrated care improved social outcomes for indigenous people in North America, including improving employment and education status, and reducing contact with criminal justice systems. Incorporating cultural beliefs and practices into health care improved community engagement and reduced stigma for indigenous people in North America.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4701;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"Don?t routinely give immunoglobulin replacement to adult hematopoietic cell transplantation recipients in the absence of recurrent infections regardless of the IgG level.";"Meta-analyses of controlled trials conclude that immunoglobulin replacement offers no advantage for infection prevention and overall survival, and may predispose to a higher risk of hepatic sinusoidal obstruction syndrome, venous thromboembolism, and impair the efficacy of post-transplant vaccinations. There may be subsets of patients where prophylactic immunoglobulin replacement may be considered, such as in umbilical cord blood transplant recipients, in children undergoing transplantation for inherited or acquired disorders associated with B-cell deficiency, and in chronic graft-versus-host disease patients with recurrent sino-pulmonary infections.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4702;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"It's not recommended performing stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.";"Asymptomatic, low-risk patients account for up to 45 percent of unnecessary ?screening?. Testing should be performed only when the following findings are present: diabetes in patients older than 40-years-old; peripheral arterial disease; or greater than 2 percent yearly risk for coronary heart disease events.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4703;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"It's not recommended performing annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.";"Performing stress cardiac imaging or advanced non-invasive imaging in patients without symptoms on a serial or scheduled pattern (e.g., every one to two years or at a heart procedure anniversary) rarely results in any meaningful change in patient management. This practice may, in fact, lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients? outcomes. An exception to this rule would be for patients more than five years after a bypass operation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4704;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"It's not recommended performing stress cardiac imaging or advanced non-invasive imaging as a pre operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.";"Non-invasive testing is not useful for patients undergoing low-risk non-cardiac surgery (e.g., cataract removal). These types of tests do not change the patient?s clinical management or outcomes.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4705;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"It's not recommended performing echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.";"Patients with native valve disease usually have years without symptoms before the onset of deterioration. An echocardiogram is not recommended yearly unless there is a change in clinical status.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4706;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society";English;"Don?t order annual electrocardiograms (ECGs) for low-risk patients without symptoms.";"Don?t obtain screening electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. In asymptomatic individuals at low risk for coronary heart disease (10-year risk <10%), screening for coronary heart disease with electrocardiography does not improve patient outcomes.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4199;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"It's not recommended issuing medical proofs after the medical event has happened to excuse the absence of a user to any commitment.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4200;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not issue proof of the absence of children to the school or high-school.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4712;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Medicina Preventiva, Sociedad Espa�ola de Medicina Preventiva Salud P�blica e Hi";Spanish;"Do not remove hair systematically to reduce the risk of surgical site infection. If necessary, use suitable hair clippers (electric razors, hair clippers, chemical hair removal).";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4201;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not make specific certificates for kindergartens, compulsory education, adult education, studies abroad, spas, gymnasiums, municipal sports activities, physical disabilities, home help or income in nursing homes.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4713;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Preventiva, Sociedad Espa�ola de Medicina Preventiva ,Salud P�blica e Hig";Spanish;"Do not continue with antibiotics for more than 24-48 hours in hospitalized patients, unless there is clear evidence of infection.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4202;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not continue treatments which were prescribed at the hospital care and the general practitioner does not consider adequate.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4714;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Preventiva, Sociedad Espa�ola de Medicina Preventiva ,Salud P�blica e Hig";Spanish;"The analysis of Clostridium diff�cile toxin is not recommended in asymptomatic patients.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4203;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not deliver an informed consent document for tests requested or performed by other health professionals.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4715;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Preventiva, Sociedad Espa�ola de Medicina Preventiva ,Salud P�blica e Hi";Spanish;"Do not use nasal decontamination with topical antimicrobial agents intended to remove Staphylococcus Aureus routinely to reduce the risk of infection of the surgical site, before cardiac or orthopedic procedures.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 6763;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"It is not recommended to perform a planned caesarean section for breech presentation before offering the external cephalic version.";"In the absence of contraindications, a planned caesarean section by breech presentation should not be performed before an external cephalic version has been offered. Information should be given to the patient, questions should be answered and her individual circumstances and preferences should be discussed. Whenever possible, an external cephalic version should be offered for breech presentation before a planned caesarean section is agreed.";2017;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 4204;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not issue medical prescriptions for vaccines included in the vaccination calendar or the vaccination campaigns for patients who are covered by the program.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4716;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Medicina Preventiva, Sociedad Espa�ola de Medicina Preventiva ,Salud P�blica e Hi";Spanish;" It is not recommended the routine replacement of peripheral venous catheters every 72-96 hours";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4205;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not provide clinical information to relatives or parents or guardians of patients over 14 years of age, unless it is motivated by the interest of the minor or for the fulfillment of parental authority.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4717;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Urgencias y Emergencias (SEMES)";Spanish;"Do not place bladder catheterization on all patients who require control of urine output, except for seriously ill patients who require strict control of urine output and cannot ensure voluntary spontaneous urination.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4206;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not perform forced recognitions under a police request, unless judicial order, when caring or treating detained patients. The patient's consent must always be mediated.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4718;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Urgencias y Emergencias (SEMES)";Spanish;"Do not perform arterial gasometry on all patients with dyspnea, except in chronic obstructive pulmonary disease with moderate or severe exacerbation with low O2 saturations and / or suspected hypercapnia, to initiate or control mechanical ventilation.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4719;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Urgencias y Emergencias (SEMES)";Spanish;"Do not perform venous ultrasound of extremities in patients with low suspicion of deep vein thrombosis and negative D-dimer.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4720;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Medicina Urgencias y Emergencias (SEMES)";Spanish;"Do not administer plasma or prothrombin complex concentrates in a non-emergency situation to reverse vitamin K antagonists.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4722;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Medicina Urgencias y Emergencias ";Spanish;"A nasogastric tube should not be placed routinely for all digestive hemorrhages.";-;2017;;;"Low value";-;"No se debe colocar una sonda nasog�strica de forma rutinaria a todas las hemorragias digestivas" 4723;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Nutrici�n Enteral y Parenteral ";Spanish;"Do not use nutritionally restrictive diets in hospitalized patients if it is not strictly necessary.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4724;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Nutrici�n Enteral y Parenteral ";Spanish;"Do not use parenteral nutrition in patients in whom the digestive system functions properly and is accessible orally or enterally.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4725;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Nutrici�n Enteral y Parenteral";Spanish;"Do not delay more than 48 hours the beginning of Enteral Nutrition in critically hemodynamically stable patients in which there is no expectation of oral intake in 3-5 days. ";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4726;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Nutrici�n Enteral y Parenteral";Spanish;"It is not recommended to use supplements of vitamin B6, vitamin B12, folic acid in people with dementia for the prevention or treatment of cognitive impairment when there is no indication or deficiency.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4727;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola Nutrici�n Enteral y Parenteral";Spanish;"It is not recommended to use arginine-enriched enteral diets for patients with severe sepsis (shock or multi-organ failure).";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5751;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is unclear whether the cost-effectiveness of H1N1 flu interventions is applicable to the Covid-19 pandemic";"The COVID-19 pandemic is placing a great strain on health systems and economies. Information on the cost-effectiveness of interventions used in other pandemics might help those making decisions about interventions for COVID-19. In this systematic review, the authors searched for studies that presented cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions. They did their search in December 2014. They identified 18 studies that assessed the cost-effectiveness of 12 different strategies. All studies examined costs from a societal perspective. Hospital quarantine, vaccination and use of an antiviral stockpile were highly cost-effective for the A/H1N1 pandemic, but it is uncertain whether these findings are applicable to the COVID-19 pandemic. School closures, antiviral treatments and social distancing may not have been cost-effective in the H1N1 pandemic, but it is uncertain whether these findings are applicable to the COVID-19 pandemic.";2017;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4728;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola Fisioterapia ";Spanish;"It is not recommended to delay the start of physiotherapy treatment in Parkinson's disease until the appearance of movement difficulties.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4729;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola Fisioterapia (AEF)";Spanish;"It is not recommended to use only passive techniques in the treatment of chronic tendinopathies, since active therapy is more effective.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4730;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola Fisioterapia ";Spanish;"It is not recommended tu do autopassive pulley exercises in the treatment of the upper limb of the hemiplegic patient.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4731;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola Fisioterapia (AEF)";Spanish;"It is not recommended to the ""one leg stand"" test to assess the risk of falls in the geriatric population.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5755;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended the use of interventions aimed at reducing visits to the emergency department of frequent adult users ";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to reduce frequent visits to the emergency department (ED) might provide information to ease this. In this systematic review, the authors searched for research evaluating the effects of interventions intended to reduce the frequency of ED visits by adult frequent ED users. They did not restrict by date, type or language of publication and did their search in October 2014. They included 21 non-controlled before?after studies, 6 randomized trials and 4 controlled before?after studies. Case management, care plans, diverting patients to non-urgent care, printout case notes and social work home visits decreased the frequency of ED visits by adult frequent ED users.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4732;19;"Choosing Wisely Canada";"Canadian Blood and Marrow Transplant Group";English;"It is not recommended to use routinely peripheral blood stem cells for patients with aplastic anemia when a suitable bone marrow donor is available due to a higher risk of graft-versus-host disease";"While faster engraftment with filgrastim-mobilized peripheral blood stem cells results in quicker recovery of peripheral blood counts compared to bone marrow in patients with aplastic anemia, the higher rate of graft-versus-host disease may be detrimental.";2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 6524;33;"Choosing Wisely � : Things we do for no reason";"Madeira C. et al. ";English;"Echocardiography is not recommended in unselected patients (normal history, physical examination, and electrocardiogram) with syncope";"Syncope is a common cause of emergency department (ED) visits and hospitalizations. Echocardiogram is frequently used as a diagnostic tool in the evaluation of syncope, performed in 39%-91% of patients. The diagnostic yield of echocardiogram for detecting clinically important abnormalities in patients with a normal history, physical examination, and electrocardiogram (ECG), however, is extremely low. In contrast, echocardiograms performed on patients with syn- cope with a positive cardiac history, abnormal examination, and/or ECG identify an abnormality in up to 29% of cases, though these abnormalities are not always definitively the cause of symptoms. Recently updated clinical guidelines for syncope management from the American College of Cardiology now recommend echocardiogram only if initial history or examination suggests a cardiac etiology, or the ECG is abnormal. Universal echocardiography in patients with syncope exposes a significant number of patients to unnecessary testing and cost and does not represent evidence-based or high-value patient care. Recomendations: ? All patients with syncope should receive a complete history, physical examination, orthostatic vital signs, and ECG. ? Perform echocardiogram on patients with syncope and a history of cardiac disease, examination suggestive of structural heart disease or congestive heart failure, or abnormal ECG. ? Echocardiogram may be reasonable in patients with syncope and abnormal cardiac biomarkers. ";2017;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 4733;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"It is not recommended to use greater than 2 mg/kg/day of methylprednisolone (or equivalent) for the initial treatment of graft-versus-host disease.";"Published studies have shown no advantage to using methylprednisolone-equivalent doses higher than 2 mg/kg/ day in acute graft-versus-host disease. In addition, using higher doses increases risks of corticosteroid related toxicity. Furthermore, at least in patients with grade I-II acute graft-versus-host disease, initial therapy with lower-dose corticosteroids at 1 mg/kg/day may be equivalent.";2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 4734;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation";English;"It is not recommended to use routinely two cord blood units for standard umbilical cord blood transplantation when a single unit of adequate size is available, recognizing that higher cell doses are preferred when using units with greater HLA mismatch";"Randomized trials demonstrate similar clinical outcomes after single-unit and double-unit umbilical cord blood transplantation, including comparable rates of relapse, engraftment failure, overall survival, and transplantation related mortality. Moreover, graft-versus-host disease may be more frequent after double-cord blood transplantation.";2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 5758;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of interventions to reduce waiting times for primary care appointments is recommended";"Existing research on the effects of interventions intended to reduce wait times in primary care may provide policy makers with information to help with this. In this systematic review, the authors searched for research evaluating interventions that might decrease waiting times for appointments in primary care. They restricted their search to publications in English or French and did the search in January 2015. They included 7 uncontrolled before-after studies, 3 surveys and one controlled before-after study. Open access scheduling, dedicated telephone calls for follow-up consultation, presence of nurse practitioners on staff, nurse and general practitioner triage and email consultations reduced waiting times for primary care appointments. The barriers of open access scheduling to some patient groups and how to mitigate these barriers are uncertain. The cumulative effect of interventions to reduce waiting times for primary care appointments is uncertain. The effects of the evaluated interventions on quality of care, care continuity and use of healthcare resources, and their cost-effectiveness are uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3967;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer MRI to women of any age at risk of breast cancer without assessing the probability of being a BRCA or TP53 carrier. ";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4735;19;"Choosing Wisely Canada";"American Society for Blood and Marrow Transplantation; Canadian Blood and Marrow Transplant Group";English;"It is not recommended to use routinely peripheral blood stem cells for matched unrelated donor transplantation using myeloablative conditioning and standard graft-versus-host disease prevention regimens when a suitable bone marrow donor is available.";"Patients undergoing myeloablative matched unrelated donor hematopoietic cell transplantation with standard graft-versushost disease prophylaxis (calcineurin inhibitor and methotrexate) with a peripheral blood stem cell graft experience more symptomatic chronic graft-versus-host disease than those receiving bone marrow, without affecting relapse rates or overall survival. Peripheral blood stem cells may be considered in cases with substantial recipient/donor size discrepancy, donor preference, and for malignant diseases with high risk for graft failure.";2017;;;"Low value";-;"Link to the recommendation on the website of the iniciative/ Enlace a la recomendaci�n en la p�gina de la iniciativa" 5759;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended the use of mobile health (mHealth) to reduce costs and support some interventions in medical and public health practice";"Existing research on the cost effectiveness of mobile health (mHealth) to deliver health care may provide useful information for policy makers. In this systematic review, the authors searched for research that evaluated the costs and outcomes of mHealth (including the use of mobile phones, patient monitoring devices, personal digital assistants and other wireless devices to support medical and public health practice). They restricted their search to studies published in English up to April 2016. They included 39 economic evaluations assessing mHealth for behavior change communication (27 studies), data collection (7) and service delivery (5). Most (34) of the included studies were from upper and upper-middle income countries. mHealth, either as a primary intervention or as a component of an intervention, can be economically beneficial and reduce costs. Text messaging and apps are effective platforms for delivering mHealth. Disease detection and point-of-care testing using mobile devices have high potential for increasing access to testing and can be cost-effective. The economic effects of mHealth in low and low-middle income countries are uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3968;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pirfenidone is recommended as an option for treating idiopathic pulmonary fibrosis only if the person has a forced vital capacity (FVC) between 50% and 80%.";-;2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6528;33;"Choosing Wisely � : Things we do for no reason";"Lind C. and Johnson D.";English;"Electrolyte Testing in Pediatric Acute Gastroenteritis is not recommended";"Acute gastroenteritis (AGE) remains a substantial cause of child- hood illness and is 1 of the top 10 reasons for pediatric hospitalization nationwide. In the United States, AGE is responsible for 10% of hospital admissions and approximately 300 deaths annually.1 The American Academy of Pediatrics (AAP) and other organizations have emphasized supportive care in the management of AGE. Routine diagnostic testing has been discouraged in national guidelines except in cases of severe dehydration or an otherwise complicated course. Despite AGE guidelines, diagnostic laboratory tests are still widely used even though they have been shown to be poor predictors of dehydration. Studies have shown that high test utilization in various pediatric disease processes often influences the decision for hospitalization without improvement in patient outcome. In children with AGE, the initial and follow-up laboratory tests may not only be something that we do for no reason, but something that is associated with more risk than benefit. Recommendations: ? Perform a thorough history and PE to diagnose AGE. ? Clinical assessment of dehydration should be performed upon initial presentation and repeatedly with vital signs throughout the stay using a validated CDS to classify the patient?s initial dehydration severity and monitor improvement. Obtain a current patient weight and compare with previously recorded weights, if available. ? Laboratory testing in patients with AGE should not be per- formed unless a patient is classified as severely dehydrated, is toxic appearing, has a comorbidity that increases the likelihood of complications, or is not improving as expected. ? Rehydration via ORT is preferred to an IV in mild and moderate dehydration.";2017;;;"Low value";-;"

Link to the recommendation on the website of the initiative

" 3969;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not modify the renin?angiotensin system antagonist dose if the change in eGFR is less than 25% or the change in serum creatinine is less than 30%. ";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5761;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The prescription made by nurses in the emergency department is recommended in the case of respiratory and painful conditions";"The COVID-19 pandemic is placing a strain on healthcare services and resources. Existing research on expanding healthcare professionals? roles, such as prescribing by nurses, may provide useful information for policy makers. In this systematic review, the authors searched for experimental studies evaluating nurse-initiated medication interventions in emergency care settings. They did not restrict by type or language of publication and included studies published up to 2016. They included one randomized trial and four quasi-experimental studies (total: 1272 participants). There was one study from each of Australia, Hong Kong, the Netherlands, Saudi Arabia and Sweden. The nurse-initiated medications were salbutamol for respiratory conditions and analgesia for painful conditions. Nurse-initiated medications were found to be safe, timely, effective, patient-centred and efficient in emergency care settings. Nurse-initiated medications in emergency care settings had no effects on adverse events, waiting time to see a doctor, or length of stay. The effects of nurse-initiated medications (or other non-medical prescribing) in other conditions settings are uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3970;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended that levetiracetam, oxcarbazepine, or sodium valproate be offered if carbamazepine and lamotrigine are inappropriate or not tolerated, as long as the cost of acquiring levetiracetam falls at least 50% from that of June 2011.";-;2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3971;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"To diagnose FH in relatives of an index individual, the gender- and age-specific criteria for low-density lipoprotein cholesterol (LDL-C) concentration. ";-;2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3980;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"The systematic prescription of anti-ulcers is not recommended in people receiving NSAIDs treatment and who do not present risk factors for gastroduodenal complications.";"Non-steroidal anti-inflammatory drugs (NSAIDs) are the group of medications in which gastroprotection is most frequently indicated. Although antiulcer agents reduce the risk of lesions of the gastroduodenal mucosa and its complications, there is no evidence to support its use in all patients receiving NSAIDs. Antiulcer drugs (H2 receptor antagonists, prostaglandins, proton pump inhibitors -IBP-) are one of the most commonly prescribed therapeutic groups in our setting for different reasons, apart from their concomitant indication with NSAIDs. Its consumption in Spain and Catalonia is very high and is above the European average. According to data from the Ministry of Health, consumption of anti-ulcers in Spain increased 310.4% between 2000 and 2012, from 33.3 daily doses defined per 1,000 inhabitants per day (DHD) in 2000 to 136.8 DHD in 2012. This increase is explained, in large part, by the increase in PPI consumption. In 2012, PPIs accounted for 96.2% of the total consumption of anti-ulcers, having increased their consumption by more than 500% compared to 2000. In Catalonia, the consumption of anti-ulcers also continues a growing trend and, according to data from the 2014, its DHD was 112.2, standing more than 10% above the OECD average. PPIs are generally considered to be safe and well tolerated drugs. However, they are not free of adverse effects, especially if used over a long period of time, among them the increased risk of fractures, hypomagnesaemia, Clostridium difficile infection and colitis, vitamin B12 deficiency or pneumonia . On the other hand, several studies have shown that the high levels of prescription of antiulcer drugs in our environment are not justified by clinical reasons and that, in many cases, their prescription is inadequate mainly in their indication for the prevention of gastric discomfort in patients receiving polymedication or in patients with dyspepsia or persistent gastroduodenal reflux. Another condition that has traditionally been associated with this inadequate prescription is the prevention of gastrointestinal complications associated with drugs. Fortunately, in recent years its trend has been declining but it is still a common practice. The American College of Gastroenterology Clinical Practice Guidelines (GPC), the Spanish GPC on the use of PPIs in the prevention of gastropathy by drugs and the recommendations of ""Do not Do"" of Semfyc, among other documents, advise avoiding systematic prescription of antiulcer agents in patients on NSAIDs and only to those with risk factors for gastrointestinal complications. That is, taking NSAIDs does not necessarily involve gastroprotection. Other publications and agencies that have made similar recommendations are the Welsh Medicine Resource Center or Choosing Wisely Italy as well as various pharmacotherapeutic newsletters. In conclusion, the systematic prescribing of anti-ulcer drugs is not recommended in people receiving NSAIDs and who do not present risk factors for gastroduodenal complications, since the evidence does not support their effectiveness in low-risk patients and, instead, increase the cost and risk of adverse effects.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3981;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Psiquiatr�a y Salud Mental";Spanish;"It is not routinely recommended the use of three combinations or more of antipsychotics for the treatment of schizophrenia without criteria of ultrresistance (resistance even to clozapine)";"Antipsychotic drugs are an essential component in the treatment of patients with schizophrenia. The combination of two antipsychotics, despite being a very common practice and a suboptimal treatment, has long been controversial. The main reason, aside from the economic cost, is that this it unclear regarding the studies that examine both effectiveness and safety. In the case of three combinations or more of antipsychotics, no evidence is available to support them. Clinical practice guidelines for the treatment of schizophrenia suggest, in case of insufficient response, to maintain the antipsychotic for a few more weeks, given the known latency of response of these drugs, dose adjustment, adherence to treatment, change of antipsychotic or, in case of resistance (failure to respond to an adequate treatment of two different antipsychotics excluding clozapine), to test clozapine and in some cases electroconvulsive therapy (ECT). The combination of antipsychotics does not appear in the guidelines, and if it does, it is usually the last of the recommended strategies and only when there has been no response to clozapine (ultrarresistencia) or this drug has not been tolerated. There is a debate, in any case, of the combinations of two antipsychotics. In clinical practice, it is common to combine them before switching to clozapine, in an attempt to increase or accelerate efficacy, treat residual positive symptoms, or reduce adverse effects by decreasing the dose or totally or partially antagonizing some effect of one of the drugs used in the combination. Often, there is also a certain resistance to prescribing clozapine because of the special safety features of this drug (special medical monitoring drug (ECM)), which can produce such important adverse effects as agranulocytosis, myocarditis and diabetes. A retrospective (2003-2008) study of treatment-resistant patients with schizophrenia in two Danish university hospitals showed that only 24% of these patients received clozapine treatment while the remaining 76% were taking a combination of antipsychotics. Regarding studies of combinations, surprising its small number. In addition, the available ones contemplate only the combination of two and no more than two antipsychotics. The meta-analyzes that have examined them more closely indicate that, in terms of efficacy, the combination of two antipsychotics is superior to monotherapy alone in open studies and in poor trials. When we look at double-blind trials and those with more methodological quality, even those in which one of the two antipsychotics combined is clozapine, no differences are observed except for some encouraging cases such as improvement of negative symptoms when one of the two antipsychotics are a partial agonist D2. Concerning safety, and depending on the combination, there are data regarding adverse effects: when two antipsychotic D2 antagonists are associated, extrapyramidal and prolactin levels (and the known adverse effects that are derived) increase , whereas if a D2 antagonist with a D2 partial agonist such as aripiprazole is combined, the initial prolactin levels decrease. It has also been observed that patients treated with clozapine combined with another antipsychotic have lower total cholesterol and LDL levels than those treated with clozapine monotherapy, but in general also have a greater number of adverse effects. Perhaps not all lies in the combination itself, but in the fact that giving two antipsychotics is adding not only the adverse effects characteristic of each of them but those derived from a higher dose - in higher chlorpromazine equivalents. And the more antipsychotics are added, the greater the risk. As will be the case of pharmacological interactions. Finally, it is necessary to take into account the therapeutic adherence, already more committed in these patients. It should not be forgotten that the greater the complexity of a treatment, the lower the adhesion. Thus, adding a second antipsychotic will compromise the intake of the first and also of those other drugs that may be taking the patient for diseases such as hypertension, diabetes, etc. Again, regarding this, the more antipsychotics are added to the equation, the more risk. Although it varies according to context, in the literature there are combinations of two or more antipsychotics in a percentage of patients that ranges from 10% to 30% of the total. The factors that are related to the association of antipsychotics are acuity, severity, complexity and chronicity of the disease. With respect to combinations of three or more antipsychotics, data from the Catalan adult mental health (CSMA) centers show that 5.07% of patients with schizophrenia have been prescribed combinations of three or more antipsychotics and 1, 09% of all patients treated in CSMA regardless of diagnosis (Integrated Information System, Catalan Health Service). In conclusion, the available scientific evidence does not support the majority of combinations of antipsychotics in routine practice, although it can not be ruled out that this strategy can have a reasonable risk / benefit balance in certain situations. In any case, given the uncertainty and, above all, the risks of these patients, this possibility should be reserved for cases of ultradresistance (resistance to clozapine) and combinations of two antipsychotics (exceptionally three), always under strict control and for a period of time to be limited.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4237;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Cardiologists (ANMCO)";English;"It is not recommended routine echocardiography as routine follow-up for mild to moderate valvular heart disease or left ventricular dysfunction, in the absence of new symptoms, signs, or clinical events.";"Due to the slow evolution of mild to moderate valvular disease and the clinical uselessness of reevaluating left ventricular function in clinically stable patients, an echocardiogram is not recommended unless there is a change in clinical status.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5773;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Use of preparedness plans is recommended to improve hospital capacity for emergencies and disasters";"Hospital surge capacity is a vital component in a healthcare system?s response to humanitarian crises. Established plans to manage large increased patient numbers may result in more effective service provision in the event of a pandemic illness. In this systematic review, the authors searched for research that evaluated hospital surge capacity in emergencies and disasters, specifically in hospitals with a preparedness approach. They restricted their search to studies published in English language peer-reviewed journals from 2000 and did their search in November 2015. They included 1 randomised trial, 2 qualitative studies and 14 cross-sectional studies. Actions in the following key domains may increase hospital surge capacity: staff, stuff, structure and system. Ways to increase surge capacity include recruiting student and retired staff, reallocation of equipment from non-essential areas to key areas, and preparation of temporary treatment areas. Appropriate planning is necessary because increasing capacity without appropriate measures, such as training volunteer forces, may adversely affect overall service capacity. There is a lack of consensus on the definition, classification and evaluation of hospital surge capacity.";2017;;;"High value";Mangement;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3982;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Pediatr�a";Spanish;"It is not recommended to perform an EEG in healthy children with a simple febrile seizure because this test alone does not serve to predict the risk of recurrent febrile seizures or the risk of future epilepsy and may lead to overdiagnosis and overtreatment in some situations.";"Febrile seizure is the most common form of pediatric seizure and affects 2-5% of all children between 6 months and 5 years. Seizures are classified as simple (85% of cases) or complex. Simple febrile seizures are defined as generalized tonic-clonic seizures that last less than 15 minutes and do not recur within 24 hours. They occur in the context of fever> 38�C and in children between 6 months and 5 years without underlying neurological pathology and without suspicion of intracranial infection or concomitant metabolic alteration. In the diagnostic evaluation of a healthy patient who has experienced a simple febrile seizure, the current recommendations emphasize minimal interventions as this is a generally benign process and has greatly reduced the incidence of bacterial meningitis because of the current schedule of systematic vaccinations . With regard to complementary examinations, an electroencephalogram (EEG) is usually requested to identify children at increased risk of recurrent febrile seizures or to predict future epilepsy. According to the American Academy of Pediatrics it is not justified to ask for a routine EEG in the neurologically healthy child who has suffered a simple febrile seizure. There is no study that has shown that EEG at the time of the febrile seizure or in the following month is predictive of major recurrences or development of epilepsy. Some studies suggest that certain findings in the abnormal EEG may be more strongly associated with the risk of epilepsy, but that EEG alone can not be used as a basis for deciding pharmacological treatment. According to a recent Cochrane review, no high-quality scientific evidence on EEG use and timing for complex febrile seizures (those that are focal or that last for more than 15 minutes or recur in less than 24 hours). The fundamental problem is that no well-designed, comparative and randomized trials have been found so far to support or refute this indication. The generalized alterations that can appear in the EEG are more associated with the age of the patient at the registry than with the circumstances of the febrile seizure. However, one-third of patients may show abnormal EEG slowness and in another third, focal or generalized paroxysmal abnormalities can be found, which is difficult to correlate with the existence of posterior epilepsy. In conclusion, in healthy children with simple febrile seizures, an EEG is not recommended as there is no evidence that doing this test helps predict recurrent febrile seizures or the subsequent development of epilepsy. In these patients, it would be necessary to try to do the minimum necessary interventions to determine the febrile etiology and no other exploration.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4238;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Cardiologists (ANMCO)";English;"It is not recommended to perform exercise stress test as part of routine follow-up in asymptomatic patients after surgical or percutaneous revascularization.";"Since there are no RCT showing events? reduction with tress test procedure after revascularization, stress test should only be performed to evaluate incomplete revascularizations or changes in clinical status.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4239;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Cardiologists (ANMCO)";English;"It is not recommended to perform 24 hour Holter monitoring in patients with effort chest pain who can perform exercise stress test, unless arrhythmias should be investigated.";"Since during Holter monitoring the amount of stress could not be calibrated, sensitivity and specificity for detecting ischemia in patients with chest pain are low. In these conditions stress test is superior.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4240;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Cardiologists (ANMCO)";English;"Don?t routinely perform stress cardiac imaging test during the initial evaluation of suspected ischemic heart disease.";"Stress cardiac imaging test should be performed only when relevant risk factors are present: diabetes in patient older than 4 - years-old, peripheral arterial disease, greater than 20% Framingham risk, or in the presence of EKG modification affecting the interpretation of the stress test.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4241;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Cardiologists (ANMCO)";English;"It is not recommended to perform exercise stress test as screening of ischemic heart disease in asymptomatic patients at low cardiovascular risk.";"In asymptomatic patients without risk factors, the likelihood of coronary heart disease is very low. The stress test increases risk of false positives and induces further diagnostic tests to rule out the doubts raised by the test.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5777;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Uncertainty exists as to whether structured electronic health records (EHR) would result in higher quality of patient care";"The COVID-19 pandemic is placing a strain on healthcare services. Existing research on electronic health records (EHR) or electronic medical records (EMR) may provide information to help policy makers with this. In this systematic review, the authors searched for research that evaluated the impacts of EHR structuring methods, with a focus on the use of patient data by secondary users (hospital administrators, information managers, developers of EHR and decision support systems, registry administrators, researchers, statisticians and healthcare service developers). They restricted their search to studies published between 1975 and 2010. They identified 85 studies that mostly evaluated EHR structuring methods at secondary or tertiary levels. More than half the articles (49) were from the USA, with others from Australia, Brazil, Canada, China, Europe, Japan and South Africa. Most of the identified benefits of structured EHR data for secondary use purposes concentrated on information content and quality or on technical quality and reliability, particularly in the case of Natural Language Processing studies.";2017;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4242;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Pediatr�a";Spanish;"It is not recommended magnetic resonance imaging for routine evaluation because it does not add value to the management of the patient in children with a simple febrile seizure,";"Simple febrile seizures (SFS) represent the majority of febrile seizures. Although they recur in approximately one third of children during early childhood, it is a benign phenomenon associated with a risk of future epilepsy that is only slightly higher than that of the general population. The current recommendations on the management of SFS emphasize the minimum realization of interventions and explorations. Also, there are no recommendations for the management of complex febrile seizures (CFS). On a magnetic resonance (MR) scan for routine evaluation in SFS, given the benign nature of the process in the vast majority of cases, and the fact that the cost and health risk of doing this test is greater than the benefits.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4243;2;"Choosing Wisely�";"AAGL ? Elevating Gynecologic Surgery";English;"It is not recommended to perform a laparotomy for the management of non-malignant disease when surgical management is indicated and a vaginal, laparoscopic or robotic-assisted approach is feasible and appropriate.";"Selection of an endoscopic approach should be tailored to patient selection, surgeon ability, and equipment ability. The surgeon should take into consideration how the procedure may be performed cost-effectively with the fewest complications.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4755;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola Fisioterapia (AEF)";Spanish;"Do not recommend to use percussion, clapping, vibration or postural drainage to stimulate the elimination of respiratory secretions.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4244;2;"Choosing Wisely�";"AAGL ? Elevating Gynecologic Surgery";English;"It is not recommended to perform routine oophorectomy in premenopausal women undergoing hysterectomy for non-malignant indications who are at low risk for ovarian cancer. ";"Outside of high-risk populations, the association of oophorectomy with increased mortality in the general population has substantial implications, particularly as it relates to higher rates of coronary heart disease and cardiovascular death. The long-term risks associated with salpingo oophorectomy are most pronounced in women who are younger than 45-50 years who were not treated with estrogen.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4756;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria (FAECAP) y Asociaci�n Enfer";Spanish;"It is not recommended to use routinely iodine povidone in children under two years of age, especially in new born under one month.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4245;2;"Choosing Wisely�";"AAGL ? Elevating Gynecologic Surgery";English;"Do not routinely administer prophylactic antibiotics in low-risk laparoscopic procedures.";"The use of prophylactic antibiotics in women undergoing gynecologic surgery is often inconsistent with published guidelines. Although the appropriate use of antibiotic prophylaxis for hysterectomy is high, antibiotics are increasingly being administered to women who are less likely to receive benefit. The potential results are significant resource use and facilitation of antimicrobial resistance.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4246;2;"Choosing Wisely�";"AAGL ? Elevating Gynecologic Surgery";English;"Avoid the unaided removal of endometrial polyps without direct visualization when hysteroscopic guidance is available and can be safely performed.";"Endometrial polyps are a common gynecologic disease. Though conservative management may be appropriate in some patients, hysteroscopic polypectomy is the mainstay of treatment. Removal without the aid of direct visualization should be avoided due to its low sensitivity and negative predictive value of successful removal compared to hysteroscopy and guided biopsy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4247;2;"Choosing Wisely�";"AAGL ? Elevating Gynecologic Surgery";English;"Avoid opioid misuse in the chronic pelvic pain patient without compromising care through education, responsible opioid prescribing and advocacy. ";"Patients have a right to appropriate assessment and management of pain; however, opioid misuse has become a public health crisis. It is essential that providers become familiar with published FDA and CDC plans and guidelines. Providers must also educate and screen for risk factors for opioid misuse and follow patients on chronic opioid therapy for any signs of misuse.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5783;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"General medicine (GP) phone consultations are recommended as a suitable alternative to face-to-face GP consultations in some settings";"The COVID-19 pandemic has resulted in widespread social distancing measures. This makes traditional general practice (GP) care more difficult. Telephone consultations may be an alternative to face-to-face GP visits. In this systematic review, the authors searched for systematic reviews and randomized trials of the effects of GP consultations by telephone. They did their search in September 2015. They included 1 randomized trial comparing a call-back telephone consultation with a same-day face-to-face appointment, one systematic review (including one randomized trial and one observational study) of telephone consultation and triage, and one systematic review (including one randomized trial and 4 observational studies) of telephone consultation. Telephone GP consultations provide a suitable alternative to face-to-face GP consultations in some settings. Triage in telephone consultations may reduce workload in some GP settings. The overall effectiveness of telephone GP consultations remains uncertain.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4248;2;"Choosing Wisely�";"American Academy of Pediatrics - Section on Endocrinology";English;"Avoid ordering LH and FSH and either estradiol or testosterone for children with pubic hair and/or body odor but no other signs of puberty. ";"Premature adrenarche is usually the diagnosis and does not involve activation of the pituitary- gonadal axis but is due to an early increase in adrenal androgens. DHEA-S levels are elevated for age but do not alter the management of this common and generally benign condition.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4760;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria (FAECAP) y Asociaci�n Enfer";Spanish;"Do not recommend to use floats for the prevention of pressure ulcers.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4249;2;"Choosing Wisely�";"American Academy of Pediatrics - Section on Endocrinology";English;"Avoid ordering screening tests looking for chronic illness or an endocrine cause, including CBC, CMP, IGF-1, thyroid tests, and celiac antibodies, in healthy children who are growing at or above the 3rd percentile for height with a normal growth rate (i.e., not crossing percentiles) and with appropriate weight gain.";"Even in children who are below the 3rd percentile for height with a normal history and physical exam, the incidence of newly diagnosed pathology was found to be only about 1%. In patients who have significant short stature (e.g. ?-2.5 SD) or who are well below their genetic potential based on parental heights, tiered or sequential screening may be considered.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4250;2;"Choosing Wisely�";"American Academy of Pediatrics - Section on Endocrinology";English;"Avoid ordering Vitamin D concentrations routinely in otherwise healthy children, including children who are overweight or obese. ";"Although a 25-hydroxyvitamin D concentration, reflecting both vitamin D synthesis and intake, is the correct screening lab to monitor for vitamin D deficiency, current evidence is not sufficient to suggest that screening in otherwise healthy including children who are overweight or obese is necessary or safe. Global consensus recommendations caution against population-based screening for vitamin D deficiency. The US Preventive Services Task Force also has noted that variability of current assays and unclear cutoffs for deficiency may lead to ?misclassification? of persons as having vitamin D deficiency, and that this misclassification ?could outweigh any benefits if there are harms?. The American Academy of Pediatrics report on Optimizing Bone Health in Children and Adolescents advises screening for vitamin D deficiency only in patients with disorders associated with low bone mass such as rickets and/or a history of recurrent, low-trauma fractures. It has been shown that children who are overweight or obese have a greater likelihood of having low vitamin D levels. If the history suggests an obese child has insufficient dietary intake of vitamin D (e.g., little milk intake), a vitamin D supplement should be recommended, which is more cost-effective than 25-hydroxyvitamin D measurements for both screening and monitoring therapy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4251;2;"Choosing Wisely�";"American Academy of Pediatrics - Section on Endocrinology";English;"Avoid routinely measuring thyroid function and/or insulin levels in children with obesity.";"TSH levels can be slightly elevated in obesity but this is more likely a consequence of obesity and rarely true hypothyroidism. Free T4 levels are usually normal and if so there is no proven benefit to treatment when TSH is minimally elevated. Testing thyroid function in otherwise healthy children should be considered only if stature and/or height velocity is decreased in relation to the stage of puberty. There are significant limitations in the use of insulin levels as a marker of insulin resistance; furthermore, it is not necessary to order this test to establish a weight control management plan. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4763;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria (FAECAP) y Asociaci�n Enfer";Spanish;"Do not recommend to apply regularly iodine povidone to clean chronic wounds except when it is necessary to reduce the bacterial load.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4252;2;"Choosing Wisely�";"American Academy of Pediatrics - Section on Endocrinology";English;"Avoid routinely ordering thyroid ultrasounds in children who have simple goiters or autoimmune thyroiditis.";"Limit this study to children who have asymmetric thyroid enlargement, palpable nodules, or concerning cervical lymphadenopathy. Ultrasound can detect nodules that elude palpation, and one prospective series found that 31.5% of patients with Hashimoto?s thyroiditis will have thyroid nodules. The majority of these lesions, however, are not harmful. Overuse of ultrasonography results in needless health care costs and time expenditures for families. More importantly, insignificant findings can create anxiety within patients and parents who are fearful of thyroid cancer. In some cases, the abnormal findings will lead to additional radiographic studies, fine needle aspiration, or aggressive treatment of ?pseudo-disease? that will not improve the health of patients. There is a known association of thyroid cancer with Hashimoto?s thyroiditis, and a pathologic diagnosis of papillary carcinoma was made in 3% of patients in the study cited above. However, there is insufficient evidence to conclude that detecting nodules before they are palpable leads to better outcomes. It seems prudent, therefore, to perform a careful annual physical exam of the thyroid, as recommended for all children who are at are at increased risk of thyroid cancer. If that exam reveals asymmetry, palpable nodules or significant cervical adenopathy then ultrasonography is indicated.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4253;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t recommend ultrasound for incidental thyroid nodules found on CT, MRI or non-thyroid-focused neck ultrasound in low-risk patients unless the nodule meets age-based size criteria or has suspicious features. ";"Imaging of the neck performed to evaluate non-thyroid-related conditions commonly reveals thyroid nodules. Most are not malignant. Even if malignant, they are likely to have indolent behavior. Fine needle aspiration often fails to definitively characterize a lesion as benign owing to the limitations of cytologic evaluation. Consequently, some patients with incidentally-discovered benign nodules undergo unnecessary serial ultrasound imaging and/or surgery. Accordingly, patients without clinical risk factors* who are found to have asymptomatic, incidental, nonsuspicious thyroid nodules on cross-sectional imaging (CT, MRI or non-thyroid ultrasound of the neck) should be referred for diagnostic thyroid ultrasound only if they meet the following criteria: (1) < 35 years of age with normal life expectancy and nodule ? 1 cm. (2) ? 35 years of age with normal life expectancy and nodule ? 1.5 cm. Two published studies reported that the percentage of nodules referred for ultrasound would be reduced by 35?46% using the proposed algorithm. Suspicious features on CT, MRI or US include signs of local invasion, and the presence of abnormal lymph nodes (enlarged nodes, nodes with cystic change, calcification, or increased enhancement). i. Size criteria for enlarged lymph nodes: 1. ?1.5 cm in short axis for jugulodigastric nodes 2. ?1 cm for other nodes ii. Lymph nodes in levels IV and VI are especially suspicious for thyroid cancer metastases. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4765;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria (FAECAP) y Asociaci�n Enfer";Spanish;"Do not recommend to use silver dressings to prevent infections of skin lesions or wounds without clear signs of local infection.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4254;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t use a protocol for abdominal CT that includes unenhanced CT followed by IV contrast-enhanced CT, except for the following indications: renal lesion characterization, hematuria work up, indeterminate adrenal nodule characterization, follow-up after endovascular stent repair, gastrointestinal hemorrhage or characterizing a focal liver mass.";"With the goal of modulating patient radiation exposure and costs, IV contrast enhanced multidetector CT (MDCT) protocols should include an unenhanced acquisition only if it will provide additional diagnostic information. In conjunction with IV contrast enhanced abdominal MDCT, the literature supports an unenhanced acquisition for the following indications: (1) Renal lesion characterization or hematuria work up a. Compare unenhanced with post-contrast to identify enhancement in a mass (2) Adrenal nodule characterization a. IV contrast phases are not necessary if nodule measures <10 Hounsfield units (HU) on unenhanced CT. b. If ? 10 HU, unenhanced attenuation is used to calculate percentage washout. (3) Endovascular stent evaluation a. Unenhanced scan enables distinction of calcification from endoleak when compared to post-contrast images (4) Gastrointestinal bleeding a. Unenhanced CT enables definitive distinction of intraluminal hemorrhage from other high-density material (i.e., medication, fecal matter); however, protocols that use only arterial and venous phase acquisitions may be sufficient, as hemorrhage changes configuration between the 2 phases. b. If available, dual energy can be used to create a virtual unenhanced dataset and avoid the unenhanced acquisition. (5) Focal liver mass a. Compare unenhanced with post contrast to identify enhancement in a mass.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5022;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ustekinumab is recommended, within its marketing authorisation, as an option for treating moderately to severely active Crohn's disease, that is, for adults who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF?alpha inhibitor or have medical contraindications to such therapies.";" 1.1 Ustekinumab is recommended, within its marketing authorisation, as an option for treating moderately to severely active Crohn's disease, that is, for adults who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a TNF?alpha inhibitor or have medical contraindications to such therapies. 1.2 The choice of treatment between ustekinumab or another biological therapy should be made on an individual basis after discussion between the patient and their clinician about the advantages and disadvantages of the treatments available. If more than 1 treatment is suitable, the least expensive should be chosen (taking into account administration costs, dosage and price per dose). 1.3 Ustekinumab should be given until treatment failure (including the need for surgery) or until 12 months after the start of treatment, whichever is shorter. People should then have their disease reassessed in accordance with NICE's recommendations for infliximab and adalimumab for the treatment of Crohn's disease to see whether treatment should continue.";2017;;;"High value";"Crohn's disease";"https://www.nice.org.uk/guidance/ta456/chapter/1-Recommendations" 4255;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t routinely use a protocol for abdominal CT that includes a delayed post-contrast phase after the venous phase, except for the following indications: renal lesion characterization, hematuria work up, CT urogram, indeterminate adrenal nodule characterization, hepatocellular carcinoma and cholangiocarcinoma.";"With the goal of modulating patient radiation exposure, IV contrast enhanced multidetector CT (MDCT) protocols should include a delayed post contrast acquisition (defined as an acquisition after the portal venous, hepatic or nephrographic phases) only if it will provide additional diagnostic information. The literature supports an additional delayed acquisition for the following indications: (1) Renal lesion characterization, hematuria work up or CT urogram a. contrast enhancement pattern of solid renal mass over time provides diagnostic information about pathologic subtype. b. delayed phase defines relationship of solid renal mass relationship to collecting system. c. delayed phase facilitates identification of transitional cell carcinoma and traumatic injury. (2) Adrenal nodule characterization. a. delayed attenuation used to calculate Absolute Percentage Washout and Relative Percentage Washout. (3) Hepatocellular carcinoma a. multiple acquisitions facilitate lesion detection and washout characterization. (4) Cholangiocarcinoma a. enhancement increases over time, justifying use of delayed in patients where distinction between cholangiocarcinoma and HCC is required.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6303;29;"Choosing Wisely Australia";"Australasian Faculty of Rehabilitation Medicine";English;"Do not discharge patients with osteoporotic fractures without an assessment and/or treatment for osteoporosis. ";"Studies of patients with osteoporotic fractures have found that they are at significantly greater risk of suffering a new fracture compared to the general population. This risk is particularly marked in but not restricted to elderly patients, particularly given that recent clinical guidelines recommend that all individuals over the age of 50 who sustain a fracture following minimal trauma (such as a fall from standing height or less) should be considered to have a presumptive diagnosis of osteoporosis. Despite this, there have been reports of insufficient provision for the management of these patients before discharge. Osteoporosis assessments and/or treatments before discharge are clinically very important and moreover may be highly cost effective even after taking account of the additional resources associated with providing these services. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4256;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t make the diagnosis of Pelvic Congestion Syndrome on CT or MRI unless the patients meet clinical and imaging criteria.";"Dilated pelvic veins can be an incidental, clinically insignificant finding on CT and MRI, or may reflect pelvic congestion syndrome. In the latter condition, dilated pelvic veins and venous reflux account for a range of symptoms, including chronic pain of more than 6-month duration. Radiologists must be cognizant of established criteria to suggest this diagnosis on CT and MRI. The diagnostic criteria include the following: 4 or more ipsilateral pelvic varicosities, 1 or more pelvic varicosities measuring more than 4 mm, ovarian (gonadal) vein dilatation > 8 mm in diameter. In patients with dilated pelvic veins that do not meet these criteria, interpretations should not suggest Pelvic Congestion Syndrome. Furthermore, since these criteria were proposed by Coakley et al in 1999, several investigations have confirmed that ovarian vein reflux, ovarian vein dilatation and parauterine vein dilatation can be observed in asymptomatic patients, particularly multiparous women. Interpretations should recommend that clinical symptoms guide decision-making with respect to the need for vascular interventional consultation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4768;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Federaci�n de Asociaciones de Enfermer�a Comunitaria y Atenci�n Primaria (FAECAP) y Asociaci�n Enfer";Spanish;"Do not recommend to do massages on bone prominences as prevention of pressure ulcers.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4257;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t routinely recommend follow-up for nonobstructed, asymptomatic, isolated, short-segment jejunojejunal intussusception in adults.";"Transient, idiopathic jejunojejunal intussusception in adult patients can be identified on MDCT in the absence of gastrointestinal pathology. In patients without an identifiable lead point mass lesion, imaging characteristics that favor the transient variety include short length (? 3.5cm) and absence of bowel dilation. Self-limited jejunojejunal intussusception can occur in the absence of any bowel disease, or the finding may indicate an infectious or inflammatory process, such as enteritis or Celiac disease. If CT reveals an asymptomatic short segment, isolated jejunojejunal intussusception (no bowel wall thickening or mesenteric inflammation, no bowel obstruction, no lead point) follow-up imaging should not be routinely recommended. Decisions regarding the need for additional work-up and follow up imaging should be made on clinical grounds.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4769;19;"Choosing Wisely Canada";"Canadian Geriatrics Society";English;"Don?t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.";"Cohort studies have found no adverse outcomes for older men or women associated with asymptomatic bacteriuria. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show increased adverse antimicrobial effects. Consensus criteria has been developed to characterize the specific clinical symptoms that, when associated with bacteriuria, define urinary tract infection. Screening for and treatment of asymptomatic bacteriuria is recommended before urologic procedures for which mucosal bleeding is anticipated.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4258;19;"Choosing Wisely Canada";"American Society for Clinical Pathology";English;"Do not order a frozen section on a pathology specimen if the result will not affect immediate (i.e., intraoperative or perioperative) patient management.";"Although the result of an intraoperative frozen section evaluation is often helpful to determine the treatment path of a patient during a surgical procedure, the frozen section analysis may be limited in regards to sampling and technical issues that can hinder interpretation and/or compromise the integrity of the specimen for the final diagnosis. If there is no therapeutic decision to be made for the patient on the day of the surgical procedure based on the results of the frozen section, it is preferable to submit the specimen for routine (or rush, if necessary) histologic processing and permanent section evaluation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4770;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Anatom�a Patol�gica (SEAP)";Spanish;"Do not recommend to read immunohistochemical results without having positive internal and/or external controls.";-;2017;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4259;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Do not repeat hemoglobin electrophoresis (or equivalent) in patients who have a prior result and who do not require therapeutic intervention or monitoring of hemoglobin variant levels.";"Pre-conception and antenatal hemoglobin electrophoresis screening is recommended, especially in high prevalence areas for sickle cell disease or thalassemia, and has become routine practice in order to detect abnormalities of hemoglobins S, C, D-Punjab, E, O-Arab, Lepore, beta-thalassemia trait, delta/beta thalassemia trait, alpha thalassemia trait (2 chain deletion), and hereditary persistence of fetal hemoglobin (HPFH). Partner testing should be offered when there is a risk of a significant hemoglobinopathy in the infant. Repeat hemoglobin electrophoresis testing is required only to make a more specific diagnosis or monitor the results of interventional therapies in patients with known hemoglobinopathies. Providers should investigate prior results before requesting a repeat hemoglobin electrophoresis.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4771;19;"Choosing Wisely Canada";"Canadian Geriatrics Society";English;"Don?t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.";"Large scale studies consistently show that the risk of motor vehicle accidents, falls and hip fractures leading to hospitalization and death can more than double in older adults taking benzodiazepines and other sedative-hypnotics. The number needed to treat with a sedative-hypnotic for improved sleep is 13, whereas the number needed to harm is only 6. Older patients, their caregivers and their health care providers should recognize these potential harms when considering treatment strategies for insomnia, agitation or delirium. Use of benzodiazepines should be reserved for alcohol withdrawal symptoms/delirium tremens or severe generalized anxiety disorder unresponsive to other therapies. Prescribing or discontinuing sedative-hypnotics in hospital can have substantial impact on long-term use. Cognitive behavioural therapy, brief behavioural interventions and benzodiazepine-tapering protocols have proven benefit in sedative-hypnotic discontinuation. These non-pharmacologic interventions are also beneficial in improving sleep.";2017;;;"Low value";-;"

Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to therecommendation on the website of the initiative

" 4260;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Do not test for Protein C, Protein S, or Antithrombin (ATIII) levels during an active clotting event to diagnose a hereditary deficiency because these tests are not analytically accurate during an active clotting event.";"These assays may be useful to test for an acquired deficiency (i.e., disseminated intravascular coagulation) in consumptive coagulopathies. These tests are not analytically accurate during an active clotting event. Moreover they are not clinically actionable at the time of an acute clot, because the same therapeutic intervention (anticoagulation) is performed regardless of the results. Deferral to the outpatient/non-acute setting allows for the testing to be done at a time when the results would change patient management, i.e., ceasing or continuing anticoagulation. Because anticoagulation may also impact the determination of results (e.g., Protein C and Protein S decrease on warfarin, while ATIII is actually elevated), testing while on anticoagulants may also yield misleading results and should be avoided.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5796;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Task shifting among healthcare workers is recommended to reduce healthcare costs";"The COVID-19 pandemic is placing a great strain on health systems and healthcare workers. One way to ease this may be to use task shifting to move the care of some patient groups from more to less specialised healthcare workers. In this systematic review, the authors searched for studies that reported program costs from a task shifted model for conducting the activity or service compared to a model that did not involve task shifting and were done in low- or middle-income countries. They restricted their search to studies published in English and did the search in March 2016. They identified 34 studies which analysed the cost implications of task shifting in sub-Saharan Africa (22 studies), Asia (8) and Central or South America (4). Most of the available evidence was from primary and community care settings, and the effects of task shifting within hospitals, secondary, tertiary and specialized care are uncertain. The available evidence was spread across many disease areas, making it difficult to form conclusions about the cost savings of task shifting for specific diseases, apart from tuberculosis, HIV/AIDS and malaria.";2017;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4261;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Do not order red blood cell folate levels at all. In adults, consider folate supplementation instead of serum folate testing in patients with macrocytic anemia.";"Since 1998, when the U.S. and Canada mandated that foods with processed grains be fortified with folic acid, there has been a significant decline in the incidence of folate deficiency. For the rare patient suspected of having a folate deficiency, simply treating with folic acid is a more cost-effective approach than blood testing. While red blood cell folate levels have been used in the past as a surrogate for tissue folate levels or a marker for folate status over the lifetime of red blood cells, the result of this testing does not, in general, add to the clinical diagnosis or therapeutic plan.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4262;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Do not use sputum cytology to evaluate patients with peripheral lung lesions.";"Sputum cytology is not effective for evaluating peripheral lesions. For peripheral lesion evaluation, consider alternative diagnostic approaches (e.g., image guided needle aspiration). ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4263;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Do not order a frozen section on a pathology specimen if the result will not affect immediate (i.e., intraoperative or perioperative) patient management.";"Although the result of an intraoperative frozen section evaluation is often helpful to determine the treatment path of a patient during a surgical procedure, the frozen section analysis may be limited in regards to sampling and technical issues that can hinder interpretation and/or compromise the integrity of the specimen for the final diagnosis. If there is no therapeutic decision to be made for the patient on the day of the surgical procedure based on the results of the frozen section, it is preferable to submit the specimen for routine (or rush, if necessary) histologic processing and permanent section evaluation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5799;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Lay?led and peer support interventions are recommended to achieve small improvements in asthma-related quality of life for adolescents with asthma, although the evidence found is weak";"People with asthma may have an increased risk of complications with COVID-19 infection. Existing research on ways to help them adhere to their treatment regimen and self-manage their condition might lower these risks. In this Cochrane review, the authors searched for randomised trials of lay-led and peer support interventions for adolescents with asthma. They did not restrict their searches by date or language of publication and did the search in November 2016. They included five studies (total: 1146 participants, aged 11-17 years) and had low confidence in the findings because of the risk of bias in the studies. They also identified one additional ongoing study and one article that is awaiting assessment. The most appropriate target populations for lay-led and peer support interventions and the attributes of a successful programme are uncertain. The effects of lay-led and peer support interventions for adolescents are uncertain for asthma control, exacerbations and medication adherence. It is uncertain whether routine use of lay?led or peer support programmes is beneficial for adolescents receiving asthma care.";2017;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4264;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t order serum ammonia to diagnose or manage hepatic encephalopathy (HE). ";"High blood-ammonia levels alone do not add any diagnostic, staging, or prognostic value in HE patients known to have chronic liver disease. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5800;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Self-management interventions that include action plans for exacerbations are recommended versus usual care in patients with chronic obstructive pulmonary disease";"Patients with respiratory conditions, such as chronic obstructive pulmonary disease (COPD), may be at higher risk of complications of COVID-19 infection. In this Cochrane review, the authors searched for randomized trials that compared COPD self-management interventions that included a written action plan for acute exacerbations versus usual care. They did not restrict their searches by language of publication and did the search in May 2016. They included 21 individual randomized trials and one cluster randomized trial (total: 3854 participants). They also identified an additional 2 ongoing studies and 12 articles that are awaiting assessment. Patients assigned to self-management interventions with action plans for exacerbations had a better health-related quality of life than those assigned to usual care, particularly those whose interventions included a smoking cessation program and, in the case of the former also decreased hospital admissions related to the respiratory tract. Whether the difference in health-related quality of life between patients allocated to self-management interventions with action plans for exacerbations and usual care is of clinical significance is uncertain.";2017;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6312;29;"Choosing Wisely Australia";"Australasian Faculty of Rehabilitation Medicine";English;"Do not routinely use splinting for prevention and/or management of contractures after stroke. ";"Reviews of the evidence and individual case studies on the use of hand splinting for stroke patients have been unable to find conclusive evidence that it leads to improvements in managing spasticity and preventing contractures or more generally improving upper limb function. Moreover, there is high quality evidence that stretch, whether administered from splints or other means, does not have clinically important effects on joint mobility in people with or without neurological conditions, at least for the periods it is typically prescribed of less than seven months.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4265;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures.";"Routine tests of coagulation do not reflect bleeding risk in patients with cirrhosis and bleeding complications of these procedures are rare.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4266;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.";"Serum ferritin values reflect an increase in hepatic iron content and have a significant false positive rate because of elevations due to inflammation. Thus, in patients with evidence of liver disease, hemochromatosis genotyping should only be performed among individuals with an elevated ferritin and fasting transferrin saturation >45% (TSat) or a known family history of HFE-associated hereditary hemochromatosis.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4778;19;"Choosing Wisely Canada";"Canadian Geriatrics Society";English;"Don?t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral feeding.";"Careful hand-feeding for patients with severe dementia is at least as good as tube-feeding for the outcomes of death, aspiration pneumonia, functional status and patient comfort. Food is the preferred nutrient. Use of oral nutritional supplements may be beneficial. Tube-feeding is associated with agitation, increased use of physical and chemical restraints and worsening pressure ulcers.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4267;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Canadian Association for the Study of Liver Disease";English;"Don?t perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions (e.g., focal nodal hyperplasia, hemangioma).";"Patients with benign focal liver lesions who do not have underlying liver disease and have demonstrated clinical (asymptomatic) and radiologic stability do not need repeated imaging as the likelihood of evolving into neoplastic lesions is very low. In contrast, patients with radiologic evidence of hepatocellular adenoma may have an increased risk of complications and/or neoplasia thus warranting closer observation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4268;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of antiviral treatment.";"Highly sensitive quantitative assays of hepatitis C RNA are appropriate at the time of diagnosis (to confirm infection) and as part of antiviral therapy, which is typically at the beginning and after therapy is completed to confirm sustained virological response at week 12 (SVR 12). Outside of these circumstances the results of virologic testing do not change clinical management or outcomes.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6316;29;"Choosing Wisely Australia";"Australasian Faculty of Rehabilitation Medicine";English;"Do not use imaging for diagnosing non-specific acute low back pain in the absence of red flags. ";"The majority of acute low back pain episodes are benign, self-limited cases that do not warrant the use of imaging (e.g. X-rays, CT or MRI). There is evidence that early imaging for low back pain in the absence of red flags does not facilitate improvements in primary outcomes such as pain and function, even for older patients. If anything such imaging may be harmful insofar as it may reveal incidental findings that divert attention and increase the risk of having unnecessary interventions and invasive treatments including unnecessary surgery.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative" 4269;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t use steroids (e.g., prednisone) for maintenance therapy in inflammatory bowel disease (IBD).";"While systemic corticosteroids (e.g., prednisone) are effective in inducing symptomatic remission in IBD, they are ineffective as maintenance therapy and are associated with both short- and long-term serious adverse effects. Consequently, if the initial steroid taper is unsuccessful or more than two courses of steroids are required within a year, health providers should consider adding a steroid-sparing agent that has proven efficacy and safety as maintenance therapy in IBD patients.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4270;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t use opioids long-term to manage abdominal pain in inflammatory bowel disease (IBD).";"While opioids may be used to manage abdominal pain in select acute settings in IBD patients, their prolonged use may mask the symptoms of active IBD or its complications (e.g., bowel perforation or megacolon). Chronic opioid use has been proven ineffective for non-malignancy associated chronic pain and is associated with excess mortality. Moreover, because of their potential risk for dependence, their long-term use for managing IBD-related abdominal pain should be avoided especially in the context of the opioid crisis in North America.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5550;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Cuidados Cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"There is uncertain evidence on high-flow nasal cannulae are more effective or safe oxygen delivery device compared with other oxygenation devices in adult ICU patients";"We found no evidence that high-flow nasal cannulae (HFNC) reduced the rate of treatment failure or risk of death compared with low?flow oxygen devices. We found no evidence of any advantages for HFNC in terms of adverse event rates, Intensive Care Unit (ICU) length of stay, or duration of respiratory support. We observed no differences in participants' blood oxygen levels or carbon dioxide blood levels, and we noted that any differences in breathing rates were small and were not considered clinically important. Studies reported no differences in patient?rated measures of comfort. The small number of studies included in this review highlights the need for further research which also should help to clarify the level of safety and efficacy of HFNC in providing respiratory support for adult ICU patients. ";2017;;;Uncertain;"Prevention COVID-19 ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4271;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t unnecessarily prolong the course of intravenous corticosteroids in patients with acute severe ulcerative colitis (UC) in the absence of clinical response.";"Non-response to intravenous corticosteroids for acute severe UC can be predicted after the first 72 hours of treatment. However, about a third of non-responders receive systemic steroid monotherapy beyond 7 days. This prolonged use of ineffective systemic steroids may unnecessarily lengthen hospitalization days and increase risk of postoperative complications in those who eventually require colectomy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4783;19;"Choosing Wisely Canada";"Canadian Geriatrics Society";English;"Don?t use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.";"People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including premature death. Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behaviour change can make drug treatment unnecessary.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4272;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t initiate or escalate long-term medical therapies for the treatment of inflammatory bowel disease (IBD) based only on symptoms.";"Clinical symptoms often prompt initiation or escalation of medical treatments for inflammatory bowel disease (IBD). However, functional bowel disorders (e.g., irritable bowel syndrome) coexist in 20% of IBD patients and can mimic symptoms of the latter. Clinical symptoms, in fact, do not correlate well with IBD disease activity. Consequently, relying on only clinical symptoms without confirming active disease may commit patients to long-term treatments that have potentially significant adverse effects and resource implications.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4273;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology";English;"Don?t use abdominal computed tomography (CT) scan to assess inflammatory bowel disease (IBD) in the acute setting unless there is suspicion of a complication (obstruction, perforation, abscess) or a non-IBD etiology for abdominal symptoms.";"Abdominal CT scanning is effective for the time-sensitive diagnosis of IBD complications such as obstruction, perforation, or non-IBD related causes of abdominal pain when these are suspected. The effective ionizing radiation dose from a single conventional abdominal CT scan (10-20mSv) is within acceptable safety limits (<50mSv). However, minimizing inappropriate utilization of CT is a priority because repeated exposure to ionizing radiation over a lifetime, particularly among younger IBD patients, may potentially increase the risk of malignancy. In the acute setting (e.g., emergency department), abdominal CT scan should only be used when there is suspicion of a complication of IBD and should not be used for the assessment of disease activity.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4018;29;"Choosing Wisely Australia";"The Royal College of Pathologists of Australasia";English;"Do not perform surveillance urine cultures or treat bacteriuria in elderly patients in the absence of symptoms or signs of infection.";"Asymptomatic bacteriuria is a common finding in all ages and in association with other comorbidities. Treatment of asymptomatic bacteriuria is recommended in pregnancy but not in other clinical situations. Prophylaxis against development of symptoms prior to simple cystoscopy and prosthetic joint replacement is not recommended. Extensive guidelines from the Infectious Diseases Society of America (IDSA) are available for this condition and asymptomatic bacteriuria in catheterised patients. The use of chemical screening strips in asymptomatic patients may lead to unnecessary urine cultures when positive results are obtained. Increasing antibiotic resistance in urinary pathogens may be a consequence of unnecessary treatment.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4274;19;"Choosing Wisely Canada";"Resident Doctors of Canada ";English;"Don?t order investigations that will not change your patient?s management plan.";"Investigations may not change your patient?s management plan for several reasons. In some cases, the patient?s pre-test probability for a condition is low, and further testing is not necessary (e.g., screening for breast cancer in younger women with low risk of breast cancer). Another example is unnecessary preoperative testing before a low-risk surgical procedure where the risk of complications is low. On the other hand, high-risk patients may warrant treatment irrespective of the test result; thus, testing in these patients would not influence the ultimate decision to treat (e.g., thrombophilia testing in patients with an unprovoked pulmonary embolism at high risk for recurrence is not helpful, since these patients should receive indefinite anticoagulation). Where possible, residents can refer to evidence-based clinical decision rules to guide appropriate testing or treatment ? examples include the Well?s criteria or pulmonary embolism rule-out criteria (PERC) for pulmonary embolism, the Canadian CT Head Rule for CT scan of the head in a trauma patient, or the Centor criteria for likelihood of bacterial infection in adult patients with a sore throat.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4788;19;"Choosing Wisely Canada";"Canadian Geriatrics Society";English;"Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults age 65 and older; moderate control is generally better.";"There is no evidence that using medications to achieve intense glycemic control in older adults with type 2 diabetes is beneficial (A1c under 7.0%). Among non-older adults, except for long-term reductions in myocardial infarction and mortality with metformin, using medications to achieve glycated haemoglobin levels less than 6 % is associated with harms, including higher mortality rates. Intense control has been consistently shown to produce higher rates of hypoglycemia in older adults. Given the long timeframe (approximately 8 years) to achieve theorized benefits of intense control, glycemic targets should reflect patient goals, health status, and life expectancy. Reasonable glycemic targets would be 7.0 ? 7.5% in healthy older adults with long life expectancy, 7.5 ? 8.0% in those with moderate comorbidity and a life expectancy < 10 years, and 8.0?8.5% in those with multiple morbidities and shorter life expectancy.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4022;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners";English;"Don?t test thyroid function as population screening for asymptomatic patients.";"This ?screening? recommendation does not apply to people with symptoms suggestive of thyroid disease. The prevalence in adults of subclinical hypothyroidism is about 4.3% (0.7% for subclinical hyperthyroidism), and prevalence is higher in older adults and women. About 2-5 percent of people with subclinical hypothyroidism and 1-2 percent with subclinical hyperthyroidism will develop overt thyroid disease per year. However, many patients with subclinical thyroid dysfunction revert to normal when followed over time. A 2014 systematic review of screening for thyroid dysfunction found that clear evidence on the benefits and harms of screening is unavailable, and recommended against population based screening. In the absence of evidence that early treatment reduces symptoms, lipid levels, or the risk of cardiovascular disease in patients with mild thyroid dysfunction detected by screening, the RACGP Guidelines for preventive activities in general practice does not recommend screening for thyroid disease in asymptomatic populations.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4024;29;"Choosing Wisely Australia";"The Royal College of Pathologists of Australasia";English;"Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years.";"Prostate cancer causes significant mortality and morbidity and all patients with concerns about their risks of having the disease and/or their prognosis if diagnosed, including the role of prostate specific antigen (PSA) testing, should discuss these with their doctor. Since any mortality benefit from early diagnosis of prostate cancer due to PSA testing is not seen within less than 6?7 years from testing, PSA testing is not recommended for men who are unlikely to live another 7 years.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4025;29;"Choosing Wisely Australia";"The Royal College of Pathologists of Australasia";English;"Do not perform population based screening for Vitamin D deficiency.";"The quality of the evidence for the health benefits of an adequate vitamin D status is highly variable. As the main source of vitamin D is UVB sunlight exposure, vitamin D status as assessed by the measurement of 25 hydroxyvitamin D (25OH-D) is correlated with time spent outdoors, exercise and other aspects of a healthy lifestyle including body weight. Vitamin D insufficiency is associated with low levels of exercise, obesity and/or reduced sun light exposure, such as occur more commonly in the elderly, the overweight, the frail and unwell or institutionalised and where there are occupational, racial or cultural reasons. In individuals at risk of vitamin D deficiency, measurement of 25OH-D is an appropriate, case-finding strategy. Routine screening of healthy infants, children and adults (including pregnant women) for vitamin D deficiency is currently not recommended.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4026;29;"Choosing Wisely Australia";"The Royal College of Pathologists of Australasia";English;"Restrict the use of serum tumor marker tests to the monitoring of a cancer known to produce these markers or where there is a strong known underlying predisposition or suspicion.";"The measurement of levels of certain tumour biomarkers is known to be helpful in monitoring the progress of specific cancers in response to treatment or in detecting changes in cancer activity or secondary or recurring cancer. In some circumstances they are helpful adjuncts in detecting specific cancers, where there is a strong known underlying predisposition or suspicion, such as in detecting liver cancer in patients with chronic hepatitis C and cirrhosis. However, the testing for a broad range of biomarkers in patients with non-specific symptoms in the hope of finding an undetected cancer is not supported by the evidence from numerous systematic reviews. Tumour markers generally should not be used in the initial diagnostic pathway and are rarely diagnostic due to low sensitivity and specificity.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4027;29;"Choosing Wisely Australia";"The Royal College of Pathologists of Australasia";English;"Do not routinely test and treat hyperlipidemia in those with a limited life expectancy.";"Measurement of lipid levels is part of absolute risk assessment for the prevention of cardiovascular disease. Age is a predominant risk factor in the elderly, so absolute risk calculators accommodate this by fixing 75 years as the maximum age that can be included in the calculation. Clinicians need to consider whether or not the assessment and treatment of risk factors beyond this age in the very elderly is likely to yield clinical benefit within the patient?s remaining life expectancy. On rare occasions lipid testing may provide relevant information in other life threatening diseases, such as pancreatitis, but in most critical illnesses lipid measurement for prevention of chronic disease will no longer be a priority.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4028;29;"Choosing Wisely Australia";"Society of Obstetric Medicine of Australia and New Zealand ";English;"Do not perform a D-Dimer test for the exclusion of venous thromboembolism during any trimester of pregnancy.";"As D-dimer levels are raised during pregnancy, they do not have a high positive predictive value for venous thromboembolism (VTE) in pregnancy (i.e. they are unreliable for ruling in VTE in pregnancy). However, nor are they a reliable rule-out test for VTE. One study estimated the sensitivity of the D-Dimer test at 73 per cent, meaning that 27 per cent of patients with a negative D-Dimer had VTE. There have also been case reports of pregnant women with pulmonary embolism presenting with a negative D-Dimer. Therefore, there is no value in performing a D-Dimer test for the exclusion of venous thromboembolism at any trimester in pregnancy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5052;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Organisation of nutrition support in hospital and the community";"All healthcare professionals who are directly involved in patient care should receive education and training, relevant to their post, on the importance of providing adequate nutrition. Education and training should cover: nutritional needs and indications for nutrition support options for nutrition support (oral, enteral and parenteral) ethical and legal concepts potential risks and benefits when and where to seek expert advice.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4029;29;"Choosing Wisely Australia";" Society of Obstetric Medicine of Australia and New Zealand ";English;"Do not test for inherited thrombophilia for placental mediated complications. ";"While older retrospective studies suggested that inherited thrombophilia is associated with adverse pregnancy outcomes such as stillbirth, recurrent miscarriage and placental abruption, more recent and more rigorous studies have either failed to find an association or have found only a weak association. Moreover, the association is a moot point as there is now good quality evidence from randomised controlled trials that low molecularweight heparin does not significantly reduce the rate of placental mediated complications.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5053;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Screening for malnutrition and the risk of malnutrition in hospital and the community";"Screening for malnutrition and the risk of malnutrition should be carried out by healthcare professionals with appropriate skills and training. All hospital inpatients on admission and all outpatients at their first clinic appointment should be screened. Screening should be repeated weekly for inpatients and when there is clinical concern for outpatients. Hospital departments who identify groups of patients with low risk of malnutrition may opt out of screening these groups. Opt-out decisions should follow an explicit process via the local clinical governance structure involving experts in nutrition support.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4030;29;"Choosing Wisely Australia";" Society of Obstetric Medicine of Australia and New Zealand ";English;"Do not do repeat testing for proteinuria in established preeclampsia. ";"Measuring proteinuria is useful as a diagnostic but not as a prognostic criterion for pre-eclampsia. This is because the level of proteinuria does not correlate with the severity of maternal complications in women with preeclampsia, nor are these levels useful in determining the timing of delivery. Thus, repeat testing for proteinuria in managing established pre-eclampsia is not recommended, particularly given the availability of superior prognostic models.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5054;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Indications for nutrition support in hospital and the community";"Nutrition support should be considered in people at risk of malnutrition who, as defined by any of the following: have eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for the next 5 days or longer have a poor absorptive capacity, and/or have high nutrient losses and/or have increased nutritional needs from causes such as catabolism. Healthcare professionals should consider using oral, enteral or parenteral nutrition support, alone or in combination, for people who are either malnourished or at risk of malnutrition. Potential swallowing problems should be taken into account.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4031;29;"Choosing Wisely Australia";"Society of Obstetric Medicine of Australia and New Zealand";English;"Do not undertake methylenetetrahydrofolate reductase (MTHFR) polymorphism testing as part of a routine evaluation for thrombophilia in pregnancy";"Patients with the thermolabile variant of the methylenetetrahydrofolate reductase (MTHFR) polymorphism are at higher risk of hyperhomocysteinaemia which has been associated with venous thrombosis. However, these associations appear to hold only in countries lacking grain products nutritionally fortified as a public health measure. Moreover, homozygous variants are found in up to 15 per cent of some populations, so that detection of this variant would lead to many women undergoing complex counselling unnecessarily and may also be a cause of distress. Polymorphism is not more prevalent in women with pregnancy-associated venous thromboembolism and testing for this polymorphism is not recommended as part of a routine evaluation for thrombophilia in pregnancy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5055;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"What to give in hospital and the community";"For people who are not severely ill or injured, nor at risk of refeeding syndrome, the suggested nutritional prescription for total intake[7] should provide all of the following: 25?35 kcal/kg/day total energy (including that derived from protein[9],[10]) 0.8?1.5 g protein (0.13?0.24 g nitrogen)/kg/day 30?35 ml fluid/kg (with allowance for extra losses from drains and fistulae, for example, and extra input from other sources ? for example, intravenous drugs) adequate electrolytes, minerals, micronutrients (allowing for any pre-existing deficits, excessive losses or increased demands) and fibre if appropriate.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4032;29;"Choosing Wisely Australia";"Society of Obstetric Medicine of Australia and New Zealand ";English;"Do not measure erythrocyte sedimentation rate (ESR) in pregnancy.";"Measuring the erythrocyte sedimentation rate (ESR) is a non-specific test to identify inflammation. An elevated result indicates inflammation but does not indicate where it is in the body or the cause. The normal range outside of pregnancy in women aged 18?50 is <20mm/h. One study found that levels varied 4?70mm/h and another found a range from 4-112mm/h, with levels being affected by gestational age and haemoglobin concentration. This is likely to reflect normal changes in pregnancy, meaning that testing for an elevated ESR does not sufficiently differentiate between healthy pregnant women and those who may be suffering from inflammatory diseases. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5056;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"Monitoring of nutrition support in hospital and the community";"Healthcare professionals should review the indications, route, risks, benefits and goals of nutrition support at regular intervals. The time between reviews depends on the patient, care setting and duration of nutrition support. Intervals may increase as the patient is stabilised on nutrition support. People having nutrition support in hospital should be monitored by healthcare professionals with the relevant skills and training in nutritional monitoring.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4033;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Don?t order computed tomography (CT) scan of the head/brain for sudden hearing loss.";"Computed tomography scanning is expensive, exposes the patient to radiation and offers no useful information that would improve initial management. CT scanning may be appropriate in patients with focal neurologic findings, a history of trauma or chronic ear disease. Sudden hearing loss is distinct from progressive loss and chronic ear disease. Sudden sensorineural hearing loss (SSHL) can be described as at least 30dB sensorineural hearing loss (SNHL) in at least three consecutive frequencies within a three-day period.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5057;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral nutrition support in hospital and the community";"Healthcare professionals should recognise that people with acute and chronic neurological conditions and those who have undergone surgery or radiotherapy to the upper aero-digestive tract are at high risk of developing dysphagia. When managing people with dysphagia, healthcare professionals with relevant skills and training in the diagnosis, assessment and management of swallowing disorders should consider: the risks and benefits of modified oral nutrition support and/or enteral tube feeding the factors listed in Box.";2017;;;"High value";Malnutrition; 1218;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.";"For further information please visit the website of the initiative (link below)";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4034;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons ";English;"Don?t prescribe oral antibiotics for uncomplicated acute discharge from grommets.";"Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections. A discharge is uncomplicated when it is not associated with any other symptom, for example fever, pain or swelling of the ear canal.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5058;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Enteral tube feeding in hospital and the community ";"Healthcare professionals should consider enteral tube feeding in people who are malnourished or at risk of malnutrition as defined in respectively, and have: nadequate or unsafe oral intake, anda functional, accessible gastrointestinal tract. Enteral tube feeding should not be given to people unless they meet the criteria or they are taking part in a clinical trial.";2017;;;"High value";Malnutrition;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4035;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons ";English;"Don?t prescribe oral antibiotics for uncomplicated acute otitis externa.";"Oral antibiotics have significant adverse effects and do not provide adequate coverage of the bacteria that cause most episodes; in contrast, topically administered products do provide coverage for these organisms. Avoidance of oral antibiotics can reduce the spread of antibiotic resistance and the risk of opportunistic infections.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5059;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Asfotase alfa is recommended as an option for treating paediatric-onset hypophosphatasia only: for people who meet the criteria for treatment within the managed access arrangement , and for the duration of this arrangement and in line with the other conditions it specifies, and when the company provides asfotase alfa with the confidential commercial terms agreed with NHS England.";"These recommendations are not intended to affect treatment with asfotase alfa that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop. For children and young people, this decision should be made jointly by the clinician and the child or young person or the child or young person's parents or carers.";2017;;;"High value";"Metabolic conditions"; 4036;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons ";English;"Don?t routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis.";"Imaging of the paranasal sinuses, including plain film radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is unnecessary in patients who meet the clinical diagnostic criteria for uncomplicated acute rhinosinusitis. Acute rhinosinusitis is defined as up to four weeks of purulent nasal drainage (anterior, posterior or both) accompanied by nasal obstruction, facial pain-pressure-fullness or both. Imaging is costly and exposes patients to radiation. Imaging may be appropriate in patients with a complication of acute rhinosinusitis, patients with comorbidities that predispose them to complications and patients in whom an alternative diagnosis is suspected.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4037;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons ";English;"Don?t obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary complaint of hoarseness prior to examining the larynx.";"Examination of the larynx with mirror or fibre optic scope is the primary method for evaluating patients with hoarseness. Imaging is unnecessary in most patients and is both costly and has potential for radiation exposure. After laryngoscopy, evidence supports the use of imaging to further evaluate 1) vocal fold paralysis, or 2) a mass or lesion of the larynx. It is essential to have the larynx examined by a specialist if the hoarseness has not resolved within 4 weeks.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4038;29;"Choosing Wisely Australia";" Paediatrics & Child Health Division";English;"Do not routinely prescribe oral antibiotics to children with fever without an identified bacterial infection.";"The vast majority of children presenting with fever do not have a bacterial infection and therefore will not benefit from being prescribed oral antibiotics. For instance, one study of febrile infants found overall bacteraemia frequency of well below one per cent. Sometimes, in exception to this, oral antibiotics are prescribed to treat an unapparent bacterial infection or prevent development of severe bacterial infection and appear to have beneficial effects, though even the significance of these effects is disputed. Given that inappropriate prescribing of antibiotics is a major cause of antibiotic resistance and antibiotics have adverse effects, it is not considered good clinical practice to prescribe antibiotics in children without a specific bacterial infection. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4550;33;"Choosing Wisely � : Things we do for no reason";"Patel S. J. Hosp. Med. 2017 January;12(1):42-45";English;"Routine catheter replacement in the absence of a clinical indication (eg, infiltration, phlebitis, infection) does not provide any additional benefit.";"For further information please visit the website of the initiative (link below) ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4806;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t order serum ammonia to diagnose or manage hepatic encephalopathy (HE).";"High blood-ammonia levels alone do not add any diagnostic, staging, or prognostic value in HE patients known to have chronic liver disease.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4039;29;"Choosing Wisely Australia";" Paediatrics & Child Health Division";English;"Do not routinely undertake chest X-rays for the diagnosis of bronchiolitis in children or routinely prescribe salbutamol or systemic corticosteroids to treat bronchiolitis in children.";"Chest X-rays Chest X-rays for patients with acute lower respiratory tract infections rarely affect clinical treatments and outcomes. Chest X-ray films do not discriminate well between bronchiolitis and other forms of lower respiratory tract infection and in mild cases do not offer information that is likely to affect treatment. It is estimated that 133 children with typical bronchiolitis would have to undergo radiography to identify one radiograph that is suggestive of an alternate diagnosis. Salbutamol With the exception of improving clinical scores in infants treated as outpatients, the evidence overwhelmingly shows that bronchodilators, including salbutamol, do not improve oxygen saturation, reduce hospital admissions or shorten the duration of hospitalisation and time to resolution of illness in children with bronchiolitis. Compared with these minimal benefits, salbutamol is associated with adverse impacts such as tachycardia, oxygen desaturation and tremors. If a bronchodilator is required, epinephrine appears to be a superior alternative to salbutamol in reducing the severity of bronchiolitis. Steroids The majority of randomised controlled trials have not found a clinically relevant, sustained impact of systemic or inhaled glucocorticoids on admissions or length of hospitalisation in children with bronchiolitis or other forms of lower respiratory tract infection.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4551;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Mammography screening is usually appropriate in breast cancer screening in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4040;29;"Choosing Wisely Australia";" Paediatrics & Child Health Division";English;"Do not routinely order chest X-rays for the diagnosis of asthma in children.";"There is extensive evidence that the majority of X-rays ordered for children admitted for asthma and wheezing disorders do not provide clinically relevant information and therefore do not contribute to their diagnosis and management. Clear clinical criteria outlining the indications for X-rays in asthma should be defined to avoid unwarranted chest X-rays in children with acute wheeze.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4552;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Digital breast tomosynthesis screening is usually appropriate in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5064;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Etelcalcetide is recommended as an option for treating secondary hyperparathyroidism in adults with chronic kidney disease on haemodialysis, only if: treatment with a calcimimetic is indicated but cinacalcet is not suitable and the company provides etelcalcetide with the discount agreed in the patient access scheme. ";"This guidance is not intended to affect the position of patients whose treatment with etelcalcetide was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop.";2017;;;"High value";"Thyroid disorders";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4041;29;"Choosing Wisely Australia";" Paediatrics & Child Health Division";English;"Do not routinely treat gastroesophageal reflux disease (GORD) in infants with acid suppression therapy.";"Gastroesophageal reflux is common in preterm infants, infants and children and uncomplicated gastroesophageal reflux typically does not require medical therapy. However, gastroesophageal reflux may evolve into gastroesophageal reflux disease (GORD), a condition where the persistent leaking of stomach contents back into the oesophagus results in heartburn and other troublesome symptoms. Proton pump inhibitors (PPI) are sometimes prescribed in cases of GORD to achieve a pronounced and longlasting reduction of gastric acid production. However, numerous randomised controlled trials have concluded that PPIs are no more effective than placebo in treating GORD in infants, though there is some evidence (of moderate quality) of their effectiveness in treating GORD in older children. Moreover, there is still a paucity of trials confirming the long term safety of PPI use in children more generally while there is considerable evidence that PPIs have significant negative side effects such headache, diarrhoea, constipation, nausea, increased rates of infection and increased rates of food allergy.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4553;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"A breast ultrasound may be appropriate in breast cancer screening in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4042;29;"Choosing Wisely Australia";" Paediatrics & Child Health Division";English;"Do not routinely order abdominal X-rays for the diagnosis of nonspecific abdominal pain in children.";"5 Retrospective studies of medical records of children and adults admitted for constipation and other forms of non-specific abdominal pain conclude that in only a very small minority (under 5%) of cases do abdominal X-rays make a difference in patient treatment. A recent study also showed that abdominal X-rays were performed more frequently in misdiagnosed children. Numerous studies yield significantly varying estimates of the sensitivity and specificity of abdominal x-rays and insufficient evidence of a diagnostic association between symptoms of constipation and faecal loading seen on abdominal X-rays. There is significant scope for reducing the number of abdominal X-rays performed without sacrificing diagnostic accuracy for children with abdominal pain.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4554;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"MRI breast with and without intravenous contrast is usually not appropriate in breast cancer screening in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4043;29;"Choosing Wisely Australia";"Internal Medicine Society of Australia and New Zealand";English;"Avoid medication related harm in older patients (>65 years) receiving 5 or more regularly used medicines by performing a complete medication review and deprescribing whenever appropriate.";"Studies show that the risk of medication-related harm rises once the number of regularly prescribed medicines exceeds five; this risk increases exponentially as the number reaches eight or more. Medicines that deserve particular attention are benzodiazepines and other sedative-hypnotics, anti-psychotics, hypoglycaemic agents, antithrombotic agents, antihypertensives, and anti-anginal agents. Trying to achieve aggressive treatment targets, such as BP <130/80 or HbA1c<7 per cent, in frail older patients with multiple co-morbidities confers little benefit and a higher risk of harm. Discontinuation should be considered where past indications for specific medicines are no longer valid, the risk of harm outweighs the benefits within a patient?s remaining life span, or medicines are associated with past toxicity or non-adherence. ";2017;;;"Low value";-; 4555;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Fluorodeoxyglucose-positron emission mammography is usually not appropriate in breast cancer screening in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4044;29;"Choosing Wisely Australia";" Internal Medicine Society of Australia and New Zealand";English;"Don?t request daily full blood counts, erythrocyte sedimentation rate (ESR) or C reactive protein (CRP) as measures of response to antibiotic treatment if patients are clinically improving.";"The decision on whether or not to cease antibiotic treatment or switch from intravenous (IV) to oral antibiotics should be guided by the results of microbiological cultures indicating bacterial species and antimicrobial sensitivities, and evidence of defervescence and improved clinical status rather than by changes in the levels of white cell count (WCC) from a full blood count, C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR). However, these markers can help to predict poor prognosis in patients with severe infections in whom the clinical response may be difficult to determine (e.g. immunosuppressed patients or those who are critically ill or those at risk of drug-resistant hospital-acquired infections). In these cases, the failure of markedly elevated CRP and WCC to decrease by specified amounts would suggest that the antimicrobial therapy is not being effective. While no references could be found that explicitly support not using ESR or CRP in mild to moderate infections, available evidence suggests that their use is only of benefit in severe infections. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4556;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"TechnetiumTc-99m sestamibi MBI is usually not appropriate in breast cancer screening in women with average-risk (less than 15% lifetime risk of breast cancer)";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4045;29;"Choosing Wisely Australia";" Internal Medicine Society of Australia and New Zealand";English;"Once patients have become afebrile (nonfeverish) and are clinically improving, don?t continue prescribing intravenous antibiotics to those with uncomplicated infections and no high-risk features if they are tolerant of oral antibiotics";"Patients with uncomplicated infections not requiring prolonged antibiotic therapy and with no high-risk features should be switched from intravenous (IV) to oral antibiotics once they are afebrile, clinically improving and able to tolerate oral medication. In hospital, this often occurs by day three. Exceptions to this rule are those suffering life threatening or deep-seated infections (such as suspected endocarditis, osteomyelitis or meningitis), and high risk patients (such as immunocompromised patients including from HIV, intravenous drug use, underlying advanced cancer, or documented multiresistant bacteraemia or hospital-acquired infection). There is no evidence to support the belief that oral medications are insufficiently bioavailable to be as effective as IV medications, or that the same agent must be used both IV and orally. The scope for early IV to-oral conversion has broadened, owing to the advent of newer, more potent oral agents that achieve higher and more consistent serum and tissue concentration. Moreover, earlier switchover from IV-tooral therapy reduces the risk of cannula-related infections, carries no risk of thrombophlebitis, and allows for earlier discharge and reduced cost.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4557;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Mammography screening is usually appropriate in breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4813;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures.";"Routine tests of coagulation do not reflect bleeding risk in patients with cirrhosis and bleeding complications of these procedures are rare.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4046;29;"Choosing Wisely Australia";" Internal Medicine Society of Australia and New Zealand";English;"Don?t request Holter monitoring, carotid duplex scans, echocardiography, electroencephalograms (EEGs) or telemetry in patients with first presentation of uncomplicated syncope and no high risk features.";"Holter monitoring, carotid duplex scans, echocardiography, electroencephalograms (EEGs) and telemetry have very low diagnostic yield in patients with uncomplicated syncope and no clinical features of, or risk factors for, the following: ?arrhythmia (e.g. palpitations preceding syncope, exertional syncope, unheralded syncope, history suggestive of heart failure or ischaemic heart disease). ?carotid stenosis (syncope would need to be associated with focal neurological symptoms or signs suggestive of transient ischaemic attack) ?cardiac valvular disorders (e.g. definite heart murmurs) or ?seizures (very rarely present as syncope with no other epileptic features e.g. tongue biting, urinary incontinence, post-ictal confusion, muscle pain). Most syncopal episodes are vasovagal or secondary to postural hypotension for which careful history, and lying and standing blood pressure measurements are the most important diagnostic criteria combined with standard 12-lead ECG.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4558;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Digital breast tomosynthesis screening is recommended for breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";"Digital breast tomosynthesis (DBT) can address some of the limitations encountered with standard mammographic views. In addition to planar images, DBT allows for creation and viewing of thin-section reconstructed images that may decrease the lesion-masking effect of overlapping normal tissue and reveal the true nature of potential false-positive findings without the need for recall. Several studies confirm that in a screening setting, the cancer detection rate is increased with use of DBT compared with 2-D mammography alone. Some authors found these advantages to be especially pronounced in women under age 50 , in those with dense breasts, and with lesion types including spiculated masses and asymmetries. Interpretation time for DBT images is greater than for standard mammography. Additionally, dose is increased if standard 2-D images are obtained in addition to DBT images. However, synthesized reconstructed images (a virtual planar image created from the tomographic dataset) may replace the need for a 2-D correlative view; current data suggest that these synthetic images perform as well as standard full-field digital images. DBT is almost always performed as part of an examination that also includes digital mammography. The digital mammography part of the examination may be in the form of traditional projection mammography or synthesized image from the DBT data.";2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4047;29;"Choosing Wisely Australia";" Internal Medicine Society of Australia and New Zealand";English;"Computerised tomography pulmonary angiography is not recommended as first choice investigation in non-pregnant adult patients with low risk of pulmonary thromboembolism (TEP) by Wells? score (score<= 4); imaging can be avoided in low risk patients if D-dimer test is negative after adjusting for age.";"The D-dimer test is highly sensitive for deep vein thrombosis and pulmonary thromboembolism, such that a negative result in non-pregnant adults (adjusted for age) rules out this condition in patients with low pre-test probability. A positive result is however non-specific and may be due to many other conditions apart from PTE. In ruling out PTE, D-dimer assay should be the first choice investigation in patients classified as being low risk according to the Wells? score (equal to or less than 4). These considerations are heightened by the risks associated with CTPA testing such as radiation exposure and incidental imaging findings, e.g. lung nodules and adrenal lesions that may provoke further investigations and diagnosis of isolated small subsegmental emboli whose natural history is unknown and for which anticoagulation is not yet shown to be of benefit. There is, however, a 1 ? 3% failure rate with a low risk Wells? score and negative D-dimer prediction method, so close follow-up is indicated in all patients in whom a D-dimer has been requested. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4559;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"MRI breast with and without intravenous contrast may be appropriate in breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";"The American Cancer Society considers there to be insufficient evidence for or against MRI as an adjunct to mammography in women at intermediate risk of breast cancer. However, recent studies support the use of screening MRI in certain subsets of this population, including women with a history of lobular carcinoma in situ or a personal history of breast cancer.";2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4048;29;"Choosing Wisely Australia";"Australian and New Zealand College of Anaesthetists";English;"Avoid routinely performing preoperative blood investigations, chest X-ray or spirometry prior to surgery, but instead order in response to patient factors, symptoms and signs, disease, or planned surgery.";"Preoperative testing aims to provide results that will guide preoperative, intraoperative and postoperative care, particularly results that may change the intended plans. Preoperative laboratory blood investigations in asymptomatic patients undergoing low risk surgery are of little value in detecting abnormalities that will alter patient management and/or improve outcomes. Even when minor abnormalities in laboratory values are detected in asymptomatic patients, adverse outcomes are rare. Clinical history and physical examination should be used to determine the need for laboratory blood testing before low risk surgery; that is, test on the basis of patient and surgical factors. Similarly, in the absence of positive clinical findings, or significant history, abnormal chest X-ray or spirometry results are uncommon. Positive results, in the absence of symptoms or signs, are unlikely to significantly influence perioperative management. Although the diagnostic yield of preoperative chest X-rays increases with age, most abnormalities reflect chronic disorders and when performed in asymptomatic patients do not impact on anaesthetic management or perioperative outcome. In other words, chest X-ray results are not predictive of postoperative pulmonary complications in most patients. Preoperative chest X-rays may, however, be appropriate prior to cardiac and thoracic surgery and as part of oncological evaluation. There is insufficient evidence to support spirometry as an appropriate tool to stratify risk of postoperative adverse respiratory events. Spirometry may be of value in lung resection surgery, unexplained dyspnoea, and uncertainty about whether known airflow obstruction is optimally reduced. Rather than performing these investigations routinely for surgery, decisions should be individualised, depending on patient history and examination. Further, for all of these tests, lack of symptoms, signs or known disease increases the likelihood that positive findings are false positives exposing patients to the risks of unnecessary further testing.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4560;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"A breast ultrasound may be appropriate in breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";"In women with dense breasts and increased risk of breast cancer, mammography sensitivity can be as low as 50%; supplementing mammography screening with US will significantly increase cancer detection, although falsepositive rates are also substantially increased. In intermediate-risk women with dense breasts, supplemental US screening is an option.";2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4049;29;"Choosing Wisely Australia";"Australian and New Zealand College of Anaesthetists";English;"Avoid ordering cardiac stress testing for asymptomatic patients prior to undergoing low to intermediate risk non-cardiac surgery. ";"Unnecessary cardiac stress testing increases the patient risk profile for the intended surgery by exposing the patient to the inherent complications of the investigation employed. A further consequence may be the invasive treatment of asymptomatic non-critical coronary disease leading to further patient risk and delay of surgery. Cardiac stress testing should be reserved for symptomatic patients who would normally qualify for the investigation regardless of the need for an operation, and asymptomatic patients at high risk of coronary disease with a significant risk of major adverse cardiac events due to co-morbidity or the high risk nature of the surgery.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4561;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Fluorodeoxyglucose-positron emission mammography is usually not appropriate in breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";"The use of FDG-PEM is limited by the lack of information about radiation dose and lack of evidence in large screening populations.";2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4050;29;"Choosing Wisely Australia";"Australian and New Zealand College of Anaesthetists";English;"Avoid administering packed red blood cells (blood transfusion) to a young healthy patient with a haemoglobin of ?70g/L who does not have on-going blood loss, unless the patient is symptomatic or haemodynamically unstable.";"The optimal haemoglobin criterion for transfusion remains controversial and under investigation, varying between 60 and 100 g/L. Compared with higher haemoglobin thresholds, a lower haemoglobin threshold is associated with fewer red blood cell units transfused, without adverse associations with mortality, cardiac morbidity, functional recovery or length of hospital stay in young otherwise healthy patients. Hospital mortality is lower in younger patients randomised to a lower haemoglobin threshold for transfusion versus those randomised to a higher haemoglobin threshold.The decision to transfuse should be based on a combination of both haemoglobin level and assessment of the patient?s clinical status, in particular, haemodynamic indicators and underlying cardiovascular pathology. Currently there is no evidence of benefit and some evidence of harm in the transfusion of packed red blood cells to young healthy haemodynamically stable patients without symptoms.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4562;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"TechnetiumTc-99m sestamibi MBI is usually not appropriate in breast cancer screening in women with intermediate-risk (with personal history of breast cancer, lobular neoplasia, atypical ductal hyperplasia, or 15% to 20% lifetime risk of breast cancer) ";"Supplementing mammography with MBI in women with dense breasts increases the cancer detection rate. However, there have been no large population studies of MBI for screening and whole body radiation dose with this technique is concerning. ";2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4818;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis.";"Serum ferritin values reflect an increase in hepatic iron content and have a significant false positive rate because of elevations due to inflammation. Thus, in patients with evidence of liver disease, hemochromatosis genotyping should only be performed among individuals with an elevated ferritin and fasting transferrin saturation >45% (TSat) or a known family history of HFE-associated hereditary hemochromatosis.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4051;29;"Choosing Wisely Australia";"Australian and New Zealand College of Anaesthetists";English;"Avoid initiating anaesthesia for patients with limited life expectancy, at high risk of death or severely impaired functional recovery, without discussing expected outcomes and goals of care.";"The high risk of postoperative morbidity and mortality in the elderly population in particular has been well documented. Patients over 70 years of age having major surgery in Australia and New Zealand health care facilities are at high risk for postoperative events, with 20% experiencing complications within 5 days, 10% requiring critical care admission and 5% dying within 30 days. Frailty is the state of increased vulnerability to stressors and increases the risk of adverse outcomes including falls, delirium and disability. Such stressors may include hospitalisation and surgery. Functional capacity, one aspect of frailty assessment, has been shown to be an independent predictor of mortality with each ASA class. There is currently much research into the implementation of frailty assessment as part of clinical practice and into whether preoperative measures and postoperative management can improve outcomes. Discussion with the patient and family about the risks and benefits of hospitalisation and surgery in this context are important. Discussion must centre on patient values and preferences for care and the goals of care when there is significant risk of perioperative morbidity or mortality. This is particularly pertinent in patients with limited life expectancy due to advanced cardiac, renal or respiratory failure and / or metastatic malignancy. Discussions around expected functional recovery and treatment limitations have been demonstrated to reduce stress and anxiety in patients and their families. Many healthcare facilities now require advanced care directives or goals of care plans on or shortly after admission in the appropriate clinical setting. For patients at highest risk, and where time allows, the discussions should be led by a multidisciplinary, consultant level team, particularly where there is a risk of futile surgery and/or futile intensive care. It is important to ensure that alternative care, focused predominantly on comfort and dignity, is offered to patients and their families.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4563;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Mammography screening is usually appropriate in breast cancer screening in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";"Annual mammography is recommended starting 8 years after radiation therapy but not before age 25 for women who received mantle radiation between 10 to 30 years of age. As there is some concern about young women with an inherited cancer predisposition having increased sensitivity to radiation, women with a genetic predisposition are recommended for annual screening beginning 10 years earlier than the affected relative at the time of diagnosis but not before age 30. The sensitivity of mammography is dependent upon breast density, with sensitivity decreasing with increasing breast density. ";2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4052;29;"Choosing Wisely Australia";" Australian and New Zealand College of Anaesthetists";English;"Avoid initiating anaesthesia for patients with significant co-morbidities without adequate, timely preoperative assessment and postoperative facilities to meet their needs.";"The ability to provide adequate perioperative care for patients with significant co-morbidities including morbid obesity is a crucial factor in determining whether surgery should be performed in a particular facility. The complexity of the proposed surgery should also be considered. Adequate and timely preoperative assessment must be facilitated to ensure that scheduling of a procedure is appropriate for the facility. In particular, small private hospitals which have no on-site medical practitioners overnight and no intensive care backup must have robust pre-admission processes in which higher risk patients are screened to ensure that they are not accepted for overnight admission unless they have been assessed as suitable for that facility by an anaesthetist or medical specialist. Intraoperative staffing, equipment and infrastructure are crucial. Postoperatively, staffing ratios and skill sets, requirements for monitoring, medical support and high dependency unit care, as well as optimal pain management, must be considered. Patients with obstructive sleep apnoea (OSA) and obese patients who may or may not have a formal diagnosis of OSA and/or obesity hypoventilation syndrome represent a particularly high risk group when pain management includes opioid analgesics. The inherent risks of postoperative respiratory depression demand adequate post procedure monitoring by skilled staff. In summary, the patient and the proposed surgery must be appropriate for the facility. Importantly, patients in rural and remote locations may accept higher risk to be closer to home and a discussion may be required with the patient and treating physicians about whether performing a procedure at a local facility is an acceptable risk. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4564;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Digital breast tomosynthesis screening is usually appropriate in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";"The sensitivity of mammography is dependent upon breast density, with sensitivity decreasing with increasing breast density. Digital breast tomosynthesis (DBT) can address some of the limitations encountered with standard mammographic views. In addition to planar images, DBT allows for creation and viewing of thin-section reconstructed images that may decrease the lesion-masking effect of overlapping normal tissue and reveal the true nature of potential false-positive findings without the need for recall. Several studies confirm that in a screening setting, the cancer detection rate is increased with use of DBT compared with 2-D mammography alone. Some authors found these advantages to be especially pronounced in women under age 50 , in those with dense breasts, and with lesion types including spiculated masses and asymmetries. Interpretation time for DBT images is greater than for standard mammography. Additionally, dose is increased if standard 2-D images are obtained in addition to DBT images. However, synthesized reconstructed images (a virtual planar image created from the tomographic dataset) may replace the need for a 2-D correlative view; current data suggest that these synthetic images perform as well as standard full-field digital images. DBT is almost always performed as part of an examination that also includes digital mammography. The digital mammography part of the examination may be in the form of traditional projection mammography or synthesized image from the DBT data.";2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4053;29;"Choosing Wisely Australia";" Australasian Society of Clinical Immunology and Allergy";English;"Don?t use antihistamines to treat anaphylaxis.";"For emergency treatment of a severe allergic reaction (anaphylaxis) it is important to promptly administer adrenaline (epinephrine) by intramuscular injection using an adrenaline autoinjector if available, or by using adrenaline ampoules and syringe (the latter is only suitable in a medical setting). There is a high risk of potential harm (disability or death) from anaphylaxis if it is not treated promptly with adrenaline. There are also cost implications from delayed or inappropriate treatment of anaphylaxis, such as additional ambulance, emergency department and hospital costs, as well as additional anxiety for patients and their families or carers. Antihistamines are recommended for treatment of mild and moderate allergic reactions, including allergic rhinitis (hay fever), but have no role in treating or preventing respiratory and cardiovascular symptoms of anaphylaxis. In particular, oral sedating antihistamines should never be used in patients with anaphylaxis as side effects (drowsiness or lethargy) may mimic some signs of anaphylaxis. Injectable promethazine should not be used in anaphylaxis as it can worsen hypotension and cause muscle necrosis.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4565;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"MRI breast with and without intravenous contrast is usually appropriate in breast cancer screening in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4054;29;"Choosing Wisely Australia";" Australasian Society of Clinical Immunology and Allergy";English;"Alternative / unorthodox methods should not be used for allergy testing or treatment.";"Whilst there is currently no cure for allergy, reliable tests and a range of treatments for allergy are available, which are backed up by scientific studies that demonstrate proven safety and efficacy. In contrast, numerous studies have demonstrated the uselessness of several alternative/unorthodox methods that claim to test or treat allergy. These methods continue to be promoted in the community and some even make false claims that they can cure allergy. There is also currently no stringent regulation of alternative/unorthodox diagnostic techniques and devices, so they can be ?listed? in Australia without having to prove that they work. There is a risk of potential harm if individuals with allergies are incorrectly diagnosed and inappropriately treated using alternative/unorthodox methods, particularly if they have severe allergies. The costs of alternative/unorthodox methods are significant, and are usually paid for by individuals, with rebates from some private health funds. There are cost implications for healthcare services as well as individuals, as these funds are being directed into non-productive areas, and are therefore not available for more useful medical tests and treatments. Examples of alternative/unorthodox methods that have been demonstrated to lack evidence for testing or treating allergy include food specific IgG and IgG4 tests, homeopathy, cytotoxic testing and kinesiology. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4566;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"A breast ultrasound may be appropriate in breast cancer screening in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";-;2017;;;"High value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4822;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions (e.g., focal nodal hyperplasia, hemangioma).";"Patients with benign focal liver lesions who do not have underlying liver disease and have demonstrated clinical (asymptomatic) and radiologic stability do not need repeated imaging as the likelihood of evolving into neoplastic lesions is very low. In contrast, patients with radiologic evidence of hepatocellular adenoma may have an increased risk of complications and/or neoplasia thus warranting closer observation. ";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4055;29;"Choosing Wisely Australia";" Australasian Society of Clinical Immunology and Allergy";English;"Allergen immunotherapy should not be used for routine treatment of food allergy? research in this area is ongoing. ";"Research into allergen immunotherapy for food allergy is ongoing and until further work determining safety and efficacy is determined, it should not be performed outside of well defined medical research studies, as there is a high risk of potential harm in individuals with severe food allergy. Allergen immunotherapy is currently only recommended for treatment of allergic rhinitis (hay fever) and sometimes allergic asthma, due to environmental allergens (such as pollen or dust mites) and for the treatment of stinging insect allergy. Allergen immunotherapy should be considered in appropriate patients when symptoms are severe, the cause is difficult to avoid (such as grass pollen or stinging insects) and medications don?t help or cause adverse side effects.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4567;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"Fluorodeoxyglucose-positron emission mammography is usually not appropriate in breast cancer screening in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4056;29;"Choosing Wisely Australia";" Australasian Society of Clinical Immunology and Allergy";English;"Food specific IgE testing should not be performed without a clinical history suggestive of IgEmediated food allergy.";"Reliable and proven diagnostic tests for food allergy include skin prick testing, blood tests for food specific IgE antibodies and medically supervised food allergen challenges. Allergy test results should never be used on their own, and must be considered together with the patient?s clinical history. In the absence of a history of clinical symptoms, low levels of allergen-specific IgE are usually of little diagnostic significance. Allergy testing of individuals where there is no evidence that food allergy plays a role in their clinical symptoms increases the likelihood of irrelevant false positive results. This may lead to potential harm due to inappropriate and unnecessary dietary restrictions, with nutritional implications for the individual (particularly in children) and unnecessary fear and anxiety (particularly for the family or carers).";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4568;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"TechnetiumTc-99m sestamibi MBI is usually not appropriate in breast cancer screening in women with high-risk (with a BRCA gene mutation and their untested first-degree relatives, women with a history of chest irradiation between 10 to 30 years of age, women with 20% or greater lifetime risk of breast cancer) ";-;2017;;;"Low value";"Breast Cancer Screening ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4057;29;"Choosing Wisely Australia";" Australasian Society of Clinical Immunology and Allergy";English;"Don?t delay introduction of solid foods to infants - ASCIA Guidelines for Infant Feeding and allergy prevention recommend introduction of solid foods to infants, around 6 months of age.";"This recommendation is consistent with ASCIA Guidelines for infant feeding and allergy prevention (2016), which recommend introduction of solid foods to infants, at around 6 months of age, but not before 4 months (including foods considered to be highly allergenic such as peanut) preferably whilst breast feeding. It is important to seek medical advice if an allergic reaction occurs and also regarding the safe introduction of foods if an infant has a sibling or parent with food allergy. This recommendation is also consistent with findings from recent studies, including the LEAP (Learning Early About Peanut Allergy) trials published in the New England Journal of Medicine (NEJM) in 2015 and 2016. The LEAP trials concluded that the early introduction of peanuts significantly decreased (by 80%) the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4825;19;"Choosing Wisely Canada";"Canadian Association for the Study of Liver Disease";English;"Don?t repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of antiviral treatment.";"Highly sensitive quantitative assays of hepatitis C RNA are appropriate at the time of diagnosis (to confirm infection) and as part of antiviral therapy, which is typically at the beginning and after therapy is completed to confirm sustained virological response at week 12 (SVR 12). Outside of these circumstances the results of virologic testing do not change clinical management or outcomes.";2017;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 4058;29;"Choosing Wisely Australia";"Australasian Paediatric Endocrine Group";English;"Do not rely on random measures of circadian hormones for diagnostic purposes.";"Numerous hormones, such as growth hormone and testosterone, are subject to circadian rhythms. Relying on random measures of these hormones is therefore of limited diagnostic utility as their levels may peak and plateau at particular times throughout the day. Unless adjustments are made to take account of these circadian rhythms then random readings will not be sufficiently informative. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4059;29;"Choosing Wisely Australia";"Australasian Paediatric Endocrine Group";English;"Do not rely solely on bone age measurement for assessing growth in young children with short stature under 2 years of age.";"There is no consensus protocol on bone-age assessment of younger children and infants, particularly those under the age of two. Skeletal growth and maturation is most rapid in infants and toddlers, so accurate bone-age assessment in these children is challenging. Of the bone-age measurement techniques available, there is a major inadequacy with one of the most used methods: the limited change in the appearance of the ossification centres of the hand/wrist change in the first months of life. A recent survey found much lower rates of confidence in the accuracy of this technique when applied to the one-to-three-year-old group. Although a recently reported and validated bone-age measurement technique based on fibular shaft length was found to outperform other methods, it still yielded significant errors when applied to infants (i.e. under one year).";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4060;29;"Choosing Wisely Australia";"Australasian Paediatric Endocrine Group";English;"Do not routinely measure insulin-like growth factor binding protein 3 (IGFBP-3) for workup and diagnosis of childhood short stature.";"Particularly given its low sensitivity, insulin-like growth factor binding protein 3 (IGFBP-3) does not significantly contribute to the diagnosis of childhood short stature resulting from growth-hormone deficiency (GHD), which can lead to the under identification of GHD. It should therefore not be used as a routine measure for the workup and diagnosis of children with short stature. However, IGFBP-3 testing may have a role, along with IGF-1 testing, as an auxiliary diagnostic index for provocative testing.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4061;29;"Choosing Wisely Australia";"Australasian Paediatric Endocrine Group";English;"Do not initiate gonadotropin-releasing hormone (GnRH) analogue treatment in children outside of central precocious puberty, for the target outcome of delaying puberty and improving final adult height. ";"While there is some evidence that the use of GnRH agonists can achieve improvements in height in females with early puberty, it is also associated with the development of polycystic ovary syndrome (PCOS) in adolescence and risks compromising bone health. Its use outside of clinical trials is not recommended. Given that the treatment duration must also be lengthy for its benefits to be manifested, its use is not recommended to augment height in adolescents with short stature and normally timed puberty. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3806;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Asociaci�n de Enfermer�a Familiar y Comunitaria de Catalu�a";Spanish;"In adult patients with asthma exacerbations, intramuscular corticosteroids are not recommended as the first option when the oral route is preserved, except in certain clinical situations.";"The first-line treatment in asthma exacerbations is the administration of systemic corticosteroids, in conjunction with inhaled beta-agonists. In the management of respiratory exacerbations, studies show that there are no significant differences in the benefit of treatment according to the route of administration, oral intake or intramuscular (IM) route and, therefore, oral intake is recommended as the route of choice in the treatment of asthma exacerbation because of its high bioavailability. The IM pathway for the treatment with corticosteroids would be indicated in severe exacerbations when the effectiveness of the oral intake is not assured. The IM route would also be indicated when therapeutic compliance is to be ensured or the patient does not collaborate in the oral intake of the drug.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4062;29;"Choosing Wisely Australia";"Australasian Paediatric Endocrine Group";English;"Do not routinely prescribe aromatase inhibitors to promote growth in children with short stature. ";"Aromatase inhibitors are used as adjuvant therapy for breast cancer. There is growing acceptance of their use to increase the adult height of children with short stature and some evidence that aromatase inhibitors can at least improve short-term growth outcomes. One recent clinical trial of aromatase inhibitors used in paediatric patients found them to be safe and effective. Even so, there is still little evidence overall that this treatment improves final adult height or is sufficiently safe. A 2015 Cochrane review found a significant proportion of pre-pubertal boys undergoing this treatment suffered mild morphological abnormalities of their vertebrae. More evidence is needed to demonstrate safety and efficacy of aromatase inhibitors before they can be routinely prescribed to promote growth in children with short stature.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3807;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"Do not request a sinus x-ray in the uncomplicated acute rhinosinusitis of the adult since it does not add any value in the approach of pathology.";"Acute rhino sinusitis (ARS) is defined as the symptomatic inflammation of the sinus and nasal cavity mucosa that has a maximum duration of twelve weeks, according to the consensus of more recent clinical guidelines. Considering that, in almost all cases, sinus involvement is accompanied by inflammation of the contiguous nasal mucosa, the last guidelines have chosen to adopt the term rhinosinusitis, instead of sinusitis, to talk about this pathology. Although their etiology may be diverse, most cases result from a viral infection of the upper respiratory tract and, less frequently, from a bacterial infection. It is estimated that between 0.5% and 2% of viral infections of the upper respiratory tract are complicated by secondary bacterial infection and that during an episode of acute rhinosinusitis, the prevalence of bacterial infection is 2% -10 % and viral infection of 90%-98%. The prevalence of acute rhinosinusitis in the general population ranges from 6% to 15% according to the studies and its impact in economic and health terms is high, since it affects quality of life and labor productivity. It is a reason for frequent consultation, especially in primary care and emergency services, and generates a high consumption of drugs. Most clinical guidelines consider that at least 2 symptoms are necessary to establish the diagnosis of acute rhinosinusitis, especially the anterior or posterior nasal discharge, nasal congestion or obstruction, pressure or facial pain and decreased smell. Other symptoms that would support the diagnosis would be fever, headache, dental pain, cough, ear pain or pressure, fatigue and halitosis. It is suspected that the etiology is bacterial when the symptoms persist beyond 7-10 days or when, after an initial improvement, they again worsen and last for more than 7-10 days. Although the diagnosis of acute rhinosinusitis is based on adequate clinical history and physical examination, it is not uncommon to perform any complementary exploration to confirm it. Traditionally the most used has been the X-ray of sinuses. Several studies have shown that sinus x-ray does not improve the diagnostic adequacy of adult acute rhinosinusitis, it does not allow differentiation between viral or bacterial etiology and, in short, does not modify therapeutic behavior. Therefore, failure to perform RX avoids diagnostic delays, unnecessary irradiation for the patient and avoidable expenses for the healthcare system. The latest versions of the Canadian, American and European clinical guidelines and some organisms, such as Semfyc and initiatives such as Choosing Wisely, have issued recommendations regarding it, advising against the performance of x-ray in cases of uncomplicated acute rhinosinusitis. It would only be justified to request it in adults in cases of recurrent acute rhinosinusitis, suspicion of complications or suspicion of other pathologies. In Catalonia, of the 46,442 diagnoses of acute sinusitis, a sinus x-ray was performed in 6.8% of the cases (SISAP-Sistema de Informaci�n de las Servicios de Atenci�n Primaria, 2016). In conclusion, it would not be appropriate to request a sinus X-ray in the uncomplicated acute rhinosinusitis of the adult since it does not contribute any value in the approach of the pathology and, instead, may imply an unnecessary risk for the patient and an expense. The diagnosis of acute rhinosinusitis must be based on clinical history (evolution of the condition and presence of key symptoms) and adequate physical examination. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4063;29;"Choosing Wisely Australia";" Australasian Faculty of Occupational and Environmental Medicine";English;"Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination. ";"The purpose of preplacement medical examinations should be to determine an individual?s ability to perform the job. However, such examinations are generally not recommended unless there is a reason for using them to assess some specific occupational risks. Even if a routine preplacement medical examination is justified, low back X-rays and other imaging are not useful preplacement tests to undertake because they have not been found to predict future injuries. These tests also result in unnecessary radiation exposure and age-related, asymptomatic, clinically unimportant findings may trigger further imaging evaluation and/or patient anxiety. ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5855;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Opciones efectivas para dejar de fumar durante la pandemia COVID-19";Spanish;"It is recommended interactive and tailored Internet?based interventions for smoking cessation";"The evidence from trials in adults suggests that interactive and tailored Internet?based interventions with or without additional behavioural support are moderately more effective than non?active controls at six months or longer, but there was no evidence that these interventions were better than other active smoking treatments. However some of the studies were at high risk of bias, and there was evidence of substantial statistical heterogeneity. Treatment effectiveness in younger people is unknown.";2017;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4064;29;"Choosing Wisely Australia";" Australasian Faculty of Occupational and Environmental Medicine";English;"Do not order X-rays or other imaging for acute non-specific low back pain, unless there are red flags or other clinical reasons to suspect serious spinal pathology.";"As little as two per cent of low back pain cases represent potentially serious conditions requiring surgical or medical intervention. The majority of acute low back pain episodes are benign, self-limiting cases that do not warrant any X-ray or imaging studies. Indeed, unnecessary X-rays and imaging can be harmful due to the potential adverse health effects associated with radiation exposure, incidental findings that trigger more imaging to be performed, and description of asymptomatic, age-related changes in the spine that can result in inappropriate patient anxiety. Moreover, the attribution of symptoms to unrelated incidental findings can then lead to unnecessary surgery. It is therefore recommended that X-rays and other imaging of the lower back should be performed only if there are red flags such as: a history of significant trauma, cauda equina syndrome, symptoms suggestive of a tumour or infection (fever, weight loss, and a history of cancer), and steroid use. Also, plain radiography is insufficiently sensitive and specific pain associated with these risk factors with the exception of suspected ?low energy? fractures e.g. low-height falls in the elderly or osteoporotic. In these cases, plain radiography can be useful to determine whether a fracture is present and inform investigation and treatment of patients at risk of osteoporosis to prevent further fragility fractures.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4065;29;"Choosing Wisely Australia";" Australasian Faculty of Occupational and Environmental Medicine";English;"Do not prescribe opioids for the treatment of acute or chronic pain without assessing the patient?s clinical condition, potential side effects, alternative analgesic options, work status, and capacity to perform safety-critical activities such as driving a motor vehicle. ";"Studies demonstrate that prescribing opioids for workers suffering back injuries is correlated with significantly longer periods of disability and a higher risk of surgery. Some of these relationships may be attributable to the higher likelihood of opiate prescription for people with more serious injuries. However, other studies have documented that long-term opioid use for chronic pain is associated with serious risks such as abuse and dependence, overdose, myocardial infarction, and motor vehicle crashes. These risks may outweigh the benefits given there is also insufficient evidence on whether the pain relief provided by opioids is sustained in the long term. The use of opioids can result in euphoria, drowsiness or inability to concentrate, so using opioids is incompatible with many jobs. Thus, opioid prescription for the treatment of acute or chronic pain should not be initiated without first assessing the patient?s clinical condition, potential side effects, alternative analgesic options, work status, and their capacity to perform safety-critical activities.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4066;29;"Choosing Wisely Australia";" Australasian Faculty of Occupational and Environmental Medicine";English;"Do not certify a patient as totally unfit for work unless the work absence is clinically necessary and the patient is unfit for suitable alternative or restricted duties. ";"While some medical conditions necessitate time off work, for example, a person recovering from surgery or experiencing debilitating pain, with many medical conditions there is a substantial discretionary element to work absence. So some patients may be able to participate in work if employers make appropriate accommodations. There is substantial evidence to support a positive link between work and (physical, mental and social) health, as well as evidence that absence from work contributes to declining health, slower recovery times, and longer duration of disability. The certification of work absences due to medically discretionary injuries and illnesses should therefore be discouraged. When asked to provide an opinion on functional abilities to employers or insurers, medical practitioners? focus should be on abilities; restrictions should be objective, specific, and listed only when medically indicated.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4067;29;"Choosing Wisely Australia";" Australasian Faculty of Occupational and Environmental Medicine";English;"Do not repeat chest X-rays when screening asbestos-exposed workers unless clinically indicated.";"Asbestosis usually takes years to decades to develop after the initial exposure and chest X-rays cannot immediately indicate whether or not asbestos fibres have been inhaled. Given the long latency period, screening and early detection of asbestosis by chest X-ray is unlikely to confer any health advantage or psychological benefit on asbestos-exposed individuals. Moreover, there is now evidence that low-dose multi-detector CT (MDCT) rather than chest X-ray is justified for initial examination because it is more sensitive. Therefore, while it may be appropriate to obtain a baseline chest X-ray at the time of first assessment, for screening purposes the radiation risk outweighs the benefit of frequent chest X-rays. Radiation exposure is also a concern for repeated CT scans. Further screening may be justified only if exposure to asbestos has continued and, in this case, the frequency and extent of exposure should determine the requirement for repeat screening. In addition, low-dose CT may be appropriate in individual cases, if there is considered to be an increased risk of lung cancer.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3812;19;"Choosing Wisely Canada";"Canadian Critical Care Society.Canadian Association of Critical Care Nurses.Canadian Society of Resp";English;"Don?t start or continue life supporting interventions unless they are consistent with the patient?s values and realistic goals of care. ";"Patients and their families often value the avoidance of invasive or overly aggressive life-sustaining measures when they are at the end of life. However, many dying patients receive aggressive life-sustaining therapies, in part due to clinicians? failures to elicit patients? preferences and to provide recommendations.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3813;19;"Choosing Wisely Canada";"Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp";English;"Don?t prolong mechanical ventilation by over-use of sedatives and bed rest.";"Maintaining critically ill patients in an immobile or minimally mobile state during care may potentiate muscle loss and deconditioning. Excessive and/or prolonged use of sedatives is associated with worse outcomes, including increased delirium, excessive use of diagnostic imaging for coma, increased number of tracheostomies, greater duration of mechanical ventilation and ICU length-of-stay.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4069;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence does not support the routine use of inhaled corticosteroids (ICS) as anti-inflammatory agents in children and adults with cystic fibrosis (CF).";"NICE summary of Cochrane review conclusions Evidence does not support the routine use of inhaled corticosteroids (ICS) as anti-inflammatory agents in children and adults with cystic fibrosis (CF). There is no evidence of objective improvements in lung function or subjective improvements in exercise tolerance or quality of life. ICS should only be used for the symptomatic relief of recurrent wheezing that is not responsive to bronchodilators alone. Outside of this indication they are likely to result in more harm than benefits. The ?Implications for practice? section of the Cochrane review stated: ?This review has found little evidence from existing trials to support the practice of routinely prescribing inhaled steroids in CF. Specifically, we cannot conclude that inhaled steroids are beneficial but there is some evidence that at a high dose, they adversely effect growth. There is also some evidence that withdrawal of ICS in the majority of those already being treated with them is safe. We recommend that the use of ICS should be restricted to those with symptomatic wheezing and in whom benefit has been proven. Individuals should be regularly reassessed to see whether ICS are having an effect and consideration should always be given to reducing the dose or stopping the drugs altogether";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3814;19;"Choosing Wisely Canada";"Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp";English;"Don?t continue mechanical ventilation without a daily assessment for the patient?s ability to breathe spontaneously.";"Screening for readiness for liberation from mechanical ventilation with spontaneous breathing trials allows clinicians earlier recognition of patients that may be liberated from mechanical ventilation.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4070;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Evidence does not support the use of ursodeoxycholic acid (UDCA) for the prevention of cystic fibrosis (CF)-related liver disease.";"NICE summary of Cochrane review conclusions Evidence does not support the use of ursodeoxycholic acid (UDCA) for the prevention of cystic fibrosis (CF)-related liver disease. Many of the studies performed to date failed to include important outcomes (for example, number of liver transplants), and showed no significant improvement in the normalisation of any single hepatocellular enzyme, increase in weight or improvement in biliary excretion with the use of UDCA. Therefore at present UDCA cannot be recommended. The ?Implications for practice? section of the Cochrane review stated: ?Evidence of the effectiveness of UDCA is as yet inconclusive. Routine use of UDCA in people with CF cannot, therefore, be recommended. However, in view of these important preliminary results and because of the lack of any other effective intervention to prevent or treat CF-related liver disease, it is essential that a large multicentre RCT of UDCA in people with CF is undertaken.? ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3815;19;"Choosing Wisely Canada";"Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp";English;"Don?t order routine chest radiographs for critically ill patients, except to answer a specific clinical question.";"Chest radiographs (?X-rays?, CXRs) are not indicated for routine assessment of critically-ill patients except when indicated for specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, pulmonary artery catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in a patient?s clinical condition, and if the information will likely impact a specific decision related to diagnosis or treatment.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 4071;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of antibiotics in acute laryngitis has not been shown objectively to have any significant clinical benefit that can justify this use in clinical practice.";"NICE summary of review conclusions The use of antibiotics in acute laryngitis has not been shown objectively to have any significant clinical benefit that can justify this use in clinical practice. Despite an overall paucity of evidence, treating acute laryngitis with conservative measures in the first instance is appropriate because antibiotics are associated with side effects and an increased incidence of antimicrobial resistance, which is costly and harmful to the population as a whole. Not using antibiotics for acute laryngitis is likely to lead to productivity savings and reduce the risk of antimicrobial resistance without compromising the clinical care of individual patients. The Implications for practice section of the Cochrane review stated: Definitive recommendations cannot be made since evidence is only available from three randomised controlled trials (RCTs). Antibiotics appear to have no benefit in the treatment of acute laryngitis. Erythromycin may reduce voice disturbance at one week and cough at two weeks, measured subjectively, and fusafungine may improve the rates of cured patients at day five (it is unclear how this was measured), however we consider that these outcomes are not relevant in clinical practice. In addition, acute laryngitis requires laryngoscopic findings for a clear diagnosis as hoarseness by itself is not the sole criterion for the assessment of a disease. Overall, there is no clear benefit for the primary outcome, which is objective assessment of voice quality, but some improvements are seen in subjective measures (i.e. cough, hoarseness of voice) that could be important to patients. However, we consider that these modest benefits from antibiotics may not outweigh their cost, adverse effects or negative consequences for antibiotic resistance patterns. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3816;19;"Choosing Wisely Canada";"Canadian Critical Care Society Canadian Association of Critical Care Nurses Canadian Society of Resp";English;"Don?t routinely transfuse red blood cells in hemodynamically stable ICU patients with a hemoglobin concentration greater than 70 g/l (a threshold of 80 g/L may be considered for patients undergoing cardiac or orthopedic surgery and those with active cardiovascular disease).";"Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, including stroke and infections, may also be reduced.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4072;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer.";"NICE summary of review conclusions The evidence from the systematic review of clinical trials suggests that high dose rate intracavity brachytherapy is comparable with low dose rate brachytherapy in improving tumour control and survival rates for women with cervical carcinoma. The incidence of small bowel complications was slightly higher with high dose rate intracavity brachytherapy but the disadvantage of this complication may be outweighed by the advantages of high dose rate brachytherapy, which include outpatient treatment, patient convenience, accuracy of treatment, individualised treatment and complete radiation protection for personnel. Replacing the use of low dose rate intracavity brachytherapy with high dose rate treatment in patients with cervical cancer will improve patient care by reducing use of a less convenient and frequently uncomfortable therapy and replacing it with an equally efficacious and more acceptable alternative for the patient. The Implications for practice section of the Cochrane review stated: Due to some potential advantages of high dose rate intracavity brachytherapy, such as rigid immobilisation, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualised treatment with source optimisation and complete radiation protection for personnel, high dose rate intracavity brachytherapy should be considered a standard treatment strategy for patients with cervical cancer instead of low dose rate intracavity brachytherapy, especially in developing countries. This review included the current available evidence and showed that high dose rate intracavity brachytherapy was comparable with low dose rate intracavity brachytherapy. In the subgroup analysis there was no significant difference between high dose rate and low dose rate when considering overall survival, disease specific survival, relapse-free survival, local control rate, recurrence and metastasis and treatment related to complications for patients with clinical stages I, II and III. Therefore, we recommend the use of high dose rate intracavity brachytherapy for all clinical stages of uterine cervix cancer.";2017;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5864;35;"Evidencias COVID-19";" Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;"There is uncertainty when comparing the effectiveness of computer?based stress management interventions with in?person stress management interventions in employees";"Chronic exposure to stress has been linked to several negative physiological and psychological health outcomes. Among employees, stress and its associated effects can also result in productivity losses and higher healthcare costs. In?person (face?to?face) and computer?based (web? and mobile?based) stress management interventions have been shown to be effective in reducing stress in employees compared to no intervention. However, it is unclear if one form of intervention delivery is more effective than the other. It is conceivable that computer?based interventions are more accessible, convenient, and cost?effective.";2017;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3817;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don't send the frail resident of a nursing home to the hospital, unless their urgent comfort and medical needs cannot be met in their care home.";"Transfers to hospital for assessment and treatment of a change in condition have become customary. However, they are often of uncertain benefit, and may result in increased morbidity. In one Canadian study, 47% of hospitalizations were considered avoidable, while a recent US study found 39% to be ?potentially avoidable?. Transfer often results in long periods in an unfamiliar and stressful environment for the patient. Other hazards include delirium, hospital acquired infections, medication side effects, lack of sleep, and rapid loss of muscle strength while bedridden. Harms often outweigh benefits. Residents assessed and treated at their care home will receive more individualized care, better comfort and end of life care. If a transfer is unavoidable, give clear prior instructions to the hospital of the patient?s needs. Respect for patient choice is a fundamental consideration in all decisions to transfer to a hospital. A clear understanding of the patient?s goals must be established taking into account current health status, values and preferences. This will reduce the likelihood of inappropriate transfer. These goals should be discussed earlier and often with the patient and family, including whether comfort, function and quality of life are their most important goals.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4073;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Bariatric surgery for non-alcoholic steatohepatitis in obese patients.";"NICE summary of Cochrane review conclusions. Bariatric surgery for non-alcoholic steatohepatitis in obese patients is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project. Reducing or stopping bariatric surgery for non-alcoholic steatohepatitis in obese patients is likely to improve quality of patient care and result in productivity savings by avoiding unnecessary operations. The ?Implications for practice? section of the Cochrane review stated: ?The lack of randomised clinical trials to demonstrate the beneficial or harmful effects of bariatric surgery procedures for treatment of non-alcoholic steatohepatitis (NASH) could not enable us to reach any scientifically sustained conclusion. Despite positive results observed in cohort studies, due to their high risk of bias and the potential risk for worsening in fibrosis scores, bariatric surgery needs to be assessed in randomised clinical trials.? ";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3818;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don?t use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.";"People with dementia can sometimes be disruptive, behaving aggressively and resisting personal care. There is often a reason for the behaviour (pain, for example) and identifying and addressing the causes can make drug treatment unnecessary. When drug treatment is chosen, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including premature death. These medications should be limited to cases where non-drug measures have already been tried and failed and the patients are a threat to themselves or others. When an antipsychotic has been prescribed, frequent review and attempts at reduction or discontinuation must be done to reduce harm.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4074;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children.";"Evidence shows that biofeedback for treating functional faecal incontinence is not effective in children and should not be used. NICE has previously recommended against the use of biofeedback to treat functional constipation; but biofeedback also demonstrates no efficacy in non-retentive functional incontinence. It is appropriate to focus resources on interventions for which there is evidence of efficacy, including other behavioural interventions and laxative use.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3819;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don?t do a urine dip or urine culture unless there are clear signs and symptoms of a urinary tract infection (UTI).";"Unless there are UTI symptoms such as urinary discomfort, abdominal/back pain, frequency, urgency or fever, testing should not be done. Testing often shows bacteria in the urine, with as many as 50% of those tested showing bacteria present in the absence of localizing symptoms to the genitourinary tract. Over-testing and treating asymptomatic bacteriuria with antibiotics leads to increased risk of diarrhea and infection with Clostridium difficile. Overuse of antibiotics contributes to increasing antibiotic-resistant organisms.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4075;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Calcium antagonists for aneurysmal subarachnoid haemorrhage.";"NICE summary of review conclusions Limited evidence suggests that oral nimodipine demonstrates increased benefits by reducing the risks of poor outcome and secondary ischaemia, with only modest risks. Evidence shows that the harms of intravenous calcium antagonists for aneurysmal subarachnoid haemorrhage may outweigh the benefits. The intravenous administration of calcium antagonists should not be offered for routine use, given the limited evidence to support its use, higher costs and potentially higher risk of hypotensive effects. Consider replacing intravenous calcium antagonists with oral nimodipine for routine use in the management of aneurysmal subarachnoid haemorrhages, which may lead to improved patient outcomes and patient safety through reduced adverse events. The ?Implications for practice? section of the Cochrane review stated: ?Based on our conclusions, we recommend oral nimodipine (60 mg every 4 hours, to be continued for 3 weeks) as standard treatment in patients with aneurysmal subarachnoid haemorrhage. Although the evidence about the beneficial effect of nimodipine is not beyond all doubt, and is mainly based on one large study where aneurysms were treated with surgical clipping, we recommend oral nimodipine given the potential benefits and modest risks associated with it. Intravenous administration of calcium antagonists is more expensive and potentially hazardous in view of hypotensive effects, and is therefore not recommended.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3820;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don?t insert a feeding tube in individuals with advanced dementia. Instead, assist the resident to eat.";"Inserting a feeding tube does not prolong or improve quality of life in patients with advanced dementia. If the resident has been declining in health with recurrent and progressive illnesses, they may be nearing the end of their life and will not benefit from feeding tube placement. Feeding tubes are often placed because of fears that patients may aspirate food or become malnourished. Studies show that tube feeding does not make the patient more comfortable or reduce suffering. Tube feeding may cause fluid overload, diarrhea, abdominal pain and discomfort/injury (from the tube itself). A tube can actually increase the risk of aspiration and aspiration pneumonia. Helping people eat, rather than tube feeding, is a better way to feed patients who have advanced dementia and feeding difficulties.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4076;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Mechanical bowel preparation for elective colorectal surgery";"NICE summary of Cochrane review conclusions Evidence shows that mechanical bowel preparation is not effective for improving outcomes in patients undergoing elective colorectal surgery and should not be used routinely. It should be reserved for procedures in which intraoperative colonoscopy might be performed or close visualisation of the bowel mucosa is needed. Stopping or reducing the routine use of mechanical bowel preparation in patients undergoing elective colorectal surgery is likely to lead to improved quality of patient care, improved patient experience and productivity savings. Mechanical bowel preparation should still be used at the surgeon?s discretion during procedures to identify pathology or when intraoperative colonoscopy might be performed. The ?Implications for practice? section of the Cochrane review stated: ?Prophylactic mechanical bowel preparation prior to colonic surgery has not been proven to be valuable for patients. This review suggested that in cases of well-defined location and size of the lesion, the surgeon and his patient are free to choose. Bowel cleansing should be considered when a surgeon needs to identify pathology - for example, a small tumour - or when an intra-operative colonoscopy might be performed.?";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3821;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don?t continue or add long-term medications unless there is an appropriate indication and a reasonable expectation of benefit in the individual patient.";"Long-term medications should be discontinued if they are no longer needed (e.g., heartburn drugs, antihypertensives) as they can reduce the resident?s quality of life while having little value for a frail elder with limited life expectancy (e.g., statins, osteoporosis drugs). Prescribing medications to meet lab test ?targets? that apply to adults living in the community (e.g., blood sugar, blood pressure) may instead have dangerous effects on mobility, function, mortality and quality of life when applied to a frail elder in care.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3822;19;"Choosing Wisely Canada";"Long Term Care Medical Directors Association of Canada";English;"Don?t order screening or routine chronic disease testing just because a blood draw is being done.";"Unless you are sure treatment can be given that would add to quality of life, don?t do these tests. ?Routine? testing may lead to harmful over-treatment in frail residents nearing the end of their life and lead to misusing healthcare resources that would do more good used wisely.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3823;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Diseases Canada";English;"Don?t collect urine specimens for culture from adults who lack symptoms localizing to the urinary tract or fever unless they are pregnant or undergoing genitourinary instrumentation where mucosal bleeding is expected.";"Urine cultures are the most frequently ordered microbiologic test, with the majority of specimens submitted from asymptomatic patients. Urine cultures should only be ordered if patients have symptoms localizing to the urinary tract such as acute dysuria, urgency, frequency, suprapubic or flank pain or fever without an obvious alternate source. Outside of these specific symptoms, positive cultures indicate asymptomatic bacteriuria and frequently result in antimicrobial therapy that is of no benefit and is potentially harmful. Cloudy or malodorous urine are not specific findings of urinary tract infection and should not prompt culture unless acute urinary tract symptoms are present. Delirium is not considered a symptom of cystitis in non-catheterized patients. In catheterized patients with fever or delirium, a positive urine culture may still represent asymptomatic bacteriuria unless alternate sources have been excluded. Laboratories should consider supplementing educational efforts to reduce collection of urine cultures from asymptomatic patients with analytical interventions that reduce processing of low-value specimens.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3824;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Diseases Canada";English;"Don?t routinely collect or process specimens for Clostridium difficile testing when stool is non-liquid (i.e., does not take the shape of the specimen container) or when the patient has had a prior nucleic acid amplification test result within the past 7 days.";"Only liquid stool specimens should be collected or processed for C. difficile detection, as a positive test in the absence of diarrhea likely represents C. difficile colonization. Diagnostic gains are minimal with repeat C. difficile nucleic acid amplification testing within 7 days of a negative test. Repeat C. difficile toxin testing by enzyme immunoassay within 7 days of a prior negative test is also of little incremental diagnostic yield but may be warranted in select cases. Test of cure in patients with recent C. difficile infection is also not recommended. Prior investigations have shown that the use of hospital information systems to restrict ordering of repeat tests for these reasons resulted in a 91% reduction in repeat testing.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3825;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Diseases Canada";English;"Don?t obtain swabs from superficial ulcers for culture as they are prone to both false positive and false negative results with respect to the cause of the infection.";"All wounds are colonized with microorganisms. Cultures should not be obtained from wounds that are not clinically infected (i.e., absence of classical signs of inflammation or purulence or increasing pain). For wounds that are clinically infected, the ideal specimens for culture are deep specimens that are obtained through biopsy or deep curettage following cleansing/debridement of the wound. Laboratories should consider use of screening criteria to reject such swabs without proceeding to culture. For superficial swab specimens that are processed/cultured, interpretation of the results should be correlated with the Gram stain.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5617;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";Spanish;"It is recommended to follow multimodal strategies (combinations) to improve compliance with hand hygiene and reduce infection rates";"Multimodal strategies (combinations) that include some but not all of the WHO recommended strategies may slightly improve compliance with hand hygiene and slightly reduce infection rates. It is urgently needed methodologically consistent research to explore the effectiveness of multimodal versus simpler interventions in increasing hand hygiene compliance. Information on hygiene practices can improve compliance with hand hygiene (low certainty of the evidence) and is likely to slightly reduce infection and colonization rates (moderate certainty of the evidence). Education can improve compliance with hand hygiene (low certainty of the evidence). Signs, such as signs or fragrances, may slightly improve hand hygiene compliance (low certainty of evidence). Placing ABHR close to the point of use probably slightly improves compliance with hand hygiene (moderate certainty of the evidence).";2017;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3826;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Diseases Canada";English;"Don?t routinely order nucleic acid amplification testing on cerebrospinal fluid (e.g., herpes simplex virus, varicella zoster virus, enteroviruses) in patients without a compatible clinical syndrome.";"Although nucleic acid amplification testing is the modality of choice for determining the viral etiology of meningitis/encephalitis, it should not be requested routinely on all cerebrospinal fluid specimens. The routine use of these tests in patients without compatible clinical syndromes can result in unnecessary empiric antiviral treatment, additional care, and prolonged length of hospitalization for patients awaiting testing results. Additionally, routine testing may result in depletion of cerebrospinal fluid needed for other diagnostic purposes. In cases where nucleic acid testing is requested for adults, laboratories should have policies for when testing will be performed if the cerebrospinal fluid cell count and protein are normal.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3827;19;"Choosing Wisely Canada";"Association of Medical Microbiology and Infectious Diseases Canada";English;"Don?t routinely obtain swabs during surgical procedures when fluid and/or tissue samples can be collected. ";"Fluids and tissue specimens can usually be obtained in the controlled setting of the operating room and represent higher quality specimens than swabs. Culture of swab specimens is associated with increased false negative results, as they are inferior in recovering anaerobic bacteria, mycobacteria and fungi, and provide inadequate volumes to perform all necessary diagnostic tests. To encourage collection of fluid and/or tissue samples, consideration should be given to making swabs unavailable in the operating room without specific request.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3828;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t insert an indwelling urinary catheter or leave it in place without daily assessment.";"The use of indwelling urinary catheters among hospital patients is common. Yet it can also lead to preventable harms such as urinary tract infection, sepsis and delirium. Guidelines support routine assessment of appropriate urinary catheter indications?including acute urinary obstruction, critical illness and end-of-life care?and minimizing their duration of use. Strategies consistent with CAUTI (catheter-associated urinary tract infection) guidelines regarding inappropriate urinary catheter use have been shown to reduce health care-associated infections.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3829;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don't advise routine self-monitoring of blood glucose between appointments for clients with diabetes who do not require insulin.";"Certain groups recommend self-monitoring of blood glucose (SMBG) to help clients with diabetes monitor glycemic control. Yet many studies show that, over time, routine SMBG does little to control blood sugar for most non-insulin-using adults with type 2 diabetes. It should be noted that SMBG would be indicated during illness or medication change, and this should be part of client assessment and education.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3830;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t add extra layers of bedding (sheets, pads) beneath patients on therapeutic surfaces.";"Additional layers of bedding can limit the pressure-dispersing capacities of therapeutic surfaces (such as therapeutic mattresses or cushions). As a result, extra sheets and pads can contribute to skin breakdown and impede the healing of existing pressure wounds.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3831;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t use oxygen therapy to treat non-hypoxic dyspnea.";"Oxygen is frequently used to relieve shortness of breath. However, supplemental oxygen does not benefit patients who are short of breath but not hypoxic. Supplemental flow of air is as effective as oxygen for non-hypoxic dyspnea.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3832;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t routinely use incontinence containment products (including briefs or pads) for older adults.";"Adult incontinence containment products are frequently used for continent patients (especially women) with low mobility. Yet the literature associates their use with multiple adverse outcomes including diminished self-esteem and perceived quality of life, and higher incidence rates of dermatitis, pressure wounds and urinary tract infections. Among older adults, nurses should conduct a thorough assessment to determine the risk of such outcomes before initiating or continuing the use of incontinence containment products. The development of a continence care plan should be a shared decision-making process that includes the known wishes of clients regarding care needs and the perspectives of carers and the health care team.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3833;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t recommend tube feeding for clients with advanced dementia without ensuring a shared decision-making process that includes the known wishes of clients regarding future care needs and the perspectives of carers and the health care team.";"Tube feeding for older adults with advanced dementia offers no benefit over careful feeding assistance related to the outcomes of aspiration pneumonia and the extension of life. While food is the preferred form of obtaining nutrition, oral supplements may be beneficial if this intervention meets the person?s known goals of care. Tube feeding may contribute to client discomfort and result in agitation, the use of physical and/or chemical restraint and worsening pressure wounds.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3834;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don't recommend antipsychotic medicines as the first choice to treat symptoms of dementia.";"People with dementia frequently exhibit responsive behaviors, which are often misinterpreted as aggression, resistance to care and challenging or disruptive behaviours. In such instances antipsychotic medicines are regularly prescribed. The benefit of these drugs is limited, however, and they can also cause serious harm including premature death. Their use should be limited to cases where non-pharmacologic measures have failed and where patients pose an imminent threat to themselves or others. Identifying and addressing the causes of behaviour change can render drug treatment unnecessary. If a nurse caring for a patient feels that medication is not the appropriate intervention, the nurse has a responsibility to discuss these concerns with the prescriber.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3835;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t recommend antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.";"Signs and symptoms suggestive of urinary tract infection (UTI) are increased frequency, urgency, pain or burning on urination, supra-pubic pain, flank pain and fever. Dark, cloudy and/or foul-smelling urine may not be suggestive of UTI but rather of inadequate fluid intake. Cohort studies have found no adverse outcomes associated with asymptomatic bacteriuria for older adults. Not only does antimicrobial treatment for such bacteriuria in older adults show no benefits, it increases adverse antimicrobial effects. Consensus criteria have been developed for the specific clinical symptoms that (when associated with bacteriuria) define UTI. Exceptions to these criteria include recommended screening for and treatment of asymptomatic bacteriuria before urologic procedures where mucosal bleeding is anticipated. If a nurse caring for a patient feels that medication is not the appropriate intervention, the nurse has a responsibility to discuss these concerns with the prescribers.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3836;19;"Choosing Wisely Canada";"Canadian Nurses Association";English;"Don?t routinely recommend antidepressants as a first-line treatment for mild depressive symptoms in adults.";"Antidepressant response rates are higher for moderate or severe adult depression. For mild depressive symptoms a complete assessment, ongoing support and monitoring, psychosocial interventions and lifestyle modifications should be the first lines of treatment. This approach can avoid the side-effects of medication and establish etiological factors important to future assessment and management. Antidepressants are appropriate in cases of persistent mild depression where a past history of more severe depression exists or where other interventions have failed. If a nurse caring for a patient feels that medication is not the appropriate intervention, the nurse has a responsibility to discuss these concerns with the prescriber.";2017;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3328;29;"Choosing Wisely Australia";"The Society of Hospital Pharmacists of Australia";English;"Don?t recommend the regular use of oral non-steroidal anti-inflammatory medicines (NSAIDs) in older people";"Non-steroidal anti-inflammatory medicines (NSAIDs) are frequently used in the short term to treat moderate acute pain. They are not usually required after the cause of the acute pain has been addressed. Treatment should be re-assessed if the acute pain is ongoing and not resolved within 2 weeks. Oral NSAIDs have considerable cardiovascular, gastrointestinal and kidney function risks. They should not be recommended without consideration of the patient?s additional diseases or conditions; in particular older people and people with kidney disease, a history of peptic ulcer disease, hypertension or heart failure. Older people should use the lowest possible dose of an oral NSAID, for the shortest duration possible and multiple NSAIDs should not be taken at the same time. The effectiveness of long-term oral NSAID treatment should be routinely assessed against the individual patient?s management plan. If possible the total dose should be reduced or ceased.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 3584;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Primary care practitioners should not make the initial diagnosis or start drug treatment in children or young people with suspected ADHD.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3840;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology-Head & Neck Surgery";English;"Don?t use oral antibiotics as a first line treatment for patients with painless ear drainage associated with a tympanic membrane perforation or tympanostomy tube unless there is evidence of developing cellulitis in the external ear canal skin and pinna.";"First line therapy constitutes a short course of topical antibiotic/steroid drops. The potential ototoxicity of any topical medication entering the middle ear space should be considered in selecting an appropriate agent. Where available, fluoroquinolone combination preparations (e.g., ciprofloxacin and dexamethasone) should be used as a first choice and caution should be exercised in using topical aminoglycosides. Microdebridement and further assessment should be considered in the following circumstances: (a) failure to respond after a 7 day course, or (b) where follow up does not permit a clear view of a normal tympanic membrane allowing the exclusion of more sinister middle ear disease such as cholesteatoma.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4096;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cirug�a Oral y Maxilofacial";Spanish;"Do not perform routine antibiotic prophylaxis in minor oral surgery, including dental extractions, without signs of previous infection.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 6400;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Computed tomography (CT) is not recommended for the evaluation of suspected appendicitis in children and young adults until ultrasonography has been considered as an option.";"Although computed tomography (CT) is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is a good diagnostic tool that will reduce radiation exposure. Ultrasound is the preferred initial consideration for imaging examination in children and young adults. If the results of the ultrasound exam are equivocal, it may be followed by CT.";2016;;;"Low value";-;"?Link to the recommendation on the website of the initiative" 3329;29;"Choosing Wisely Australia";"The Society of Hospital Pharmacists of Australia";English;"Don't recommend the use of medicines with sub-therapeutic doses of codeine (<30mg for adults) for mild to moderate pain";"Products containing low dose (<12mg) codeine per tablet combined with another analgesic medicine are available without a prescription and are commonly recommended for the treatment of mild to moderate pain. Codeine is converted to morphine in the body to work. The extent of this metabolism depends on each individual?s pharmacogenetics, which are not readily known and highly variable between individuals. There is evidence that doses of codeine less than 30 mg every 6 hours, are no more effective than paracetamol or an NSAID alone. Therefore, combination products that contain low dose codeine should not be recommended for mild to moderate pain. If used their effectiveness should be assessed within 48 hours. If symptoms persist the product should be ceased and the patient referred for further assessment. Codeine can lead to constipation, nausea, vomiting, bloating and abdominal pain. Any of these symptoms can impact on quality of life.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3585;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Universal screening for ADHD should not be undertaken in nursery, primary and secondary schools.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3841;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology-Head & Neck Surgery";English;"Don?t perform particle repositioning maneuvers (Epley or Semont) without a clinical diagnosis of posterior semicircular canal benign paroxysmal positional vertigo in the affected ear.";"Posterior semicircular canal benign paroxysmal positional vertigo should be diagnosed and confirmed with a positive Dix-Hallpike test, and only then should a particle repositioning maneuver be performed. If a patient with positional vertigo has a Dix-Hallpike test that is repeatedly negative or results in atypical nystagmus, less common BPPV variants or central positional vertigo should be considered.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4097;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola deTraumatolog�a y Cirug�a Ortop�dica";Spanish;"Do not delay more than 48 hours the surgery of hip fracture in old people in the absence of formal medical contraindication.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3330;29;"Choosing Wisely Australia";"Haematology Society of Australia and New Zealand";English;"Do not conduct thrombophilia testing in adult patients under the age of 50 years unless the first episode of venous thromboembolism (VTE): occurs in the absence of a major transient risk factors (surgery, trauma, immobility), or occurs in the absence of o";"Thrombophilia testing is costly and can result in harm to patients if the duration of anticoagulation is inappropriately prolonged or if patients are incorrectly labelled as thrombophilic. Thrombophilia testing does not change the management of venous thromboembolism (VTE) occurring in the setting of major transient VTE risk factors.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3586;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Top-up transfusion is not generally suitable as a long-term regime for sickle cell disease because it is iron positive.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3842;19;"Choosing Wisely Canada";"Canadian Paediatric Society";English;"Don?t routinely use acid blockers or motility agents for the treatment of gastroesophageal reflux in infants.";"Medications that decrease acidity in the stomach do not improve infants? crying or spitting up. These symptoms are common and usually improve on their own, as the child grows up. Studies show that infants who take medications that block stomach acid secretion have more respiratory and gastrointestinal infections. Motility agents do not improve symptoms of reflux in infants but they can have side effects on the heart and nervous system, as well as dangerous interactions with other medications. For example, domperidone can increase the QTc interval on the EKG, particularly when used with other medications that affect liver metabolism, and metaclopromide can cause tardive dyskinesia. Infants with gastroeosophageal reflux and poor growth, who have recurrent respiratory problems or who bleed from their gastrointestinal tract, need further evaluation and may need medication. However, most infants will not need them.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4098;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola deTraumatolog�a y Cirug�a Ortop�dica";Spanish;"Do not extend antibiotic prophylaxis more than 24 hours after an uncomplicated surgical procedure.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3331;29;"Choosing Wisely Australia";"Haematology Society of Australia and New Zealand";English;"Limit surveillance computed tomography (CT) scans in asymptomatic patients with confirmed complete remission following curative intent treatment for aggressive lymphoma ? except for patients on a clinical trial";"CT surveillance in asymptomatic patients in remission from aggressive lymphoma may be harmful through a small but cumulative risk of radiation-induced malignancy. It is also costly and has not been demonstrated to improve survival. Therefore the anticipated benefits of post-treatment CT scans should be weighed against the potential harm of radiation exposure. Due to a decreasing probability of relapse with the passage of time and a lack of proven benefit, CT scans in asymptomatic patients more than 2 years beyond the completion of treatment are rarely advisable.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3587;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"During intensified phototherapy: do not interrupt phototherapy for feeding but continue administering intravenous/ enteral feeds. continue lactation/feeding support so that breastfeeding can start again when treatment stops. Maternal expressed milk is the";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3843;19;"Choosing Wisely Canada";"Canadian Paediatric Society";English;"Don?t perform screening panels (IgE tests) for food allergies without previous consideration of the pertinent medical history.";"Allergy tests for food may be falsely positive when they are performed in children who don?t have a history suggesting a serious (IgE mediated) allergy to that food. These results can lead to avoidance of foods to which a true allergy has not been validly documented. When symptoms suggest a food allergy, a careful history should be completed before ordering specific tests, and these should be selected based on the history. A history that suggests serious allergy to a food may include: (1) combinations of the skin, ocular, respiratory, gastrointestinal and cardiovascular symptoms of anaphylaxis that occur within minutes to hours of eating the specific food, or (2) moderate to severe atopic dermatitis. Testing should be selected based on the history and should not include large screening panels.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4099;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola deTraumatolog�a y Cirug�a Ortop�dica";Spanish;"Do not indicate an articular prosthesis in the first episode of acute knee or hip pain, although there are osteoarthritic radiographic signs.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5635;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (COVID-19): asistencia en remoto mediante la telesalud";Spanish;"It is encouraged to use Automated Telephone Communication Systems interventions to change patients' health behavior, improve clinical outcomes, and increase health care, with positive effects in several important areas, including vaccination, screening, Attendance at medical appointments and adherence to drugs or tests. ";"The decision to integrate SCTA interventions into routine healthcare should reflect variations in the certainty of available evidence and the size of the effects on different diseases, along with the diverse nature of the SCTA interventions evaluated. Future research should investigate both the content of SCTA interventions and the modality thereof; user experiences, particularly regarding acceptability; and clarify which types of SCTA are most effective and profitable.";2016;;;"High value";"Management of the patient";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3332;29;"Choosing Wisely Australia";"Haematology Society of Australia and New Zealand";English;"Do not extend anticoagulation beyond 3 months for a patient with a non-extensive, index venous thromboembolic event (VTE), which occurred in the setting of a major, transient risk factor";"Anticoagulation is potentially harmful and costly. Patients with a first venous thromboembolism (VTE) triggered by a major, transient risk factor are at low risk for recurrence once the risk factor has resolved and an adequate treatment regimen with anticoagulation has been completed. Evidence-based and consensus guidelines recommend three months of anticoagulation over shorter or longer periods of anticoagulation in patients with VTE in the setting of a reversible provoking factor.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3588;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"During phototherapy: using clinical judgement, encourage short breaks (of up to 30 minutes) for breastfeeding, nappy changing and cuddles. Continue lactation/feeding support. Do not give additional fluids to babies who are breastfed. Maternal expressed mi";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3844;19;"Choosing Wisely Canada";"Canadian Paediatric Society";English;"Don?t administer psychostimulant medications to preschool children with Attention Deficit Disorder (ADD), but offer parent-administered behavioural therapy.";"The treatment of preschool-aged children with ADD should involve evidence-based behavioural therapy first, as it is more effective than psychostimulants in this age group. Preschool-aged children are more sensitive to all psychostimulant side effects, including those associated with growth velocity. Behavioural therapy requires more time and resources, but the benefits are more sustained with minimal adverse events.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4100;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola deTraumatolog�a y Cirug�a Ortop�dica";Spanish;"Do not prescribe opioids in acute disabling low back pain before evaluating and considering other alternatives.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3333;29;"Choosing Wisely Australia";"Haematology Society of Australia and New Zealand";English;"Do not perform baseline or routine surveillance CT scans or bone marrow biopsy in patients with asymptomatic early stage chronic lymphocytic leukaemia (CLL)";"In patients with asymptomatic, early-stage chronic lymphocytic leukaemia (CLL) , baseline and routine surveillance computed tomography (CT) scans do not improve survival and are not necessary to stage or prognosticate patients. CT scans expose patients to small doses of radiation, and can detect incidental findings that are not clinically relevant but lead to further investigations and are costly. For asymptomatic patients with early-stage CLL, clinical staging and blood monitoring is recommended over CT scans.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3589;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"In babies who are clinically well, have a gestational age of 38 weeks or more and are more than 24 hours old, and who have a bilirubin level that is below the phototherapy threshold by more than 50 micromol/litre (see the threshold table in CG38 and the t";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3845;19;"Choosing Wisely Canada";"Canadian Paediatric Society";English;"Don?t routinely do a throat swab when children present with a sore throat if they have a cough, rhinitis, or hoarseness as they almost certainly have viral pharyngitis.";"When children with a sore throat present symptoms strongly suggestive of viral illness, such as a runny nose (rhinorrhea), cough or a hoarse voice, a throat swab is unlikely to change management, as these children seldom have ?Strep Throat? as the cause of their sore throat.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4101;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola deTraumatolog�a y Cirug�a Ortop�dica";Spanish;"Do not do a chest X-ray in the preoperative study in a healthy young patient.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3334;29;"Choosing Wisely Australia";"Haematology Society of Australia and New Zealand";English;"Do not treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a platelet count <30,000/L without risk factors for bleeding";"Treatment for immune thrombocytopenic purpura (ITP) should be aimed at treating and preventing bleeding episodes and improving quality of life. Unnecessary treatment exposes patients to potentially serious treatment side effects and can be costly, with little expectation of clinical benefit. Unless they are preparing for surgery or invasive procedure, or have significant additional risk factor for bleeding , ITP treatment is rarely indicated in adult patients with platelet counts greater than 30,000/L. In patients preparing for surgery or other invasive procedures, short-term treatment may be indicated to increase the platelet count prior to the planned intervention and during the immediate post-operative period.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3590;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use ECT routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3846;19;"Choosing Wisely Canada";"Canadian Paediatric Society";English;"Don?t recommend the use of cough and cold remedies in children under six years of age.";"Cough and cold remedies sold over the counter often contain combinations of several medications. Research shows that they are not effective when given to children. They can, however, cause serious harmful effects, including accidental overdose, particularly when combined with other medications. For these reasons, since 2008, Health Canada has advised against their use in children less than six years of age.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4102;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�";Spanish;"Do not use intensive therapeutic measures to achieve a reduction of HbA1 <7.5% in elderly patients with multimorbidity, frail, dependent and with a life expectancy of <10 years.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3335;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Ophthalmologists";English;"In the absence of relevant history, symptoms and signs, ?routine? automated visual fields and optical coherence tomography are not indicated";"When a patient?s visual symptoms can be explained by simple refractive error and a comprehensive eye examination including slit lamp, extraocular movements, intraocular pressures, fundoscopy and confrontation visual fields is normal, there is no need for further tests. There are occasional exceptions ? eg if the patient is specifically being reviewed in relation to an inherited retinal or optic nerve disorder, or as screening or baseline for drug-related toxity. When testing for driving eligibility, the confrontation method is acceptable to screen for visual field defects. Automated perimetry is only required when significant field defects are suspected. As in almost all branches of medicine, history and examination precede investigations and not the other way around.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3591;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The following strategies should not be used routinely: augmentation of an antidepressant with a benzodiazepine for more than 2 weeks as there is a risk of dependence, augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valpr";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4103;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�";Spanish;"Do not prescribe drugs without considering the previous treatment, assess interactions and the degree of adherence to compliance.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3336;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Ophthalmologists";English;"AREDS-based vitamin supplements only have a proven benefit for patients with certain subtypes of age-related macular degeneration. There is no evidence to prescribe these supplements for other retinal conditions, or for patients with no retinal disease";"The AREDS studies were randomised controlled trials which demonstrated benefit for specific combinations of supplements for certain subtypes of age-related macular degeneration (AMD). They did not show benefit for patients without AMD, and have not been tested for retinal conditions other than AMD. There is no high-level evidence to support the use of dietary supplements for the prevention or treatment of other retinal conditions, assuming a normal diet and the absence of specific vitamin or other nutrient deficiency. Despite this, there is widespread promotion and use of dietary supplements perceived to have benefits for other retinal diseases.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3592;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely vary the treatment strategies for depression described in this guideline either by depression subtype (for example, atypical depression or seasonal depression) or by personal characteristics (for example, sex or ethnicity) as there is no ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4104;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�";Spanish;"Do not make clinical decisions in people older than 75 years without having evaluated their functional situation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3337;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Ophthalmologists";English;"Don't prescribe tamsulosin or other alpha-1 adrenergic blockers without first asking the patient about a history of cataract or impending cataract surgery";"Alpha-1 adrenergic blockers such as tamsulosin nearly always affect the structural integrity of the iris and this can be permanent after only a few doses of the drug. As a result, ?intraoperative floppy-iris syndrome? often results when intraocular surgery, especially cataract surgery, is performed. This can lead to iris damage and post-operative glare problems but also increase the risk of more serious complications such as posterior capsule rupture, vitreous loss, macular oedema and retinal detachment. This risk is up to ten times greater in some series. Surgeons can minimise the risk if they know a patient has taken the drug. Patients on long waiting lists can sometimes forget to tell the ophthalmologist they have been prescribed it whilst waiting for surgery. Better still, if the need for taking tamsulosin is not absolute and immediate, delaying its prescription until after any impending cataract surgery is performed would be in the patient?s best interest.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3593;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk?benefit ratio is poor, but consider them for people with: a past history of moderate or severe depression or initial presentation";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4105;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�";Spanish;"Do not indicate nasogastric tube placement or percutaneous gastrostomy in patients with advanced stage dementia.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 3338;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Ophthalmologists";English;"Intravitreal injections may be safely performed on an outpatient basis. Don't perform routine intravitreal injections in a hospital or day surgery setting unless there is a valid clinical indication";"Studies show that giving intravitreal injections, most commonly anti-VEGF agents for ?wet? macular degeneration, can be safely done in an outpatient setting if standard, well published protocols are followed. These protocols include the use of standard aseptic technique, topical antiseptic in the conjunctival sac, and a face mask. Performing these injections in a hospital or day surgery adds enormous cost to the procedure for no clinical benefit. This cost, initially borne by private health funds, clearly puts pressure on the sustainability of the private health system and contributes to the need to increase health insurance premiums and to reduce benefits for other procedures.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3594;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely offer resting echocardiography before surgery.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4106;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�";Spanish;"Do not indicate the study of dementia genetic risk factors (such as APOE Genotype) for the purpose of genetic counseling in an asymptomatic patient.";-;2016;;;"Low value";-;"Sociedad Espa�ola Sociedad Espa�ola de Geriatr�a y Gerontolog�a. Sociedad Espa�ola de Medicina Geri�trica" 3339;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Ophthalmologists";English;"In general there is no indication to perform prophylactic retinal laser or cryotherapy to asymptomatic conditions such as lattice degeneration (with or without atrophic holes), for which there is no proven benefit";"Lattice degeneration and related asymptomatic retinal conditions are frequently found in eyes with retinal detachment. Intuitively one would expect that prophylactic treatment of such visible areas of abnormality would reduce the risk of retinal detachment, and such treatments used to be commonplace. The available evidence has however failed to demonstrate any convincing benefit, and there are also significant potential side effects to such treatment. One reason for the absence of demonstrated benefit is the frequent occurrence of retinal breaks outside areas of visible abnormality. With occasional exceptions, there is no justification for such treatment in asymptomatic eyes, and it has been a recommendation of the American Academy of Ophthalmology for many years that such treatment is not indicated. Counselling and follow-up of at-risk patients is likely more effective, and far more cost-effective, in preventing loss of vision due to retinal detachment.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3595;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely offer chest X-rays before surgery.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4107;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Nuclear e Imagen Molecular";Spanish;"Do not perform PET-FDG as a population screening technique for prostate cancer.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3340;29;"Choosing Wisely Australia";"The Endocrine Society of Australia";English;"Don?t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland";"Thyroid ultrasound is used to identify and characterize thyroid nodules, and is not part of the routine evaluation of abnormal thyroid function tests (over- or underactive thyroid function) unless the patient also has a palpably large goitre or a nodular thyroid. Incidentally discovered thyroid nodules on ultrasound are common. Overzealous use of ultrasound will frequently identify nodules, which are unrelated to the abnormal thyroid function, and may divert the clinical evaluation to assess the nodules, rather than the thyroid dysfunction, may lead to further unnecessary investigation, unwarranted patient anxiety and increased costs. Imaging may be needed in thyrotoxic patients; when needed, a radionuclide thyroid scan, not an ultrasound, is used to assess the aetiology of the thyrotoxicosis and the possibility of focal autonomy in a thyroid nodule or nodules.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3596;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely offer urine dipstick tests before surgery.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3852;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t treat asymptomatic urinary tract infections in catheterized patients.";"Urinary tract infections (UTIs) in catheterized patients are considered ?complicated UTIs?. However, this term can be misleading and prompt clinicians to over treat infections in this population. It is generally recommended that persons with spinal cord injury (SCI) be treated for bacteriuria only if they have symptoms. Specifically, the 2006 Consortium for Spinal Cord Medicine Guidelines for Healthcare Providers require that the following three criteria be met before an individual with SCI is diagnosed with a UTI: (1) significant bacteriuria, (2) pyuria, and (3) signs and symptoms of a UTI.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4108;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Nuclear e Imagen Molecular";Spanish;"Do not substitute the isotopic sentinel lymph node technique for other non-isotopic techniques until the latter reach the same level of diagnostic security and scientific evidence that isotopes currently have.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3341;29;"Choosing Wisely Australia";"The Endocrine Society of Australia";English;"Don?t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency";"Many of the symptoms attributed to male hypogonadism are commonly seen in normal male aging or in the presence of comorbid conditions. Testosterone therapy has the potential for serious side effects and represents a significant expense. It is therefore important to confirm the clinical suspicion of hypogonadism with biochemical testing. Current guidelines recommend the use of a total testosterone level obtained in the morning. A low level should be confirmed on a different day, again measuring the total testosterone. In some situations, for example conditions in which sex hormone-binding globulin concentrations are altered, a calculated free or bioavailable testosterone may be of additional value.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3597;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely offer HbA1c testing before surgery to people without diagnosed diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3853;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t regularly prescribe bed rest and inactivity following injury and/or illness unless there is scientific evidence that harm will result from activity.";"Bed rest is often used to treat a variety of medical conditions. Prolonged bed rest causes major cardiovascular, respiratory, musculoskeletal and neuropsychological changes. Negative effects include thromboembolism, pneumonia, muscle wasting and physical deconditioning. Many of the negative effects begin within days of confinement, but consequences can last much longer. Specifically, in acute DVT/PE, bed rest has no impact on the risk of developing new PE. Furthermore, in acute low back pain, advice to stay active compared to rest in bed showed benefits in pain relief and functional improvement. Therefore, it is important to limit bed rest as much as possible.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4109;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Nuclear e Imagen Molecular";Spanish;"Do not perform myocardial perfusion scintigraphy (GPS) for the diagnosis of ischemic heart disease in asymptomatic patients with low risk of disease, in patients with low pre-test probability with interpretable ECG and capacity to do exercise, and in preoperative assessments of patients for low risk surgeries.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3342;29;"Choosing Wisely Australia";"The Endocrine Society of Australia";English;"Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity";"Measurement of insulin either in the fasting state or during an oral glucose tolerance test is not a clinically useful method (and may be costly because of the insulin assay) to estimate insulin sensitivity. The hyperinsulinemic-euglycemic (HIEG) clamp is the gold standard for assessing insulin sensitivity as it is possible to assess tissue specific sensitivity and can be used in all types of populations. This feature is important because a method of standardisation must be developed to control for various factors prior to any methods for measurement.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3598;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely offer testing for sickle cell disease or sickle cell trait before surgery.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3854;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t order prescription drugs for pain without considering functional improvement.";"Prescription pain medications have been shown to be effective for pain relief. However, a number of adverse events have been established. While pain reduction is an important outcome measure for patients, they also highly value improved function and quality of life. The addition of prescription pain medications does not always improve functional outcomes, or even pain. There is also a significant risk of long-term addiction. It is imperative that providers work with patients to establish treatment goals, regularly reassess pain and function, and taper or discontinue medications as able or if patients experience harm.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4110;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Nuclear e Imagen Molecular";Spanish;"Do not perform parathyroid scintigraphy with SPECT-CT for the location of parathyroid adenomas in patients without a biochemical diagnosis of hyperparathyroidism and in patients who are not candidates for surgery.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3343;29;"Choosing Wisely Australia";"The Endocrine Society of Australia";English;"Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia";"Once target control is achieved in adults with stable type 2 diabetes and the results of self-glucose monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming. There are many exceptions, such as for acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3599;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The following are not recommended within their marketing authorisations for treating the first recurrence of platinum-sensitive ovarian cancer: ?gemcitabine in combination with carboplatin ?trabectedin in combination with PLDH ?topotecan. The appraisal co";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3855;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t order CT scans for low back pain unless red flags are present. ";"Low back pain is one of the leading causes of disability, with a lifetime prevalence of 40%. Routine imaging for low back pain in the absence of red flag symptoms does not change clinical outcomes including pain, function, quality of life and mental health. Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. In comparing early versus late imaging for non-specific low back pain, there is no difference between groups in terms of overall treatment plan. Imaging can result in ?labeling? of patients, exposure to radiation, and unnecessary invasive procedures.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4111;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Nuclear e Imagen Molecular";Spanish;"Do not perform breast or melanoma oncological surgery, which meet criteria for sentinel lymph node using radioactive tracers, if the medical-surgical team does not have sufficient experience in the management of it.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3344;29;"Choosing Wisely Australia";"The Endocrine Society of Australia";English;"Don?t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients";"T4 (thyroxine) is converted into T3 at the cellular level in virtually all organs. Intracellular T3 levels regulate pituitary secretion and blood levels of thyroid-stimulating hormone (TSH), as well as the effects of thyroid hormone in multiple organs; a normal TSH indicates an adequate T4 dose. Conversion of T4 to T3 at the cellular level may not be reflected in the T3 level in the blood. Compared to patients with intact thyroid glands, patients with hypothyroidism taking T4 may have higher blood T4 and lower blood T3 levels. Thus the blood level of total or free T3 may be misleading (low normal or slightly low); in most patients a normal TSH indicates a correct dose of T4.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3600;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Topotecan is not recommended within its marketing authorisation for treating recurrent platinum-resistant or platinum-refractory ovarian cancer.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3856;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t use benzodiazepines for the treatment of agitation in the acute phase of traumatic brain injury after initial stabilization. ";"After initial stabilization and when intracranial pressure is controlled, the use of benzodiazepines in the acute phase of traumatic brain injury should be limited to specific medical indications, such as alcohol withdrawal. In animal models of acute TBI, benzodiazepines have been associated with slowed or halted recovery. Moreover, benzodiazepines have adverse effects on cognition, and can cause respiratory depression, paradoxical agitation, and anterograde amnesia. Non-pharmacologic interventions are essential components of the management of agitation after TBI. Beta blockers, such as propranolol, are first line pharmacotherapeutic agents, and anticonvulsants can also be used to decrease agitated behaviours.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4112;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Psiquiatr�a";Spanish;"Do not use the measurement of plasma serotonin levels with a diagnostic criterion of depressive disorder.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3345;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Don?t request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain";"Trials have consistently shown that there is no advantage from routine imaging of non-specific low back pain and there are some potential harms. Imaging is instead recommended for cases of low back pain where there is a suspicion of an underlying medically serious disease, like cancer or infection. In people who present to primary care with low back pain, medically serious disease is uncommon. Patients with a higher likelihood of medically serious disease as the cause of their low back pain can be identified by red flags, like a history of cancer. A recent Australian study revealed that most people experiencing acute low back pain expect imaging, believing it will identify the cause of their pain and so is considered a prerequisite for effective care. These views conflict with the available evidence on imaging.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3601;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The evidence does not support the routine use of ultrasound scanning after 24 weeks of gestation and therefore it should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3857;19;"Choosing Wisely Canada";"Canadian Association of Physical Medicine and Rehabilitation";English;"Don?t recommend carpal tunnel release without electrodiagnostic studies to confirm the diagnosis and severity of nerve entrapment.";"Carpal tunnel release is a highly effective treatment for Carpal Tunnel Syndrome. Clinicians considering referral for surgical management should be aware that good surgical outcome is best correlated with a combination of positive clinical and positive electrodiagnostic studies (EDX). Clinical tests together with EDX have a better association with surgical outcome than either alone. Pre-op nerve conduction study severity can also better predict time to resolution and degree of resolution of symptoms.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4113;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Psiquiatr�a";Spanish;"Do not prescribe antipsychotics for the treatment of Generalized Anxiety Disorder in Primary Care.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3346;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Don?t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule";"Cervical spine imaging of every trauma patient is costly and results in significant radiation exposure to a large number of patients, very few of whom will have a spinal column injury. The Canadian C-Spine rule identifies patients who can safely be managed without imaging with high sensitivity.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3602;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The evidence does not support the routine use of antenatal electronic fetal heart rate monitoring (cardiotocography) for fetal assessment in women with an uncomplicated pregnancy and therefore it should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4114;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Psiquiatr�a";Spanish;"Do not prescribe antihistamines for the treatment of panic disorder.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3347;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Don?t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the Rules)";"Most clinically significant acute ankle injuries can be diagnosed with history, examination, and selective use of plain radiography. The Ottawa Ankle Rules dictate selective use of plain radiography in patients with acute ankle injury is useful in identifying patients who have sustained clinically important fracture, dislocation, and osteochondral injuries. However, acute ligamentous injuries involving the anterior talofibular ligament can be diagnosed clinically and treated symptomatically. When there are persistent symptoms, which raise suspicion of either instability or other internal derangement such as osteochondral injury, MRI can be used if the non-urgent weight bearing x-rays show no abnormality.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3603;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine formal fetal-movement counting should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4115;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Psiquiatr�a";Spanish;"Do not administer long half-life benzodiazepines for the treatment of chronic insomnia, in people older than 65 years.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3348;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Don't routinely use incentive spirometry after upper abdominal and cardiac surgery";"Postoperative pulmonary complications occur in ~40% of patients undergoing open coronary artery surgery and upper abdominal surgery. A Cochrane review of 592 open coronary artery surgery patients found no significant benefit on pulmonary complication risk of incentive spirometry over no treatment for atelectasis, pneumonia, or length of hospital stay. Another Cochrane review of 1834 upper abdominal surgery patients found no significant benefit on pulmonary complication risk of incentive spirometry over: no treatment, deep breathing exercises, or other physiotherapy. Further research into incentive spirometry could be conducted, particularly in some subgroups such as high-risk patients. However, these Cochrane reviews identify a substantial pool of existing evidence that has not demonstrated any benefits of incentive spirometry. Other interventions, such as preoperative inspiratory muscle training do improve postoperative outcomes in these patients, when added to established standard care such as early mobilisation. Therefore, until evidence of a benefit from incentive spirometry becomes available, it is recommended that it not be routinely used in these surgical populations.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3604;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Fetal presentation should be assessed by abdominal palpation at 36 weeks or later, when presentation is likely to influence the plans for the birth. Routine assessment of presentation by abdominal palpation should not be offered before 36 weeks because it";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4116;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Psiquiatr�a";Spanish;"Do not recommend using a loading dose of antipsychotics (rapid neuroleptization technique) in children's psychosis and schizophrenia ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3349;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Avoid using electrotherapy modalities in the management of patients with low back pain";"Although used in clinical practice for many years, current evidence-based clinical practice guidelines do not endorse electrotherapy modalities (such as ultrasound, laser, interferential) in the management of low back pain, due to lack of evidence of effects on clinically relevant outcomes. Instead, patients with (sub)acute low back pain should be reassured of a favourable prognosis, advised to stay active, and be referred for prescribed analgesia if necessary. For chronic low back pain, helpful interventions include short-term use of medication/manipulation/acupuncture, supervised exercise therapy, cognitive behavioural therapy and multidisciplinary treatment.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3605;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine Doppler ultrasound should not be used in low-risk pregnancies.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3350;29;"Choosing Wisely Australia";"The Australian Physiotherapy Association";English;"Don?t provide ongoing manual therapy for patients with adhesive capsulitis of the shoulder";"Adhesive capsulitis (also termed frozen shoulder) is a condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder and disability that restricts activities of daily living, work and leisure. Most studies indicate that it is a self-limiting condition lasting up to two to three years, although 40% people may experience clinically detectable restriction of movement and disability beyond this time point without significant pain. Well-designed randomised trials have not demonstrated any worthwhile clinical benefits from ongoing physiotherapy beyond the benefits of a simple home exercise program.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3606;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine screening for preterm labour should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3351;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists";English;"Do not assume that bilateral redness and swelling of both lower legs is due to infection. Do not prescribe antibiotics unless there is clinical evidence of sepsis or microbiological confirmation of infection";"Bilateral lower leg cellulitis is very rare. Most commonly the bilateral inflammation is due to underlying skin disease such as venous eczema, dry skin, irritant or allergic contact dermatitis, or lymphoedema. A careful history and physical examination should be undertaken and swabs taken from both legs for microbiology to confirm whether infection is present.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3607;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Although there is a great deal of material published on alternative screening methods for pre-eclampsia, none of these has satisfactory sensitivity and specificity, and therefore they are not recommended";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3863;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ramucirumab, in combination with docetaxel, is not recommended within its marketing authorisation for treating locally advanced or metastatic non-small-cell lung cancer in adults whose disease has progressed after platinum-based chemotherapy. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3352;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists";English;"Do not routinely prescribe antibiotics for inflamed epidermal cysts of the skin evaluated in the first 3-4 days of appearance unless infection is confirmed microbiologically";"The initial inflammation with epidermal cysts is secondary to an intense foreign body reaction to the cyst contents leaking into dermis and subcutaneous tissues and will respond to incision and drainage plus/minus intralesional corticosteroids that will reduce the inflammatory response. Bacterial infection is a secondary complication.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3608;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine antenatal serological screening for toxoplasmosis should not be offered because the risks of screening may outweigh the potential benefits.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3864;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Necitumumab, in combination with gemcitabine and cisplatin, is not recommended within its marketing authorisation for adults with locally advanced or metastatic epidermal growth factor receptor (EGFR)-expressing squamous non-small-cell lung cancer that has not been treated with chemotherapy.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3353;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists";English;"Do not investigate episodes of acute urticaria of less than 6 weeks duration unless the clinical history or examination reveals a likely infective, inflammatory or neoplastic trigger or swelling and skin changes persist longer than 24 hrs";"The causes of acute urticaria are many and are rarely identified by blood investigations. The individual weals of acute urticaria and angioedema can be widespread and variable in appearance, resolving in 24 hours leaving normal skin.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3609;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Pregnant women should not be offered routine antenatal screening for group B streptococcus because evidence of its clinical and cost effectiveness remains uncertain.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3865;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cobimetinib in combination with vemurafenib is not recommended within its marketing authorisation for treating unresectable or metastatic melanoma in adults with a BRAF V600 mutation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3354;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists";English;"Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless microbiological confirmation of a dermatophyte infection has been obtained";"50% thickened distorted toenails are caused by pressure from footwear (onychogryphosis) or other trauma, disorders such as psoriasis, lichen planus, or congenital pachyonychia, and are not due to fungal nail infection.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3610;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The available evidence does not support routine cytomegalovirus screening in pregnant women and it should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3866;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women with polycystic ovary syndrome who are being treated with gonadotrophins should not be offered treatment with gonadotrophin-releasing hormone agonist concomitantly because it does not improve pregnancy rates, and it is associated with an increased risk of ovarian hyperstimulation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5658;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"It is not recommended generalized telemonitoring with information from the healthcare professional between visits to the specialist asthma office.";"Studies have not yet shown that additional telemonitoring strategies lead to better symptom control or a reduced need for oral corticosteroids over routine asthma care, nor have they ruled out the unexpected deleterious effects. The researchers observed small benefits for quality of life, although they are subject to risk of bias, because blinding was not performed in the studies. Similarly, some benefits for lung function are uncertain due to possible attrition bias.";2016;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 3355;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists";English;"Monotherapy for acne with either topical or systemic antibiotics should be avoided. Combine with topical antiseptics such as benzoyl peroxide to reduce antibiotic resistance";"Acne is a very common disorder in adolescence often persisting into the early 20s. Treatment may be necessary over many years. Current evidence suggests that the antibiotics effective in acne exert an anti-inflammatory effect rather than a bactericidal effect.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3611;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Chlamydia screening should not be offered as part of routine antenatal care.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3867;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine use of post-coital testing of cervical mucus in the investigation of fertility problems is not recommended because it has no predictive value on pregnancy rate.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3356;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Don?t perform repair of minimally symptomatic or asymptomatic inguinal hernias without careful consideration, particularly in patients who have significant co-morbidities.";"The proportion of patients presenting with inguinal hernias who are suffering significant co-morbidities is increasing. In these populations and in the presence of multiple of co-morbidities, the importance of carefully assessing the risks and benefits of surgical intervention is vital. Studies have shown that adoption of a watch and wait approach does not heighten the risk of the patient developing more severe symptoms. In cases of minimally symptomatic and asymptomatic inguinal hernias, the patient?s prognosis and long term health may be improved by non-surgical intervention. Ongoing surgical review is required to ensure that an individual's condition is monitored and that a re-evaluation of their surgical need is made should their symptoms increase in severity.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3612;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Pregnant women should not be offered routine screening for bacterial vaginosis because the evidence suggests that the identification and treatment of asymptomatic bacterial vaginosis does not lower the risk of preterm birth and other adverse reproductive ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3868;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence to recommend the use of gamete intrafallopian transfer or zygote intrafallopian transfer in preference to IVF in couples with unexplained fertility problems or male factor fertility problems. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5660;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There are no important differences between face-to-face versus remote asthma check-ups in terms of exacerbations, asthma control, or quality of life.";"There is insufficient information to rule out differences in efficacy, or to establish whether remote asthma screening is a safe option compared to face-to-face consultations.";2016;;;Uncertain;"management of patients";"Link to the recommendation on the website of the initiative" 3357;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Do not use ultrasound for the further investigation of clinically apparent groin hernias. Ultrasound should not be used as a justification for repair of hernias that are not clinically apparent.";"The role of ultrasound in the diagnosis and treatment of groin hernias is limited. When the clinical diagnosis of a groin hernia is uncertain, any sonographic findings should be interpreted in conjunction with clinical judgment and treated conservatively. The diagnostic accuracy of ultrasound is reduced in the absence of any clinically palpable hernia";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3613;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The presence of an isolated soft marker, with the exception of increased nuchal fold, on the routine anomaly scan, should not be used to adjust the a priori risk for Down's syndrome.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3869;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)La detecci�n de anticuerpos anti-esperma";English;"Screening for antisperm antibodies should not be offered because there is no evidence of effective treatment to improve fertility. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3358;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Don?t transfuse more units of blood than absolutely necessary, noting that many hospitals have developed policies on indications for transfusion with a view to minimisation.";"The limited blood resources available within the health system and the lack of evidence to support transfusing more blood than required necessitate the use of appropriate guidelines. Patients should be carefully evaluated (through use of applicable guidelines) when being assessed for blood transfusions and closely monitored.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3614;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The routine anomaly scan (at 18 weeks 0 days to 20 weeks 6 days) should not be routinely used for Down's syndrome screening using soft markers.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3870;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of basal body temperature charts to confirm ovulation does not reliably predict ovulation and is not recommended. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3359;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeons";English;"Do not use endoscopy for investigation in gastric band patients with symptoms of reflux.";"The treatment of reflux in gastric band patients should be carefully considered. Endoscopy should not be used without consideration of alternative strategies. Reflux in gastric band patients is often related to the device. It is best managed by removal of fluid, in consultation with a Bariatric Surgeon or other appropriately qualified person.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3615;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"When routine ultrasound screening is performed to detect neural tube defects, alpha-fetoprotein testing is not required.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3871;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Replacement of embryos into a uterine cavity with an endometrium of less than 5 mm thickness is unlikely to result in a pregnancy and is therefore not recommended. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3360;29;"Choosing Wisely Australia";"Royal Australasian College of Surgeon";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children and young adults until after ultrasound has been considered as an option.";"Although computed tomography (CT) is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is a good diagnostic tool that will reduce radiation exposure. Ultrasound is the preferred initial consideration for imaging examination in children and young adults. If the results of the ultrasound exam are equivocal, it may be followed by CT.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3616;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine screening for cardiac anomalies using nuchal translucency is not recommended.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3872;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Testing for Y chromosome microdeletions should not be regarded as a routine investigation before ICSI. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3361;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative M";English;"Do not delay discussion of and referral to palliative care for a patient with serious illness just because they are pursuing disease-directed treatment";"Palliative care provides an added layer of support to patients with life-limiting disease and their families. Symptomatic patients can benefit regardless of their diagnosis, prognosis or disease treatment regimen. Studies show that integrating palliative care with disease-modifying therapies improves pain and symptom control, as well as patient quality of life and family satisfaction. Early access to palliative care has been shown to reduce aggressive therapies at the end of life, prolong life in certain patient populations, and significantly reduce hospital costs.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3617;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3873;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men with idiopathic semen abnormalities should not be offered antioestrogens, gonadotrophins, androgens, bromocriptine or kinin-enhancing drugs because they have not been shown to be effective.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3362;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative M";English;"Do not delay conversations around prognosis, wishes, values and end of life planning (including advance care planning) in patients with advanced disease";"Advance care planning is a process, which includes choosing a surrogate or alternate decision-maker and communicating values or wishes for medical care. Evidence shows that advance care planning conversations improve patient and family satisfaction with care and concordance between patients? and families? wishes, reduce the likelihood of patients receiving hospital care and the number of days spent in hospital, and increase the likelihood of receiving hospice care.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3618;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Routine breast examination during antenatal care is not recommended for the promotion of postnatal breastfeeding.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3874;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Inform women undergoing IVF treatment that the evidence does not support continuing any form of treatment for luteal phase support beyond 8 weeks' gestation. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3363;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative M";English;"Do not use oxygen therapy to treat non-hypoxic dyspnoea in the absence of anxiety or routinely use oxygen therapy at the end of life";"Oxygen is frequently used to relieve shortness of breath in patients with advanced illness. However, supplemental oxygen does not benefit patients who are breathless but not hypoxic. Supplemental flow of air is equally as effective as oxygen under these circumstances. The use of a fan for facial air streaming can also be effective.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3619;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"The effectiveness and safety of oral treatments for vaginal candidiasis in pregnancy are uncertain and these treatments should not be offered.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3875;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Inform couples that there is insufficient evidence to recommend that HIV negative women use pre-exposure prophylaxis, when all the criteria in recommendation 1.3.10.2 are met ( the criteria is detailed in the description section)";"1.3.10.2 Advise couples where the man is HIV positive that the risk of HIV transmission to the female partner is negligible through unprotected sexual intercourse when all of the following criteria are met: - the man is compliant with highly active antiretroviral therapy (HAART) - the man has had a plasma viral load of less than 50 copies/ml for more than 6 months - there are no other infections present - unprotected intercourse is limited to the time of ovulation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3364;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative M";English;"Do not use percutaneous feeding tubes in patients with advanced dementia; instead use oral assisted feeding";"Strong evidence exists that artificial nutrition does not prolong life or improve quality of life in patients with advanced dementia. Substantial functional decline and recurrent or progressive medical illnesses may indicate that a patient who is not eating is unlikely to obtain any significant or long-term benefit from artificial nutrition. Feeding tubes are often placed after hospitalization, frequently with concerns for aspirations, and for those who are not eating. Contrary to what many people think, tube feeding does not ensure the patient?s comfort or reduce suffering; it may cause fluid overload, diarrhoea, abdominal pain, local complications, less human interaction and may increase the risk of aspiration. Assistance with oral feeding is an evidence-based approach to provide nutrition for patients with advanced dementia and feeding problems.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3620;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Iron supplementation should not be offered routinely to all pregnant women. It does not benefit the mother's or the baby's health and may have unpleasant maternal side effects.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3876;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a lower age limit for cryopreservation for fertility preservation in people diagnosed with cancer.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3365;29;"Choosing Wisely Australia";"Australian and New Zealand Society of Palliative Medicine & the Australasian Chapter of Palliative M";English;"To avoid adverse medication interactions and adverse drug events in cases of polypharmacy, do not prescribe medication without conducting a drug regime review";"Older patients disproportionately use more prescription and non-prescription drugs than other populations. Evidence shows that such polypharmacy increases the risk of adverse drug reactions and hospital admissions. Medication review with follow up is therefore recommended for optimising prescribed medication and improving quality of life in older adults with polypharmacy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3877;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use any of the following tests individually to predict any outcome of fertility treatment: ovarian volume, ovarian blood flow, inhibin B, oestradiol.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3366;20;"Choosing Wisely Netherlands Campaign";"Netherlands Orthopaedic Association";English;"No hip and knee replacements without adequate conservative treatment.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3878;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Advise couples that if all the criteria in recommendation 1.3.10.2 are met (further information in the description section), sperm washing may not further reduce the risk of infection and may reduce the likelihood of pregnancy. ";"1.3.10.2 Advise couples where the man is HIV positive that the risk of HIV transmission to the female partner is negligible through unprotected sexual intercourse when all of the following criteria are met: - the man is compliant with highly active antiretroviral therapy (HAART) - the man has had a plasma viral load of less than 50 copies/ml for more than 6 months - there are no other infections present - unprotected intercourse is limited to the time of ovulation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3367;20;"Choosing Wisely Netherlands Campaign";"Netherlands Orthopaedic Association";English;"No reconstruction of the anterior cruciate ligament in the first few weeks after the injury was sustained.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3879;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who have developed at least 3 follicles before oocyte retrieval should not be offered follicle flushing because this procedure does not increase the numbers of oocytes retrieved or pregnancy rates, and it increases the duration of oocyte retrieval and associated pain. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3368;20;"Choosing Wisely Netherlands Campaign";"Netherlands Orthopaedic Association";English;"No arthroscopy and no MRI in cases of degenerative knees without symptoms of a locked knee joint.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3880;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should be informed that bed rest of more than 20 minutes' duration following embryo transfer does not improve the outcome of IVF treatment. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3369;20;"Choosing Wisely Netherlands Campaign";"Netherlands Orthopaedic Association";English;"Do not operate in cases of discogenic pain.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3881;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use growth hormone or dehydroepiandrosterone (DHEA) as adjuvant treatment in IVF protocols. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3370;20;"Choosing Wisely Netherlands Campaign";"Netherlands Orthopaedic Association";English;"No subacromial decompression on young patients suffering from a painful shoulder.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3882;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Assisted hatching is not recommended because it has not been shown to improve pregnancy rates. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3883;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When using gonadotrophins for ovarian stimulation in IVF treatment: use an individualised starting dose of follicle-stimulating hormone, based on factors that predict success, such as: age, BMI, presence of polycystic ovaries, ovarian reserve; do not use a dosage of follicle-stimulating hormone of more than 450 IU/day.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3884;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women aged under 40 years who have not conceived after 2 years of regular unprotected intercourse or 12 cycles of artificial insemination (where 6 or more are by intrauterine insemination), offer 3 full cycles of IVF, with or without ICSI. If the woman reaches the age of 40 during treatment, complete the current full cycle but do not offer further full cycles. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3885;1;"NICE ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina";English;"Do not offer women natural cycle IVF treatment";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3886;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer oral ovarian stimulation agents (such as clomifene citrate, anastrozole or letrozole) to women with unexplained infertility.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3375;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate foll";"Recommendation grade B";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3887;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women with possible fertility problems are no more likely than the general population to have thyroid disease and the routine measurement of thyroid function should not be offered. Estimation of thyroid function should be confined to women with symptoms of thyroid disease. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6703;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"Antibiotics are not recommended in all patients with a respiratory tract infection";"Recommendation prepared from systematic reviews, clinical practice guidelines and primary studies.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3376;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up.";"Recommendation grade B";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3888;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should not be offered hysteroscopy on its own as part of the initial investigation unless clinically indicated because the effectiveness of surgical treatment of uterine abnormalities on improving pregnancy rates has not been established. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3377;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10% or greater 10-year cardiovascular risk, are not at increased risk for bleeding, h";"Recommendation grade B";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3889;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who are concerned about their fertility should not be offered a blood test to measure prolactin. This test should only be offered to women who have an ovulatory disorder, galactorrhoea or a pituitary tumour. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3890;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should not be offered an endometrial biopsy to evaluate the luteal phase as part of the investigation of fertility problems because there is no evidence that medical treatment of luteal phase defect improves pregnancy rates. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6706;36;"Choosing Wisely UK";"British Society for Antimicrobial Chemotherapy";English;"It is recommended the use of antibiotics in patients with bacteriuria presenting with minimal, nonspecific, or long lasting symptoms.";"Recommendation prepared from systematic reviews, clinical practice guidelines and primary studies";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3379;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend screening adults aged 60 to 74 for CRC with FOBT (either gFOBT or FIT) every two years OR flexible sigmoidoscopy every 10 years.";"These recommendations apply to adults aged ?50 years who are not at high risk for colorectal cancer (CRC). They do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more first degree relatives, or adults with hereditary syndromes predisposing to CRC (e.g. familial adenomatous polyposis, Lynch Syndrome).";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3891;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Use of NSAIDs and/or tranexamic acid should be stopped if it does not improve symptoms within 3 menstrual cycles. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3380;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend screening adults aged 50 to 59 for CRC with FOBT (either gFOBT or FIT) every two years OR flexible sigmoidoscopy every 10 years.";"These recommendations apply to adults aged ?50 years who are not at high risk for colorectal cancer (CRC). They do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more first degree relatives, or adults with hereditary syndromes predisposing to CRC (e.g. familial adenomatous polyposis, Lynch Syndrome).";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3892;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of adjuvant growth hormone treatment with gonadotrophin-releasing hormone agonist and/or human menopausal gonadotrophin during ovulation induction in women with polycystic ovary syndrome who do not respond to clomifene citrate is not recommended because it does not improve pregnancy rates. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6708;36;"Choosing Wisely UK";"British Society for Antimicrobial Chemotherapy";English;"It is recommended stop treatment after four days in patients with controlled abdominal infection after surgery or drainage";"Recommendation prepared from systematic reviews, clinical practice guidelines and primary studies";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3381;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend not screening adults aged 75 years and over for CRC.";"These recommendations apply to adults aged ?50 years who are not at high risk for colorectal cancer (CRC). They do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more first degree relatives, or adults with hereditary syndromes predisposing to CRC (e.g. familial adenomatous polyposis, Lynch Syndrome).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3893;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Saline infusion sonography should not be used as a first-line diagnostic tool. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3382;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend not using colonoscopy as a screening test for CRC.";"These recommendations apply to adults aged ?50 years who are not at high risk for colorectal cancer (CRC). They do not apply to those with previous CRC or polyps, inflammatory bowel disease, signs or symptoms of CRC, history of CRC in one or more first degree relatives, or adults with hereditary syndromes predisposing to CRC (e.g. familial adenomatous polyposis, Lynch Syndrome).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3894;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Removal of healthy ovaries at the time of hysterectomy should not be undertaken. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3383;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults aged 55-74 years with at least a 30 pack-year* smoking history who currently smoke or quit less than 15 years ago, we recommend annual screening with LDCT up to three consecutive times. Screening should ONLY be carried out in health care settin";"These recommendations apply to adults aged 18 years and older who are not suspected of having lung cancer. These recommendations do not apply to individuals who have a history of lung cancer, or suspected lung cancer. The CTFPHC based the recommendations on the overall balance between the possible benefits and harms of screening for lung cancer, weighing the potential benefits of early disease detection against the harms of overdiagnosis and invasive follow up testing.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3895;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Post-operative medical treatment does not improve pregnancy rates in women with moderate to severe endometriosis and is not recommended. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3384;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For all other adults, regardless of age, smoking history or other risk factors, we recommend not screening for lung cancer with LDCT";"These recommendations apply to adults aged 18 years and older who are not suspected of having lung cancer. These recommendations do not apply to individuals who have a history of lung cancer, or suspected lung cancer. The CTFPHC based the recommendations on the overall balance between the possible benefits and harms of screening for lung cancer, weighing the potential benefits of early disease detection against the harms of overdiagnosis and invasive follow up testing.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3896;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral progestogens given during the luteal phase only should not be used for the treatment of HMB. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6712;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"It is recommended to investigate all high-risk patients in preclinical stages";"All high-risk elective patients should be seen and fully screened in pre-screening clinics. screened in pre-evaluation clinics. Preparations should be in place to ensure that the most urgent surgical patients have the same robust workup";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3385;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend that chest x-ray not be used to screen for lung cancer, with or without sputum cytology.";"These recommendations apply to adults aged 18 years and older who are not suspected of having lung cancer. These recommendations do not apply to individuals who have a history of lung cancer, or suspected lung cancer. The CTFPHC based the recommendations on the overall balance between the possible benefits and harms of screening for lung cancer, weighing the potential benefits of early disease detection against the harms of overdiagnosis and invasive follow up testing.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3897;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Only continue GLP-1 mimetic therapy if the person with type 2 diabetes has had a beneficial metabolic response (a reduction of at least 11 mmol/mol [1.0%] in HbA1c and a weight loss of at least 3% of initial body weight in 6 months). ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4153;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for latent tuberculosis infection in populations at increased risk.";"Recommendation grade B";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3386;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend against screening1 for developmental delay using standardized tools in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no concerns about development.";"The recommendation applies only to children aged 1 to 4 years who are not at high risk for developmental delay, have no signs suggestive of a developmental delay and whose parents or clinicians have no concerns about development. Thus, this recommendation applies to children for whom there is no concern about failure to sequentially acquire age-appropriate developmental milestones for gross and fine motor, social/emotional, language, and cognitive domains. Milestone ages should be based on the oldest age by which the skill should have been achieved. The recommendation does not apply to children who present with signs, symptoms, or parental concern that could indicate delayed development; or whose development is being closely monitored because of risk factors, such as premature birth or low birth weight.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3898;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4154;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding.";"Recommendation grade B ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3899;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men with leucocytes in their semen should not be offered antibiotic treatment unless there is an identified infection because there is no evidence that this improves pregnancy rates. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4155;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Statin preventive medication: adults ages 40?75 years with no history of CVD, 1 or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater.";"The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75 years; 2) they have 1 or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75 years.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3900;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Medical treatment of minimal and mild endometriosis diagnosed as the cause of infertility in women does not enhance fertility and should not be offered. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6716;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended to provide training of psychologically informed practice, e.g. Back Skills Training (BeST) intervention, for clinicians treating patients aged 16 and over with sub-acute and chronic low back pain.";"This guide covers the evaluation and treatment of low back pain and sciatica in people older than 16 years. Describes physical, psychological, pharmacological, and surgical treatments to help people manage their low back pain and sciatica in their daily lives. The aim of the guide is to improve people's quality of life by promoting the most effective forms of treatment for low back pain and sciatica.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3389;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Fetal and umbilical doppler ultrasound in normal pregnancy";"NICE summary of review conclusions The review of trials of routine Doppler ultrasound of the baby?s vessels in pregnancy identified five studies involving more than 14,000 women and babies. The studies were not of high quality and were all undertaken in the 1990s. They showed that the use of routine umbilical artery Doppler ultrasound, or a combination of umbilical and uterine artery Doppler ultrasound in lowrisk or unselected populations benefits neither mother nor baby and should not be used. Stopping or reducing the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low-risk or unselected populations is likely to lead to improved quality of patient care and improved patient experience through the reduced use of unproven and unnecessary investigations. This is in line with the recommendation in NICE clinical guideline 62, ?Antenatal care for uncomplicated pregnancies.? More research is needed to clarify whether this will also lead to improvements in patients? safety. The Implications for practice section of the Cochrane review stated: Existing data do not provide robust enough evidence that the use of routine umbilical artery Doppler ultrasound, or combination of umbilical and uterine artery Doppler ultrasound in low risk or unselected populations benefits either mother or baby. Until further research can support new practices, Doppler ultrasound examination should be reserved for use in high-risk pregnancies (Alfirevic et al, 2013).?";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3901;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Measuring menstrual blood loss either directly (alkaline haematin) or indirectly ('Pictorial blood loss assessment chart') is not routinely recommended for HMB. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6717;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"It is recommended to help patients stop smoking, reduce alcohol consumption, increase physical activity and reduce body weight.";"This recommendation was developed from a clinical practice guideline";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3390;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine 72-96 hour replacement of peripheral venous catheters";"NICE summary of review conclusions This Cochrane systematic review concluded that there is insufficient evidence to support the routine replacement of patients? peripheral intravenous catheters every 72 to 96 hours. Clinical teams should inspect catheter insertion sites for signs of infection at each shift change and adopt a policy of replacing catheters only when clinically indicated. Such a policy would lead to significant cost savings and prevent unnecessary discomfort for patients associated with routine catheter replacement. The Implications for practice section of the Cochrane review stated: The review found no difference in catheter-related bloodstream infection or phlebitis rates whether peripheral intravenous catheters are changed routinely every 72 to 96 hours or when clinically indicated. The consistency in these results, which include a very large multi-site study, indicate that healthcare organisations should adopt a clinically-indicated replacement policy. This would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications. Busy clinical staff would also reduce time spent on this intervention. To minimise peripheral catheter-related complications, the insertion site should be inspected at each shift change and the catheter removed if signs of inflammation, infiltration, or blockage are present.?";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3902;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance imaging (MRI) should not be used as a first-line diagnostic tool.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6718;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended to use stratification tools to guide treatment for patients aged 16 an dover with back pain e.g. include STarT Back in Primary Care.";"This guide covers the evaluation and treatment of low back pain and sciatica in people older than 16 years. Describes physical, psychological, pharmacological, and surgical treatments to help people manage their low back pain and sciatica in their daily lives. The aim of the guide is to improve people's quality of life by promoting the most effective forms of treatment for low back pain and sciatica.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3391;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Abdominal drainage versus no drainage post-gastrectomy for gastric cancer";"This Cochrane review concludes that there is no convincing evidence to support the routine use of abdominal drains in patients under-going gastrectomy for gastric cancer. The four trials included in the review recruited a total of 438 patients and were of moderate methodological quality. No statistically significant differences were observed between those with and without abdominal drains with regards to the primary outcomes of mortality and post-operative complications, however this evidence was of a ?very low? and ?low? grade respectively. Two studies reported drain-related complications affecting 5 patients in total. Given the possibility of drain-related complications and the statistically significant difference in the secondary outcomes of operation time and length of postoperative hospital stay, the authors conclude that abdominal drains increase harm without providing any additional benefit in this group of patients.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3903;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lumacaftor?ivacaftor is not recommended, within its marketing authorisation, for treating cystic fibrosis in people 12 years and older who are homozygous for the F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6719;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"It is not recommended to perform routine preoperative examinations on healthy patients undergoing minor surgery";"This guide covers routine preoperative testing for people over the age of 16 who are going to undergo elective surgery. Its goal is to reduce unnecessary testing by advising which tests to offer people before minor, intermediate, and major or complex surgery, taking into account specific comorbidities (cardiovascular, renal, and respiratory conditions and diabetes and obesity). It does not cover pregnant women or people undergoing cardiothoracic procedures or neurosurgery.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3648;6;"Less Is More Collection - JAMA Network";"Handley N.JAMA Intern Med. 2016;176(1):19-20.";English;"Antibiotic Overuse and Paronychia A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3904;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In fluid-filled thermal balloon endometrial ablation (TBEA), endometrial thinning is not needed.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3649;6;"Less Is More Collection - JAMA Network";"Wright A.JAMA Intern Med. 2016;176(1):7-8.";English;"Strategies for Flipping the Script on Opioid Overprescribing";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3905;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In adults with type 2 diabetes, do not offer or continue pioglitazone if they have any of the following: heart failure or history of heart failure hepatic impairment diabetic ketoacidosis current, or a history of, bladder cancer uninvestigated macroscopic haematuria.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3394;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pediatria";Spanish;"Bronchitis in children should not be routinely treated with antibiotics, unless a secondary bacterial infection coexists, or is suspected.";"The most frequent cause of acute bronchitis in children are viruses; therefore, antibiotic treatment is not routinely recommended. Antibiotics should be only used when a secondary bacterial infection is strongly suspected. Unnecessary use of antibiotics may cause avoidable adverse effects, and contribute to the development of antibiotic resistant infections.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3650;32;"Otros art�culos/Other articles on this topic";"Nelson H.JAMA Oncol. 2016;2(2):261-262.";English;"There is a risk of potential risk of overdiagnosis in mammography screening.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3906;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below 45 ml/minute/1.73m2: Stop metformin if the eGFR is below 30 ml/minute/1.73m2. Prescribe metformin with caution for those at risk of a sudden deterioration in kidney function and those at risk of eGFR falling below 45ml/minute/1.73m2.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3651;6;"Less Is More Collection - JAMA Network";"Laracy J.JAMA Intern Med. Published online June 20, 2016.";English;"Don't perform trans rectal prostate biopsy in patients older than 65 years, with a PSA level less than 10, and a life expectancy of less than 10 to 15 years.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3907;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hysterectomy should not be used as a first-line treatment solely for HMB. Hysterectomy should be considered only when:other treatment options have failed, are contraindicated or are declined by the woman, there is a wish for amenorrhoea, the woman (who has been fully informed) requests it, the woman no longer wishes to retain her uterus and fertility.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3396;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Societat Catalana de Medicina Familiar i Comunit�ria-Societat Catalana de Neumologia";Spanish;"The routine treatment with antibiotics in patients with lower airways infections is not recommended when the presence of pneumonia is clinically ruled out and there is no baseline respiratory comorbidity.";"Lower respiratory tract infections account for 20% of the cases of infections cared for in primary care. Despite 90% of these non-complicated lower respiratory tract infections are caused by viral agents, approximately two thirds of the patients in Catalonia are treated with antibiotics. The routine treatment with antibiotics in patients with lower respiratory tract infections is not recommended when the presence of pneumonia is clinically ruled out and there is no baseline respiratory comorbidity.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3652;32;"Otros art�culos/Other articles on this topic";"Burns S.JAMA Intern Med. Published online June 13, 2016.";English;"Carotid duplex ultrasound is not recommended in the evaluation of simple syncope in patients with normal neurological examination.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3908;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If a woman is being treated with gonadotrophin-releasing hormone analogue and UAE is then planned, the gonadotrophin-releasing hormone analogue should be stopped as soon as UAE has been scheduled.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3397;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Societat Catalana de Medicina Familiar i Comunit�ria-Societat Catalana d?Otorinolaringologia";Spanish;"In pharyngitis in adults it is not recommended to prescribe antibiotics except when the result of the rapid strep test is positive.";"Acute pharyngitis is the most prevalent infectious disease in primary care, and its one of the diseases for which more antibiotics are prescribed inappropriately. Apart from some very infrequent causes, the antibiotic treatment is only recommended when the pharyngitis is caused by group A ?-hemolytic streptococcus, which is identified with a positive result in the rapid strep test. The unjustified use of antibiotics is associated with the spread of antimicrobial resistance and the presence of adverse effects.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3653;32;"Otros art�culos/Other articles on this topic";"Lu P.JAMA Intern Med. Published online June 06, 2016.";English;"Educating the Primary Care Clinician on Preexposure Prophylaxis for Human Immunodeficiency Virus A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3909;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For women who are taking clomifene citrate, do not continue treatment for longer than 6 months.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3398;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pneumologia (SOCAP)-Societat Catalana de Medicina Familiar i Comunit�ria (CAMFi";Spanish;"In adult asthma patients, if the disease is not well controlled, long-acting ? adrenoceptor agonists (LABA) should not be prescribed as monotherapy. They should always be associated with inhaled corticosteroids.";"The prevalence of asthma in the adult population is around 5%, and it is a frequent cause of visits to emergency departments and absenteeism. Treatment focuses primarily on reducing inflammation and preventing exacerbations using a stepwise therapeutic strategy to achieve disease control. After the treatment with corticosteroids has been started, long-acting ? adrenoceptor agonists (LABA) blockers, such as salmeterol and formoterol may be used. In adult asthmatic patients LABAs should be used in combination with inhaled corticosteroids when the disease is not adequately controlled with the latter. They should never be prescribed as monotherapy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3654;6;"Less Is More Collection - JAMA Network";"Khan F.JAMA Intern Med. 2016;176(6):739-740.";English;"Don't perform CT of the abdomen and/or pelvis for the screening of occult cancer detection in patients with an unprovoked venous thromboembolism who have no clinically significant medical history of cancer or V/T and have normal basic blood test results.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3910;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Female hormone testing should not be carried out on women with HMB.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3399;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Societat Catalana de Medicina Familiar i Comunit�ria-Societat Catalana d?Otorinolaringologia";Spanish;"Benign paroxysmal positional vertigo should not be routinely treated with vestibular sedatives.";"Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo; it involves a spinning sensation caused by brief changes in the head position. The diagnosis of BPPV of the posterior canal is achieved by the Dix-Hallpike maneuver, while the treatment of choice is the Epley, or repositioning, maneuver. BPPV should not be routinely treated with vestibular sedatives (neuroleptic agents, antihistamines, benzodiazepines, betahistine) because they might hinder the spontaneous compensation of the vertigo, due to the lack of effectiveness in short lived BPPV, and their adverse effects.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3655;6;"Less Is More Collection - JAMA Network";"Wang C.JAMA Intern Med. 2016;176(6):735-736.";English;"The Horrible Taste of Nectar and Honey?Inappropriate Use of Thickened Liquids in Dementia A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3911;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Etamsylate should not be used for the treatment of HMB.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5703;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Senior doctor triage is recommended to reduce waiting times, length of stay and proportion of patients leaving without care or before treatment end in emergency departments";"The COVID-19 pandemic is placing a strain on healthcare workers. Placing a senior doctor at triage in emergency departments, compared with single-nurse triage, can be an effective way to enhance a range of performance measures. In this systematic review, the authors searched for comparative studies on the role of senior doctor triage in emergency departments. They restricted their searches to articles published in English language, and did the search between 1994 and 2014. They included 25 studies, 16 were before and after studies, 2 clinical controlled trials, 3 cohort studies, and 4 randomised controlled trials. 12 studies were conducted in the US, 5 in Australia, 2 in Canada and the UK, and 1 in Hong Kong, Jamaica, Singapore, and Sweden.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3400;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Psiquiatr�a y Salud Mental";Spanish;"In the outpatient treatment for substance addictions, the routine urine testing for evidence of drug abuse is not recommended.";"The main objective of urinalysis is to effectively determine the drug abstinence status, i.e. cocaine, heroin, as declared by the patient and suggested by the clinic. Routine urine testing for likely drugs of abuse is frequent. The indiscriminate screening of drugs of abuse involves a high, unjustified expenditure. Test sampling according to a personalised plan based on the patient's evolution, or testing randomly selected samples are preferred options. The routine urine testing for evidence of drug abuse in patients following outpatient therapy for substance addiction should be avoided.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3656;6;"Less Is More Collection - JAMA Network";"Kepes J.JAMA Intern Med. 2016;176(6):737-738.";English;"Complications of Indwelling Urinary Catheter Care and Care Transitions A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3912;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people in complete remission after first-line treatment with curative intent for diffuse large B-cell lymphoma: - do not offer LDH surveillance for detecting relapse. - do not offer routine surveillance imaging (including chest X-ray, CT and PET-CT) for detecting relapse in people who are asymptomatic.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5704;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty regarding triage by senior doctors in emergency departments, in terms of patient satisfaction or cost-effectiveness";"The COVID-19 pandemic is placing a strain on healthcare workers. Placing a senior doctor at triage in emergency departments, compared with single-nurse triage, can be an effective way to enhance a range of performance measures. In this systematic review, the authors searched for comparative studies on the role of senior doctor triage in emergency departments. They restricted their searches to articles published in English language, and did the search between 1994 and 2014. They included 25 studies, 16 were before and after studies, 2 clinical controlled trials, 3 cohort studies, and 4 randomised controlled trials. 12 studies were conducted in the US, 5 in Australia, 2 in Canada and the UK, and 1 in Hong Kong, Jamaica, Singapore, and Sweden";2016;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3401;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Radi�legs de Catalunya-Societat Catalano-Balerar d'Oncologia";Spanish;"Barium enema should not be used as first choice for diagnosis suspicious cases of colorectal cancer or other colonic pathologies.";"Colorectal cancer is the second cause of incidence and mortality for cancer, both in men and women, in the majority of developed countries. The use of barium enema as a diagnostic test in patients with suspicion of colorectal cancer or of other colonic pathologies shows worse outcomes in identifying polyps as well as established neoplasms in comparison with colonoscopy or colonography computed tomography. When diagnosing colorectal cancer or other colon pathologies the barium enema should not be used as first choice. The diagnostic should be made through colonoscopy or colonography computed tomography, because they show better outcomes with less adverse effects and less ionizing radiations for patients.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3657;6;"Less Is More Collection - JAMA Network";"Schoen M.JAMA Intern Med. 2016;176(6):741-742.";English;"False Bed Alarms A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3913;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use starch based solutions or hydroxyethyl starches for fluid resuscitation for people with sepsis.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3402;26;"Hemoterapia Basada en el Sentido Com�n";"American Association of Blood Banks";English;"Don?t routinely use blood products to reverse warfarin.";"Patients requiring reversal of warfarin can often be reversed with vitamin K alone. Prothromobin complex concentrates or plasma should only be used for patients with serious bleeding or requiring emergency surgery.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3658;6;"Less Is More Collection - JAMA Network";"Jones M.JAMA Intern Med. 2016;176(5):594-595.";English;"Inappropriate Prescription of Proton Pump Inhibitors in the Setting of Steroid Use A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3914;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use routine liver blood tests to assess for advanced liver fibrosis in people with non-alcoholic fatty liver disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3403;26;"Hemoterapia Basada en el Sentido Com�n";"American Society of Hematology";English;"Don?t administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (i.e. outside of the setting of major bleeding, intracranial hemorrhage or anticipated emergent surgery)";"Blood products can cause serious harm to patients, are costly a nd are rarely indicated in the reversal of vitamin K antagonist s. In non-emergent situations, elevations in the international normalized ratio are best addressed by holding the vitamin K antagonist and/or by administering vitamin K.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3659;6;"Less Is More Collection - JAMA Network";"Maiti M.JAMA Intern Med. 2016;176(5):592-593.";English;"Indiscriminate Testing for Heparin-Induced Thrombocytopenia A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3915;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use routine laboratory liver blood tests to rule out cirrhosis. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5451;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The is uncertainty about the potential benefits and harms of putting critically ill adults on to their sides or turning them regularly from side-to-side.";"Some patients with COVID-19 will become critically ill and may be immobilized in bed or need mechanical ventilation (MV). Their body position may affect their heart and lungs, recovery and their chances of survival. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials evaluating the effects of turning patients onto their sides when they have to stay in bed. They did not impose any languages restrictions and did their searches in May 2015. They identified 24 trials. Of these, 15 were limited to patients on MV and the other 9 recruited who were breathing for themselves as well as patients on MV. Because of shortcomings in the existing research, the potential benefits and harms of putting critically ill adults onto their sides or turning them regularly from side-to-side are uncertain for important outcomes (such as pulmonary and cardiovascular morbidity and mortality).";2016;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3404;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Transfusion Medicine";English;"Don?t transfuse plasma to correct a mildly elevated (<1.8) international normalized ratio (INR) or activated partial thromboplastin time (aPTT) before a procedure.";"A mildly elevated INR is not predictive of an increased risk of bleeding. Furthermore, transfusion of plasma has not been demonstrated to significantly change the INR value when the INR was only minimally elevated (<1.8).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3660;32;"Otros art�culos/Other articles on this topic";"Fernandez L.JAMA Intern Med. 2016;176(5):590-591";English;"Unwarranted Cancer Screening A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 3916;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer acid-suppression drugs (proton pump inhibitors or H2-receptor antagonists) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3405;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Transfusion Medicine";English;"Don?t routinely use plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists.";"Patients requiring non-emergent reversal of warfarin can often be treated with vitamin K or by discontinuing the warfarin therapy. Prothrombin complex concentrates should only be used for patients with serious bleeding or for those who need urgent surgery. Plasma should only be used in this setting if prothrombin complex concentrates are not available or are contraindicated.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3661;6;"Less Is More Collection - JAMA Network";"Holroyd K.JAMA Intern Med. 2016;176(4):432-433.";English;"Misanalysis of Urinalysis A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3917;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use recombinant factor Vlla except when all other methods have failed. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5709;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";Spanish;"Case management is advised to reduce emergency service visits in high-risk populations";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to reduce unnecessary Emergency Department (ED) visits might inform policies and actions to ease this. In this systematic review, the authors searched for research into programs designed to reduce ED visits that had been conducted in the USA. They restricted their search to studies published in English between 1 January 2003 and 31 December 2014. They included 13 studies that they rated as moderate to high quality, which had assessed programs focusing on high-risk populations (4 studies) and low-acuity visits (9).";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3406;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Transfusion Medicine";English;"Don?t routinely transfuse platelets for patients with chemotherapyinduced thrombocytopenia if the platelet count is greater than 10 x109/L in the absence of bleeding.";"A platelet count of 10 x 109/L or greater usually provides adequate hemostasis. Platelet transfusions are associated with adverse events and risks. Considerations in the decision to transfuse platelets include the cause of the thrombocytopenia, comorbid conditions, symptoms of bleeding, risk factors for bleeding, and the need to perform an invasive procedure.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3662;32;"Otros art�culos/Other articles on this topic";"Himmel M.JAMA Intern Med. 2016;176(4):431-432.";English;"Hemodialysis in a Healthy Patient?A Case of an Erroneous Laboratory Result A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3918;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5710;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The cost-effectiveness or effectiveness of many programmes aimed at reducing emergency service visits in patients with low severity is unclear";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to reduce unnecessary Emergency Department (ED) visits might inform policies and actions to ease this. In this systematic review, the authors searched for research into programs designed to reduce ED visits that had been conducted in the USA. They restricted their search to studies published in English between 1 January 2003 and 31 December 2014. They included 13 studies that they rated as moderate to high quality, which had assessed programs focusing on high-risk populations (4 studies) and low-acuity visits (9)";2016;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3407;26;"Hemoterapia Basada en el Sentido Com�n";"American Association of Blood Banks";English;"Don?t transfuse more units of blood than absolutely necessary.";"Each unit of blood carries risks. A restrictive threshold (7.0-8.0g/dL) should be used for the vast majority of hospitalized, stable patients without evidence of inadequate tissue oxygenation (evidence supports a threshold of 8.0g/dL in patients with pre-existing cardiovascular disease). Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Additional units should only be prescribed after re-assessment of the patient and their hemoglobin value.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3663;6;"Less Is More Collection - JAMA Network";"Gutierrez R.JAMA Intern Med. 2016;176(3):300-301.";English;"Intensive Glycemic Control in Type 2 Diabetes Mellitus?A Balancing Act of Latent Benefit and Avoidable Harm A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3919;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use adrenaline as monotherapy for the endoscopic treatment of non-variceal upper gastrointestinal bleeding. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5455;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"A semi-recumbent position (30-60 degrees) reduces the risk of clinically suspected ventilator-associated pneumonia in patients on mechanical ventilation, when compared to a supine position (0-10 degrees).";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but this can cause complications, including ventilator-associated pneumonia (VAP). A semi-recumbent position (also known as ?head bed elevation?) may prevent VAP in comparison to a supine position. In this Cochrane systematic review, the authors included randomized trials that compared semi-recumbent versus supine positioning, or alternative degrees of positioning, in patients on MV. They did not restrict by date, type or language of publication and did their searches in October 2015. They identified 10 trials (878 participants). A semi-recumbent position (30-60 degrees) reduces the risk of clinically suspected VAP in patients on MV, when compared to a supine position (0-10 degrees).The comparative effects of the different positions are uncertain for outcomes other than clinically suspected VAP.";2016;;;"High value";"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3408;26;"Hemoterapia Basada en el Sentido Com�n";"American Association of Blood Banks";English;"Don?t transfuse red blood cells for iron deficiency withouthemodynamic instability.";"Blood transfusion has become a routine medical response despite cheaper and safer alternatives in some settings. Pre-operative patients with iron deficiency and patients with chronic iron deficiency without hemodynamic instability (even with low hemoglobin levels) should be given oral and/or intravenous iron.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3664;32;"Otros art�culos/Other articles on this topic";"Lessing J.JAMA Intern Med. 2016;176(2):165-166.";English;"Don't neglect to consider Latent Crystal Formation in the diagnosis of Acute Gout. .";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3920;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use routine liver blood tests to rule out non-alcoholic fatty liver disease. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3409;26;"Hemoterapia Basada en el Sentido Com�n";"American Society of Anesthesiologists";English;"Don?t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ? 6 g/dL unless symptomatic or hemodynamically unstable.";"The hemoglobin transfusion threshold used in multiple studies has varied from 6.0 to 10.0 g/dL. The optimal hemoglobin/hematocrit criterion for transfusion remains controversial in several clinical settings. Nevertheless, compared with higher hemoglobin thresholds, a lower hemoglobin threshold is associated with fewer red blood cell units transfused without adverse associations with mortality, cardiac morbidity, functional recovery or length of hospital stay. Hospital mortality remains lower in patients randomized to a lower hemoglobin threshold for transfusion versus those randomized to a higher hemoglobin threshold. The decision to transfuse should be based on a combination of both clinical and hemodynamic parameters.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3665;6;"Less Is More Collection - JAMA Network";"Oberndorfer T.JAMA Intern Med. 2016;176(1):18-19.";English;"Surgical Intervention in Terminal Illness?Doing Everything A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3921;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer tests to diagnose cirrhosis for people who are obese (BMI of 30 kg/m2 or higher) or who have type 2 diabetes, unless they have Non-alcoholic fatty liver disease (NAFLD) and advanced liver fibrosis (as diagnosed by a score of 10.51 or above using the enhanced liver fibrosis (ELF) test.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3410;26;"Hemoterapia Basada en el Sentido Com�n";"American Society of Hematology";English;"Don?t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range (7 to 8 g/dL in stable, non-cardiac in-patients).";"Transfusion of the smallest effective dose of RBCs is recommended because liberal transfusion strategies do not improve outcomes when compared to restrictive strategies. Unnecessary transfusion generates costs and exposes patients to potential adverse effects without any likelihood of benefit. Clinicians are urged to avoid the routine administration of 2 units of RBCs if 1 unit is sufficient and to use appropriate weight-based dosing of RBCs in children.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3922;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer surveillance for hepatocellular carcinoma (HCC) for people who are receiving end of life care.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3411;26;"Hemoterapia Basada en el Sentido Com�n";"American Society of Hematology";English;"Don?t routinely transfuse patients with sickle cell disease (SCD) for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication.";"Patients with SCD are especially vulnerable to potential harms from unnecessary red blood cell transfusion. In particular, they experience an increased risk of alloimmunization to minor blood group antigens and a high risk of iron overload from repeated transfusions. Patients with the most severe genotypes of SCD with baseline hemoglobin (Hb) values in the 7-10 g/dl range can usually tolerate further temporary reductions in Hb without developing symptoms of anemia. Many patients with SCD receive intravenous fluids to improve hydration when hospitalized for management of pain crisis, which may contribute to a decrease in Hb by 1-2 g/dL. Routine administration of red cells in this setting should be avoided. Moreover, there is no evidence that transfusion reduces pain due to vaso-occlusive crises. For a discussion of when transfusion is indicated in SCD, readers are referred to recent evidence-based guidelines from the National Heart, Lung, and Blood Institute (NHLBI) (see reference below).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3923;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not rely on fever or hypothermia to rule sepsis either in or out. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3412;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Internal Medicine";English;"Don?t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure or stroke.";"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 circulatory overload, and sepsis. Studies of transfusion strategies among multiple patient populations suggest that a restrictive approach is associated with improved outcomes.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3924;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform a lumbar puncture without consultant instruction if any of the contraindications described in the description section are present.";" - Signs suggesting raised intracranial pressure or reduced or fluctuating level of consciousness (Glasgow Coma Scale score less than 9 or a drop of 3 points or more). - Relative bradycardia and hypertension - Focal neurological signs - Abnormal posture or posturing - Unequal, dilated or poorly responsive pupils - Papilloedema - Abnormal 'doll's eye' movements - Shock - Extensive or spreading purpura - After convulsions until stabilized - Coagulation abnormalities or coagulation results outside the normal range or platelet count below 100x109/litre or receiving anticoagulant therapy - Local superficial infection at the lumbar puncture site - Respiratory insufficiency in children.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3413;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Palliative Care";English;"Don?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.";"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 circulatory overload, and sepsis.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3925;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a person's temperature as the sole predictor of sepsis. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5461;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;" It is uncertain whether any of the vasopressors at assessed doses are superior to others for mortality in COVID-19.";"Some patients with COVID-19 will become critically ill and may develop hypotensive shock, but there is uncertainty about the most beneficial way to treat this. Vasopressors have shown evidence of benefit in hypotensive shock, probably because of their ability to raise blood pressure. Their effects for patients with hypotensive shock caused by other factors might indicate their effects in patients with COVID-19. In this Cochrane systematic review, the authors searched for randomized trials comparing different vasopressor regimens on mortality in critically ill patients with hypotensive shock. They did not restrict by date, type or language of publication and did their most recent search in June 2015. They identified 28 studies (3497 participants), covering six different vasopressors. Vasopressor therapy is an important part of haemodynamic support for patients with shock. It is uncertain whether any of the vasopressors at assessed doses are superior to others for mortality.";2016;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3414;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Transfusion Medicine";English;"Don?t transfuse blood if other non-transfusion therapies or observation would be just as effective.";"Blood transfusion should not be given if other safer non-transfusion alternatives are available. For example, patients with iron deficiency without hemodynamic instability should be given iron therapy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3926;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer consolidation with high-dose therapy and autologous or allogeneic stem cell transplantation to people presenting with concurrent diagnoses of follicular lymphoma and diffuse large B-cell lymphoma that have responded to first-line treatment. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3415;26;"Hemoterapia Basada en el Sentido Com�n";"Canadian Society of Transfusion Medicine";English;"Don?t transfuse more than one Red cell unit at a time when transfusion is required in stable, non-bleeding patients.";"Indications for red blood transfusion depend on clinical assessment and the cause of the anemia. In a stable, non-bleeding patient, often a single unit of blood is adequate to relieve patient symptoms or to raise the hemoglobin to an acceptable level. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Additional units should only be prescribed after re-assessment of the patient and their hemoglobin value.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3671;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Catalan Society of Paediatrics -Catalan Society of Urology";Spanish;"Children under three years should not receive a circumcision to treat phimosis.";"Phimosis is physiological until age 3 or 4. It affects 96% of newborns, 50% of infants, 20% of children aged 2 years, and 10% of children under 3 years. Because of the young age, the surgical intervention (circumcision) in children under 3 years is performed under general anesthesia. Children under 3 years should not receive a circumcision, given the high probability of spontaneous resolution of phimosis and the potential adverse effects of surgery.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3927;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer FDG-PET-CT imaging for interim assessment during treatment for diffuse large B-cell lymphoma. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3416;26;"Hemoterapia Basada en el Sentido Com�n";"American Association of Blood Banks";English;"Don?t transfuse O negative blood except to O negative patients and in emergencies for women of child bearing potential with unknown blood group.";"O negative blood units are in chronic short supply due in part to overutilization for patients who are not O negative. O negative red blood cells should be restricted to: (1) O negative patients; or (2) women of childbearing potential with unknown blood group who require emergency transfusion before blood group testing can be performed.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3672;2;"Choosing Wisely�";"American Society of Breast Surgeons";English;"Don?t routinely order breast MRI in new breast cancer patients.";"After a new diagnosis of breast cancer, breast MRI can be useful in selected patients to aid treatment decisions. However, there is a lack of evidence that routine use of MRI lessens cancer recurrence, death from cancer or the need for re-operation after lumpectomy surgery. The routine use of MRI is associated with an increased need for subsequent breast biopsy procedures, delays in time to treatment and higher cost of care. Increased mastectomy rates can occur if the MRI finds additional cancers or indeterminate findings cause patient anxiety, leading to patient requests for mastectomy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3928;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use immunohistochemistry to assess the prognostic value associated with cell of origin in people with diffuse large B-cell lymphoma";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3673;2;"Choosing Wisely�";"American Society of Breast Surgeons";English;"Don?t routinely excise all the lymph nodes beneath the arm in patients having lumpectomy for breast cancer.";"After a new diagnosis of invasive breast cancer, most patients undergoing partial breast removal (lumpectomy) benefit from a sentinel node (SN) biopsy, a procedure that removes a small number of lymph nodes beneath the arm. In the past, patients found to have cancer in any SN underwent extra surgery to remove more nodes. Recent evidence suggests further node surgery is not necessary in patients with cancer found in fewer than three SN if the patient receives other recommended cancer treatments.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3929;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless: the person is on insulin; or there is evidence of hypoglycemic episodes; or the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery; or the person is pregnant, or is planning to become pregnant. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4185;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not diminish quickly or excessively the blood pressure figures in a hypertensive emergency.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3418;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Escitalopram is no more effective than other SSRIs but cause more cardiac disorders, including dose-dependent prolongation of the QT interval and torsades de pointes (Rev Prescrire n� 386).";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3674;2;"Choosing Wisely�";"American Society of Breast Surgeons";English;"Don?t routinely order specialized tumor gene testing in all new breast cancer patients.";"There are multiple new tumor multi-gene signature tests that provide selected patients with information about their risk of distant cancer recurrence, dying of cancer or the likelihood they will benefit from chemotherapy. These tests are helpful in selected patients, including those with early stage hormone receptor positive cancers with low scores on 21 gene recurrence testing, who can safely omit chemotherapy. There is no evidence these tests should be used routinely in every patient. These tests should not be done in patients who indicate the test results would not change their choice of treatment.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3930;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer antiplatelet therapy (aspirin or clopidogrel) for adults with type 2 diabetes without cardiovascular disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4186;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not administer oxygen to adult patients with suspected acute coronary syndrome with normal levels oxygen saturation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3419;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Analysis of the cardiovascular adverse effects of nonsteroidal anti-inflammatory drugs (NSAIDs) revealed that diclofenac causes more cardiovascular adverse effects, including myocardial infarction, heart failure and cardiovascular deaths than other NSAIDs";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3675;2;"Choosing Wisely�";"American Society of Breast Surgeons";English;"Don?t routinely re-operate on patients with invasive cancer if the cancer is close to the edge of the excised lumpectomy tissue.";"Patients undergoing partial breast removal (lumpectomy) of the breast for invasive cancer benefit from re-operation to excise more breast tissue if microscopic review of the lumpectomy breast tissue indicates cancer cells at the tissue edge. However, if cancer cells are close to the edge, but not at the actual edge, then re-operation is not mandatory but can be considered on a case-by-case basis.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3931;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer aspirin for the primary prevention of cardiovascular disease to adults with type 1 diabetes. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4187;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not hyperoxygen after leaving a cardiorespiratory arrest: immediately after cardiopulmonary resuscitation, arterial oxygen saturation must be maintained in the range of 94-98%.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3676;2;"Choosing Wisely�";"American Society of Breast Surgeons";English;"Don?t routinely perform a double mastectomy in patients who have a single breast with cancer.";"After a new diagnosis of breast cancer in a single breast, many patients desire removal of both breasts, believing their cancer risk in the other breast is high and their cancer cure rate will be improved with double mastectomy. Double mastectomy should not be routinely performed in these patients until they have been provided with adequate understandable information about the generally low risk they will develop cancer in the other breast and the minimal effectiveness, if any, of double mastectomy improving their life expectancy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3932;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not generally use phosphate replacement in the management of DKA in adults. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4188;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"It is not necessary to administer large volumes of intravenous fluids until achieving control of the hemorrhage, in situations of acute hypovolemia. Liquids have to be replenished to a limited extent to maintain a systolic blood pressure above 80-90 mmHg.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3677;2;"Choosing Wisely�";"American Dental Association";English;"Don?t recommend non-fluoride toothpaste for infants and children.";"The benefit of fluoride-containing toothpaste arises from its topical effect on dental enamel by interrupting enamel demineralization caused by bacterial acids and enhancing remineralization of the enamel surface. Anti-caries (anti-cavities) benefit begins with eruption of the first primary tooth. Brushing with non-fluoridated toothpaste provides no anti-caries benefit. Use of recommended amounts of fluoride toothpaste minimize risks of fluorosis, a whitish discoloration of enamel.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3933;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not generally use bicarbonate in the management of DKA in adults.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4189;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not prescribe antibiotic therapy in all cases of exacerbation of chronic obstructive pulmonary disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3678;2;"Choosing Wisely�";"American Dental Association";English;"Avoid restorative treatment as a first line of treatment in incipient (non-cavitated) occlusal caries without first considering sealant use.";"High quality evidence shows sealants are safe and effective in arresting caries progression in initial stage (incipient) non-cavitated, occlusal caries. Sealants offer a tooth-preserving treatment when compared to restorations, which may require removal of some healthy tooth structure, thereby weakening the tooth and increasing the risk that the tooth will eventually require more extensive treatment. Applying sealants as soon as initial stage caries is detected can improve outcomes by minimizing the later need for more extensive restorative care.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3934;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not advise routine use of rapid-acting insulin analogues after meals for adults with type 1 diabetes. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4190;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not administer steroids systematically in the treatment of acute traumatic spinal cord injury.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3679;2;"Choosing Wisely�";"American Dental Association";English;"Avoid protective stabilization, sedation or general anesthesia in pediatric patients without consideration of all options with the legal guardian.";"Some children do not respond to communicative behavior guidance techniques and require treatment of dental disease. Advanced behavior guidance techniques of sedation, protective stabilization, and general anesthesia offer risks and benefits often beyond the health knowledge of parents and other caretakers. Informed consent best practice requires a thorough, understandable explanation of these techniques and alternatives including deferral of treatment with its inherent risks.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3935;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adults newly diagnosed with type 1 diabetes non-basal?bolus insulin regimens (that is, twice-daily mixed, basal only or bolus only). ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4191;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not perform gastric lavage routinely in drug intakes that do not meet the indication criteria.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3680;2;"Choosing Wisely�";"American Dental Association";English;"Avoid routinely using irreversible surgical procedures such as braces, occlusal equilibration and restorations as the first treatment of choice in the management of temporomandibular joint disorders.";"There is a lack of evidence that temporomandibular joint disorders (TMD) (defined as musculo-skeletal disorders, not the lesion of traumatic occlusion) are always progressive, and evidence exists that in many instances, patients with TMD have spontaneous remissions without treatment. Therefore, management is generally conservative and includes reversible strategies such as patient education, medications, physical therapy and/or the use of occlusal appliances that do not alter the shape or position of the teeth or the alignment of the jaws.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3936;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Monitoring blood glucose using sites other than the fingertips cannot be recommended as a routine alternative to conventional self-monitoring of blood glucose. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4192;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not perform a test strip in patients with a bladder catheter.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3681;2;"Choosing Wisely�";"American Dental Association";English;"Don?t replace restorations just because they are old.";"Dental restorations (fillings) fail due to excessive wear, fracture of material or tooth, loss of retention, or recurrent decay. The larger the size of the restoration and/or the greater the number of surfaces filled increases the likelihood of failure. Restorative materials have different survival rates and fail for different reasons, but age should not be used as a failure criteria.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3937;1;"NICE ";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina";English;"Do not advise adults with type 1 diabetes to follow a low glycaemic index diet for blood glucose control.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4193;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not perform simple abdominal radiography in case of acute abdominal pain, unless there is suspicion of obstruction or perforation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3938;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not measure C-peptide and/or diabetes-specific autoantibody titres routinely to confirm type 1 diabetes in adults. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4194;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not perform a routine chest x-ray in asthmatic exacerbations.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6754;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"It is not recommended aspirin as a way of reducing the chances of pregnant women developing blood clots (thromboprophylaxis).";"It is not recommended aspirin as a way of reducing the chances of pregnant women developing blood clots (thromboprophylaxis).";2016;;;"Low value";Treatment.;"Link to the recommendation on the website of the initiative" 3939;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not discount a diagnosis of type 1 diabetes if an adult presents with a BMI of 25 kg/m2 or above or is aged 50 years or above. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4195;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not systematically perform x-rays on ankle sprains (Otawa's ankle rules).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6755;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"Ultrasound is not recommended to make a diagnosis of PCOS";"Polycystic ovaries do not have to be present to make the diagnosis, and the finding of polycystic ovaries does not alone establish the diagnosis. Symptoms and a hormonal profile* will usually be enough to establish a diagnosis. *NICE recommends: Testosterone/SHBG/LH/FSH/Prolactin/TSH";2016;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 3940;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Angiotensin-converting enzyme (ACE) inhibitors should not be used in people with familial hypercholesterolaemia (FH) who are being treated with LDL apheresis. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4196;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not use routinely the intramuscular route for the administration of drugs.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3941;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer nicotinic acid (niacin) for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4197;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not systematically place a nasogastric tube in patients with suspected high-varicose non-variceal bleeding.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5477;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Vasopressor therapy is an important part of haemodynamic support for patients with shock.";"Some patients with COVID-19 will become critically ill and may develop hypotensive shock, but there is uncertainty about the most beneficial way to treat this. Vasopressors have shown evidence of benefit in hypotensive shock, probably because of their ability to raise blood pressure. Their effects for patients with hypotensive shock caused by other factors might indicate their effects in patients with COVID-19. In this Cochrane systematic review, the authors searched for randomized trials comparing different vasopressor regimens on mortality in critically ill patients with hypotensive shock. They did not restrict by date, type or language of publication and did their most recent search in June 2015. They identified 28 studies (3497 participants), covering six different vasopressors. Vasopressor therapy is an important part of haemodynamic support for patients with shock. It is uncertain whether any of the vasopressors at assessed doses are superior to others for mortality.";2016;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3942;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer fibrates for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4198;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo Urgencias y Atenci�n Continuada";Spanish;"Do not use scopolamine butylbromide (Buscopan�) in the treatment of renal colic.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3943;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer the combination of a bile acid sequestrant (anion exchange resin), fibrate, nicotinic acid or omega-3 fatty acid compound with a statin for the primary or secondary prevention of CVD.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3944;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer omega-3 fatty acid compounds for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3945;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a bile acid sequestrant (anion exchange resin) for the prevention of CVD to any of the following: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3946;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer coenzyme Q10 or vitamin D to increase adherence to statin treatment. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6762;36;"Choosing Wisely UK";"Royal College of Obstetricians & Gynaecologists: ";English;"Initial surgical treatment of patients with endometrial hyperplasia is not recommended. ";"Endometrial hyperplasia can often be treated without surgery. Hysterectomy should not be considered as first-line treatment for hyperplasia without atypia. Progestogen therapy induces histological and symptomatic remission in most women and avoids the morbidity associated with major surgery. The patient should be given information, questions should be answered and her individual circumstances and preferences should be discussed.";2016;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 3947;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not stop statins because of an increase in blood glucose level or HbA1c. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3948;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely exclude from statin therapy people who have liver transaminase levels that are raised but are less than 3 times the upper limit of normal. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3693;6;"Less Is More Collection - JAMA Network";"Bischoff-Ferrari H.JAMA Intern Med. 2016;176(2):.";English;"Monthly High-Dose Vitamin D Treatment for the Prevention of Functional Decline A Randomized Clinical Trial";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3949;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not advise any of the following to take plant stanols or sterols for the prevention of CVD: -people who are being treated for primary prevention -people who are being treated for secondary prevention -people with CKD -people with type 1 diabetes -people with type 2 diabetes. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6765;36;"Choosing Wisely UK";"Royal College of Paediatrics and Child Health";English;"Polyethylene Glycol should be used in preference to Lactulose in the treatment of Chronic Constipation in children and adults";"Lactulose and Polyethylene Glycol (PEG) are both commonly used osmotic laxatives that have been shown to be effective and safe treatments for chronic constipation. Evidence from the MEDLINE, EMBASE and CINAHL databases, and the Cochrane Central Register of Controlled Trials for all randomised controlled trials (RCTs) comparing the use of lactulose and polyethylene glycol in the management of faecal impaction and chronic constipation suggests that polyethylene glycol is better than lactulose in outcomes of stool frequency per week, form of stool and the need for additional products in both adults and children. Only difference is seen in relief of abdominal pain, where PEG is better than lactulose in children, but not in adults (no difference is seen). ";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3694;6;"Less Is More Collection - JAMA Network";"Fenton J. JAMA Intern Med. 2016;176(2):191-197.";English;"Promoting Patient-Centered Counseling to Reduce Use of Low-Value Diagnostic Tests A Randomized Clinical Trial";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3950;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a risk assessment tool for people who are at high risk of developing CVD because of familial hypercholesterolaemia or other inherited disorders of lipid metabolism. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6766;36;"Choosing Wisely UK";"Royal College of Pathologists";English;"It is recommended to use restrictive thresholds for patients needing red cell transfusions and give only one unit at a time except when the patient has active bleeding, in adults";"The optimal hemoglobin threshold for administration of red blood cell transfusions in patients with anemia is unknown. Blood is a scarce resource and in some countries transfusions are less safe than in others due to a lack of testing for viral pathogens. Evidence from a Cochrane systematic review and from a NICE clinical practice guideline suggest that allogeneic RBC transfusions can be avoided in most patients with hemoglobin thresholds above 7 g/dL to 8 g/dL.";2016;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 3695;6;"Less Is More Collection - JAMA Network";"Pierce C. JAMA Intern Med. 2016;176(2):261-262.";English;"Frequency of Attending Physician?Led Discussion of Test-Ordering Principles During Teaching Rounds";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3951;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a risk assessment tool for CVD, for people with pre-existing CVD. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4207;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Urology Nurses (AIURO)";English;"Don?t use the bladder catheterization if not expressly recommended. If necessary, follow the guidelines as far as the choice of the devices, the insertion procedure, the management, the early removal and patient education are concerned.";"The practice of bladder catheterization appears to be, long since, among the most prevalent in health facilities - including private hospitals and home care - thus resulting in a procedure with a significant transversal scope. An improper indication and subsequent management of bladder catheterization can determine up to 40% of infections related to care practices, resulting in increased morbidity and costs. From this data comes the need to standardize the knowledge and skills of all workers involved in the process of bladder catheterization, especially in order to prevent the care-related infections associated with this practice.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6767;36;"Choosing Wisely UK";"Royal College of Pathologists";English;"It is recommended to transfuse O Rh D negative red cells to O Rh D negative patients, and in emergencies for females of childbearing potential with unknown blood group.";"The surface of red blood cells contains markers that the immune system can recognize. One of these markers is the Rh factor (Rh [D] antigen). A person whose blood contains the Rh factor is Rh positive (D). A person whose blood does not contain the Rh factor is Rh negative (d). This recommendation was not based on any studies or does not have strong evidence to support it.";2016;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 3696;6;"Less Is More Collection - JAMA Network";"Drescher F. JAMA Intern Med. 2016;176(2):273-275.";English;"Use of Computed Tomography in Emergency Departments in the United States A Decade of Coughs and Colds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3952;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a risk assessment tool to assess CVD risk in people with type 1 diabetes. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4208;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Urology Nurses (AIURO)";English;"Don?t practice bladder catheterization with 2-ways latex catheters; caliber of less than 22 ch for men and 20 ch for women; in patients with suspected or confirmed diagnosis of macrohematuria.";"An improper indication and subsequent management of bladder catheterization can determine up to 40% of infections related to care practices, resulting in increased morbidity and costs. In case of macrohematuria it is indicated to use catheters that have as minimum requisites the indicated size and are 3-ways silicone devices. From this data comes the need of standardizing the knowledge and skills of all professionals who have to perform the procedure of bladder catheterization, especially in order to prevent CAUTI (Catheter Associated Urinary Tract Infections). In patient with suspected or confirmed macrohematuria, the correct choice of the device allows for an effective management of the care process, significantly reducing the occurrence of catheter obstruction, urethral trauma and /or UTI. In case these conditions arise, it is often necessary to repeat the catheterization procedure resulting in the patient's additional exposure to the risks arising from the operation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3697;6;"Less Is More Collection - JAMA Network";"Sheridan S. JAMA Intern Med. 2016;176(1):31-41.";English;"A Comparative Effectiveness Trial of Alternate Formats for Presenting Benefits and Harms Information for Low-Value Screening Services A Randomized Clinical Trial";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3953;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use opportunistic assessment as the main strategy in primary care to identify CVD risk in unselected people. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4209;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Urology Nurses (AIURO)";English;"Don?t carry out the assessment of pain without using standardized scales in the immediate post-operative period.";"In many surgeries the administration of post-operative analgesic therapy is a standard practice. However, the pain previously perceived by the patient it is not always rated. If there is a prescription for a pain killer treatment ""under condition"", i.e. with the possibility of opting for different active ingredients prescribed by shared interdisciplinary protocols, the choice should be guided by a systematic assessment of pain as a symptom. The use of standardized scales (eg. Numerical Rating Scale and Visual Analogue Scale), allows to standardize the behaviors in this regard and encourages the choice of the treatment most suitable to the situation and the patient. Where possible, the preoperative patient education is also important, as well as the assessment of pain before surgery.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3698;6;"Less Is More Collection - JAMA Network";"Barry M. JAMA Intern Med. 2016;176(1):15-16.";English;"A Proximal Hamstring Injury?Getting Off a Slippery Slope";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3954;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4210;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Urology Nurses (AIURO)";English;"Unless there is any complication, don?t renew the dressing of the surgical site in the first 48 hours after surgery.";"The dressing of the surgical wound is always source of debate for what concerns: methods, materials and frequency of renewal. Currently, replacing the dressings positioned in the operating room during the first day, i.e. before 24 hours from placement, is routinely. Leaving the dressing in place for 48 hours after surgery is the gold standard to limit infection and complications of the surgical site and to promote the natural tissue regeneration.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3699;6;"Less Is More Collection - JAMA Network";"Leis J. JAMA Intern Med. 2016;176(1):113-115.";English;"Medical Directive for Urinary Catheter Removal by Nurses on General Medical Wards";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3955;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a risk assessment tool to assess CVD risk in people with an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 and/or albuminuria. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4211;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Urology Nurses (AIURO)";English;"Don?t renew the advanced dressings placed on complicated and/or infected surgical site with different timing than indicated by the guidelines and the product specifications.";"The increasingly widespread use of ""advanced dressings"", i.e. of devices for the treatment of surgical wounds made up of biocompatible materials enhancing their healing, is the result of ongoing pharmacological, epidemiological and infectious diseases research. In order to ensure an appropriate patient care, it is necessary that nurses know the different types of products, both for choosing the most suitable one and to schedule how and when to replace it. It is therefore necessary to neglect the philosophy of ""daily medication"" to grant a direct control of a complex surgical wound, and rather opt for renewal criteria guided by the clinical judgment of the practitioner and taking into account the characteristics of the product itself. It is also important to share information with other professionals using a language universally shared and preferably accompanied by iconography.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3956;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine monitoring of creatine kinase is not recommended in asymptomatic adults or children/young people with familial hypercholesterolaemia (FH) who are receiving treatment with a statin. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4212;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Critical Care Nurses (ANIARTI)";English;"Don?t replace regularly the mechanical ventilator circuits to reduce the risk of VAP (Ventilator Associated Pneumonia)";" Routine replacement of the mechanical ventilator circuits is not recommended. These should only be replaced if they are visibly dirty (with plenty of moisture and / or secretions). VAPs produce increased morbidity and mortality and rise the costs for hospitalized patients in intensive care (ICU) with the presence of endotracheal tube (ETT). Routine replacement of the ventilation circuit does not decrease the risk of infection. Effective interventions to reduce VAPs can be inserted in a ""bundle"" (combination of preventive strategies) which considers: keeping the patients' head elevated at least 30 � (compatibly with any constrained position due to functional limitations); hygiene of the oral cavity with an alcoholic solution of chlorhexidine mouthwash to 0.12% at least every 6 hours; hand hygiene of healthcare workers; use of ETT with subglottic suction lumen; early extubation and mobilization.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3957;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In asymptomatic children and young people with heterozygous familial hypercholesterolaemia (FH), evaluation of coronary heart disease is unlikely to detect clinically significant disease and referral should not be routinely offered. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4213;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Critical Care Nurses (ANIARTI)";English;"Don?t routinely use personal protective equipment (gowns, masks, hats, gloves, ....) for the access of family members in ICU.";"The infections related to care practices are an important cause of morbidity, mortality, prolonged hospital stay and have a significant economic impact. Patients admitted to intensive care units (ICU) are at high risk of acquiring infections due to reduced immunity (eg. trauma outcomes, corticosteroid therapy), and frequent exposure to invasive procedures. The entry of family members in ICU highlighted the importance of controlling any infectious risk, but the use of personal protective equipment is not effective in limiting bacterial colonization, infections and patients' mortality. However, hand hygiene before and after entering the unit is essential to prevent infections.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3958;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Serum cholesterol concentrations should not be measured routinely during pregnancy. ";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4214;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Critical Care Nurses (ANIARTI)";English;"Don?t perform endotracheal aspirations at regular intervals but according to early indicators of retention of bronchial secretions.";"Endotracheal suctioning of secretions through a ventilatory prosthesis (orotracheal or tracheostomy tube) is not a riskless procedure. Despite international literature is lacking both on the ways and on the times of suction, since long ago the main recommendations are that the procedure should be carried out with the minimum frequency or when clinically indicated by the presence of secretions in the ventilatory prosthesis. The early indicators for the diagnosis of bronchial secretions retention are: change in the volume flow loop (presence of a ""saw tooth"" track); presence of coarse crackles (detectable by dedicated tools); increase in peak pressure in volumetric ventilation or decreased current volume in pressometric ventilation, arterial desaturation. In the absence of these indicators do not perform ""routine aspirations.""";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6774;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is not recommended to review uncomplicated cataract cases on day one post-op.";"Phacoemulsification is now the preferred method for cataract surgery because rapid postoperative visual rehabilitation is permitted by a small self-sealing incision. Cataract surgery is also increasingly being performed as a day-case procedure and studies have demonstrated that day-case surgery does not adversely affect the outcome of cataract surgery and patients report a high level of satisfaction. Routine review has traditionally been conducted on the first post-operative day following cataract surgery. Current phacoemulsification techniques for cataract surgery are, however, associated with a much lower post-operative complication rate than extracapsular cataract surgery. Raised intraocular pressure is the most common postoperative complication requiring specific treatment. Post-operative elevation of intraocular pressure is selflimiting. Since most eyes can tolerate a short period of elevated intraocular pressure without damage, the value of detecting and treating transient post-operative elevation of intraocular pressure is questionable. This might still be considered important in certain patients with susceptible optic nerve heads (such as glaucoma).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3959;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People with familial hypercholesterolaemia (FH) should not routinely be recommended to take omega-3 fatty acid supplements. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4215;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Critical Care Nurses (ANIARTI)";English;"Don?t replace peripheral venous catheters at regular intervals but based on clinical evaluation.";"The routine replacement (or at regular intervals) of peripheral venous catheters has a lower cost-benefit than a replacement following clinical criteria. The decision to replace the peripheral venous catheter should be based on the assessment of the patient's conditions; the vascular access site; the skin integrity and used vein; the duration and type of prescribed therapy; the integrity, patency and stability of the device; the fastening dressing. Replacement strategies of the catheters as clinically indicated reduce costs and inconvenience for patients without increasing the risk of phlebitis. Potential complications such as phlebitis, occlusion and accidental catheter removal are related to other risk factors.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6775;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is not recommended to try to unblock a blocked nasolacrimal duct in children under 12 months old.";"No link is available as a source of evidence for this recommendation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3960;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When the decision has been made to offer adults or children/young people with familial hypercholesterolaemia (FH) treatment with a statin, baseline liver and muscle enzymes (including transaminases and creatine kinase, respectively) should be measured before initiation of therapy. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4216;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Critical Care Nurses (ANIARTI)";English;"Don?t maintain routine preoperative fasting since the midnight preceding the elective surgery.";"Even today, in many surgical units patients are invited to fast solids and liquids since the midnight preceding surgery, even though it is shown that this practice does not reduce the possibility of aspiration into the airway in case of general anesthesia. Indeed, scientific literature shows that drinking water before surgery produces significantly less gastric volumes in patients not considered at risk, defined class 1 (healthy patient) or 2 (mild systemic disease) according to ASA (American Society of Anesthesiology) classification. For these reasons patients ASA I and II and patients not affected by diseases impacting the digestive function (obesity, gastroesophageal reflux, diabetes) can take clear liquids up to two hours before surgery (water, tea, chamomile tea, black coffee ... i.e. anything that has the effect of ""transparency""). To help patients in medication intake in the immediate pre-operative, you may administer up to 30 ml of water. If the surgery is postponed, the opportunity of administer some water to avoid excessive thirst and dehydration should be considered. Adults undergoing emergency surgery should be treated as if they were on a full stomach. The caring approach must be interdisciplinary and involve all persons appointed to manage the ""preoperative fasting""";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6776;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is not recommended to carry out laser retinopexy for asymptomatic lattice degeneration/atrophic retinal holes.";"Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these lesions frequently is recommended, in spite of the fact that the effectiveness of this therapy is unproven. Since no trials were found that met the inclusion criteria no studies were assessed for risk of bias, no data were extracted and no meta?analysis could be performed. No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks or lattice degeneration, or both. Current recommendations for treatment, based upon a consensus of expert opinion, should be assessed in a randomized controlled trial.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3705;6;"Less Is More Collection - JAMA Network";"Kumar A. JAMA Intern Med. 2016;176(6):731-732.";English;"To Cure Sometimes, to Relieve Often, to Comfort Always";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3961;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should exercise caution when adding a fibrate or nicotinic acid to a statin because of the risk of muscle-related side effects (including rhabdomyolysis). Gemfibrozil and statins should not be used together. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4217;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Medicine Nurses (ANIMO)";English;"Don?t mince and disguise medications in foods to administer them to patients with dysphagia and/or via NG-tube (nasogastric tube) or PEG (Percutaneous Endoscopic Gastrostomy) if not specifically indicated.";"If not recommended, crushing and disguising drugs is considered an inappropriate procedure to be included in potential medication errors. Altering the formulation of drugs and administer them disguised in food or beverages may increase their toxicity, determine instability, affect the absorption times, make them less effective and attractive. When possible, it would be appropriate to use alternative pharmaceutical applications, or consider different ways and means of administration in order to ensure a correct clinical efficacy, adequate absorption of the medicament and to minimize the obstruction of the tube.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6777;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is not recommended to send samples to the laboratory or to treat with antibiotics if conjunctivitis is thought to be viral. ";"The proposed evidence/guidance site (The NICE Clinical Knowledge Summaries (CKS)) is only available to users in the UK, Crown Dependencies and British Overseas Territories.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3706;6;"Less Is More Collection - JAMA Network";"Johansen M. JAMA Intern Med. 2016;176(6):769-775.";English;"Estimation of Potential Savings Through Therapeutic Substitution";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3962;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Coronary heart disease risk estimation tools such as those based on the Framingham algorithm should not be used because people with familial hypercholesterolaemia (FH) are already at a high risk of premature coronary heart disease. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4218;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Medicine Nurses (ANIMO)";English;"Don?t make regular use of restraint as a falls risk management tool.";"In the relevant scientific literature there is no evidence suggesting physical restraint as an intervention to prevent patient falls. On the contrary, mechanical restraint can cause psychological and direct and indirect physical side effects. Instead, it's necessary to assess the risk of falling for each patient and implement interventions aimed at reducing the personal and environmental risk factors.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5754;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the effects of interventions to modify the length of consultations with primary care physicians";"The COVID-19 pandemic is placing a strain on healthcare systems and healthcare workers. Existing research into intervention to alter the length of consultations between primary care clinicians and patients may provide policy makers with information to help with this. In this systematic review, the authors searched for randomized and non-randomized controlled trials of interventions intended to alter the length of primary care consultations. They did their search in January 2016. They included 2 randomized trials and 3 non-randomized trials (all from the UK), and rated the overall strength of the evidence as very low. They also identified one ongoing study (also from the UK). It is unclear whether changing the length of care of a primary appointment leads to changes in the actual length of the visit, the number or referrals and exams, prescriptions, resources used, or patient satisfaction.";2016;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6778;36;"Choosing Wisely UK";"Royal College of Ophthalmologists";English;"It is not recommended to make further investigation of an initial episode of unilateral anterior uveitis ";"No link is available as a source of evidence for this recommendation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3707;6;"Less Is More Collection - JAMA Network";"Brown D. JAMA Intern Med. 2016;176(5):597-598.";English;"Continuing Use of Prophylactic Percutaneous Coronary Intervention in Patients With Stable Coronary Artery Disease Despite Evidence of No Benefit";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3963;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Chlorhexidine mouthwash should not be offered as prophylaxis against infective endocarditis to people at risk of infective endocarditis undergoing dental procedures. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4219;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Medicine Nurses (ANIMO)";English;"Don?t resort to bladder catheterization for managing incontinence or performing simple diagnostic tests.";"Often, in the care of not self-sufficient elderly patients recourse is made to bladder catheterization to manage incontinence and/or perform diagnostic tests. The literature gives precise indications concerning the situations in which you need to resort to bladder catheterization, beyond which the patient is subjected to an unnecessary and increased risk of infection.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6779;36;"Choosing Wisely UK";"Royal College of Paediatrics and Child Health";English;"Buccal midazolam or lorazepam is recommended instead of intravenous or rectal diazepam in the treatment of prolonged seizures in children and young people";"Prolonged convulsive seizures are seizures that continue for more than 2 minutes longer than a person's usual seizure and should be treated as a medical emergency. Buccal midazolam and lorazepam have been found to be more efective in the treatment of prolonged seizures than intravenous or rectal diazepam in children and young people. For seizures that continue for 5 minutes or more, follow the recommendations in the status epilepticus section. -Manage prolonged seizures (any seizure that lasts more than 2 minutes longer than a person's usual seizure) as a medical emergency. -If a person has a prolonged seizure: follow their individualized emergency management plan if immediately available or consider giving a benzodiazepine, such as midazolam or clobazam, immediately if an individualized emergency management plan is not immediately available. - After a prolonged seizure, agree on an emergency management plan with the person if they do not already have one and there is concern that prolonged seizures may recur. -After a prolonged nonconvulsive seizure (a nonconvulsive seizure that continues for more than 2 minutes longer than a person's usual seizure), agree on an emergency management plan with the person if they do not already have one and there is concern than a prolonged non-convulsive seizure -Convulsive seizures may recur.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3708;6;"Less Is More Collection - JAMA Network";"Wald H. JAMA Intern Med. 2016;176(5):587-588.";English;"Don't rely on urine testing in the absence of localized symptoms in frail old patients with a long term catheter.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3964;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotic prophylaxis against infective endocarditis is not recommended routinely: -for people undergoing dental procedures -for people undergoing non-dental procedures at the following sites: upper and lower gastrointestinal tract; genitourinary tract (this includes urological, gynaecological and obstetric procedures and childbirth);upper and lower respiratory tract.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4220;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Medicine Nurses (ANIMO)";English;"Don?t leave in place any type of venous catheter (central; peripheral; short, medium or long term) if the problem for which it was set is no longer present.";"Often in daily practice, vascular devices are left in place only for the likelihood that once removed they can be necessary again. The main guidelines indicate that in order to prevent and reduce complications (infections, phlebitis, thrombosis) a venous catheter should be removed as soon as possible, unless the signs that induced its placement are lasting,";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5756;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is advised the use of interventions aimed at reducing visits by frequent assistants to primary care .";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into ways to reduce frequent visits to primary care by frequent attenders may provide information to help ease this burden and improve the frequent attenders? quality of life. In this systematic review, the authors searched for randomized trials of the effects of interventions intended to reduce the frequency of primary care visits on quality of life, morbidity and consultation frequency. They restricted their search to studies published between 1980 and 2015, but did not restrict by language of publication, and did the search in August 2015. They included 17 trials covering a variety of frequent attenders A patient-tailored approach moderately decreased consultation frequency by frequent attenders in primary care. A depression management programme provided modest improvements in quality of life and depression-free days for frequent attenders in primary care.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3709;6;"Less Is More Collection - JAMA Network";"Wheeler D. JAMA Intern Med. 2016;176(5):708-710.";English;"Phlebotomy should be restricted unless there is a clinical indication.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3965;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Children with bronchiolitis are not prescribed antibiotics to treat the infection.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4221;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Hospital Medicine Nurses (ANIMO)";English;"Don?t follow the mobilization protocols and those for the treatment of pressure sores as ""standard"" protocols in the dying patient.";"Given the limited temporal horizon, the mobilization and the wound care performed routinely do not bring any benefit to the dying patient. Instead, these procedures can engender discomfort and cause unnecessary pain. At the end of life you need to redefine the goals of care and target them to the comfort and control of the disturbing symptoms. In particular, it is essential to assess the risk of pressure sores and use anti-decubitus devices without mobilizing the patient routinely but only according to his/her real needs and requirements, ensuring maximum comfort. In presence of bedsores, taking into consideration that the continuous control of bacteria and/or the debridement of necrotic tissue are meaningless, it becomes a priority to use atraumatic dressings, which can remain in place for several days and can control the stink.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6781;36;"Choosing Wisely UK";"Royal College of Paediatrics and Child Health";English;"Bronchodilators are not recommended in the treatment of mild or moderate presentations of acute bronchiolitis in children without any underlying conditions";"The recommendation is based on a Cochrane systematic review ""Bronchodilators for bronchiolitis for infants with first?time wheezing"" and on a SIGN guideline.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3710;6;"Less Is More Collection - JAMA Network";"Steinman M. JAMA Intern Med. 2016;176(4):482-483.";English;"Polypharmacy?Time to Get Beyond Numbers";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3966;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Alirocumab is not recommended for treating primary non-familial hypercholesterolaemia or mixed dyslipidaemia in adults without a history of cardiovascular disease. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4222;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Physiotherapists (AIFI)";English;"Do not use continuous passive mobilization (CPM) devices for postsurgical treatment of knee ligament reconstructions or uncomplicated hip or knee arthroplasties.";"Some systematic reviews and some recent randomized clinical trials highlight the ineffectiveness of continuous passive mobilization (CPM) in patients following total knee or hip prosthesis surgery or anterior cruciate ligament (ACL) reconstruction. The only studies that show a possible temporary benefit and, in any case, not clinically relevant, use CPM for several hours per day, while in Italy it is generally prescribed only for 1-2 hours per day, making the therapy completely useless.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3711;6;"Less Is More Collection - JAMA Network";"Phillips C. JAMA Intern Med. 2016;176(4):433-435.";English;"Severe Mitral Regurgitation in Hypovolemic Shock Masquerading as Mitral Valve Perforation A Rising Tide Lifts an Anchor";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4223;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Physiotherapists (AIFI)";English;"Do not use mechanical or manual traction, as single treatment or in combination with other treatments, in patients with low back pain, in presence or absence of radicular pain.";"Some systematic reviews and international guidelines show that tractions have no or minimal impact on pain intensity, functionality, overall improvement and return to work in patients with low back pain, in presence or absence of radicular pain. Minimal positive effects, clinically not relevant, have been demonstrated in some studies with reduced samples and high risk of bias. On the contrary, over 20% of the studies considered reported negative effects of traction, such as increased pain, worsening of neurological signs and consequent surgical treatment. On the basis on these evidences, the use of this therapeutic approach is therefore not recommended.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6783;36;"Choosing Wisely UK";"Royal College of Pathologists";English;"PSA testing is not recommended in patients with lower risk of prostate cancer or with no family history";"Unless a patient is at increased risk of prostate cancer because of race or family history, PSA testing does not necessarily lead to a longer life. Any asymptomatic man, aged 50 and over can make an appointment with their GP to discuss having the PSA test. GPs should not proactively raise the issue with asymptomatic men. Further information on the quality of evidence not avaliable.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3712;6;"Less Is More Collection - JAMA Network";"Fenton J. JAMA Intern Med. 2016;176(3):391-393.";English;"Osteoporosis Overtreatment in a Regional Health Care System";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4224;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Physiotherapists (AIFI)";English;"Do not use specific exercises of selective strengthening of the vastus medialis obliquus (VMO) in patellofemoral pain syndrome.";"Many studies have shown that it is not possible to selectively activate the vastus medialis obliquus (VMO) with respect to vastus medialis longus or even to vastus lateralis. At the same time, no correlation between vastus medialis symptoms and its level of strength or activation has been demonstrated, while a general quadriceps strengthening program has the same effectiveness as selective strengthening programs, considerably more complex, expensive and time- consuming.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6784;36;"Choosing Wisely UK";"Royal College of Pathologists";English;"Calcium testing is not recommended earlier than 3 months after the previous test, except in acute conditions, during major surgery, or in critically ill patients, where testing should be done no more frequently than every 48 hours.";"No link is available as a source of evidence for this recommendation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3713;6;"Less Is More Collection - JAMA Network";"Reid C. JAMA Intern Med. 2016;176(3):338-339.";English;"Why We Need Nonpharmacologic Approaches to Manage Chronic Low Back Pain in Older Adults";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4225;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Physiotherapists (AIFI)";English;"Do not use ultrasound therapy for rotator cuff tendinopathy, ankle sprains and low back pain.";"Some reviews show the ineffectiveness of therapeutic ultrasound in the treatment of these disorders. Its therapeutic efficacy on pain or functionality is not superior to placebo in rotator cuff tendinopathy, while in ankle sprains the effect is clinically negligible, in particular at 2-4 weeks after the injury. The available evidences on low back pain do not highlight the effectiveness of this therapeutic approach. For all the considered disorders, there is a lack of high-quality randomized controlled trials comparing the treatment with appropriate control groups. In absence of such evidences, the clinical use of ultrasound for the treatment of these disorders is not justified and should be discouraged.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3714;6;"Less Is More Collection - JAMA Network";"M�ssener U. JAMA Intern Med. 2016;176(3):321-328.";English;"Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students A Randomized Clinical Trial";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4226;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Physiotherapists (AIFI)";English;"Do not teach or have patients with acute or chronic respiratory diseases practice diaphragmatic breathing.";"There are very limited evidences regarding the benefit of diaphragmatic breathing administered in order to improve the distribution of ventilation by reducing energy consumption, decrease dyspnea and increase exercise capacity. On the other hand, it has been shown that, in patients with moderate to severe chronic obstructive pulmonary disease (COPD), this practice may cause some adverse effects such as an increase in asynchronous and paradoxical breathing movements of the rib cage, decreased efficiency of respiratory mechanics and consequently of breathing work and burden imposed on respiratory muscles, dyspnea worsening, with the lack of improvements in lung function and the ability to maintain physical exercise.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6786;36;"Choosing Wisely UK";"Royal College of Pathologists";English;"Platelet transfusion is not recommended for patients with chemotherapy-induced thrombocytopenia where the platelet count is < 10 x 109/L except when the patient has clinical significant bleeding or will be undergoing a procedure with a high risk of bleeding";"No link is available as a source of evidence for this recommendation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3715;6;"Less Is More Collection - JAMA Network";"Annweiler C. JAMA Intern Med. 2016;176(6):865.";English;"Widespread assessments by Serum analysis or algorithm is not necessary to measure 25 (OH) D status for fall prevention among seniors with Vitamin D efficiency, unless there is a clinical indication.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4227;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Registered Nurses' Colleges ? Pediatric Nursing Area";English;"Don?t run the newborn hearing screening at birth but at least after 48 hours of life in a 1st level birth center.";"Newborn hearing screening allows an early detection of congenital hearing loss, whose prevalence is 1-3 cases per thousand births in the absence of risk factors. It must be performed in all birth centers, on all newborns before discharge, by trained personnel, in well defined ideal environmental conditions and using appropriate instruments. The screening aims at diagnosing within the first 3 months of life and intervene within 6. The first level neonatal screening provides for the automatic evaluation of transient evoked otoacoustic emissions (TOAEs) in response to acoustic stimuli. They are not always early detectable, due to the persistence of material in the external ear canal or to signal masked by other noises or in born by Caesarean section, with more false positive results than expected and great parents' concerns . Perform routine testing 48 h after birth may facilitate the diagnosing; reduce false positives, relieve parents' anxiety and spare the time and money necessary to repeat the first level screening during the same hospitalization or to undergo a brainstem auditory evoked response (BAER) test in a 2nd level center.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3716;6;"Less Is More Collection - JAMA Network";"Zapata J. JAMA Intern Med. 2016;176(8):1058-1059.";English;"Partial Codes?A Symptom of a Larger Problem";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3972;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not delay statin treatment in secondary prevention to manage modifiable risk factors. ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4228;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Registered Nurses' Colleges ? Pediatric Nursing Area";English;"Don?t replace devices without assessing the skin integrity.";"The skin breakdown. i.e. the destruction of soft tissues is a disregarded situation. Believing that children are not exposed to tissue damage is wrong. On the contrary, they are at greater risk of prejudices subsequent to the action of forces such as pressure, friction and stretching. Before replacing a feeding, peristomal, ventilation and / or respiration device it is necessary to inspect the skin, optimize nutrition, managing the environmental humidity and verify the integrity of the devices. It is important not to follow the routine or the time expiration. Replacing devices taking into account the assessment of the skin breakdown gives similar results in terms of cost and secondary complications and is less stressing for the child.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6788;36;"Choosing Wisely UK";"Royal College of Paediatrics and Child Health";English;"Helmet therapy is not recommended in the treatment of positional plagiocephaly in children.";"The recommendation was not based on any studies, or does not have strong evidence to support it.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3717;6;"Less Is More Collection - JAMA Network";"Lee T. JAMA Intern Med. 2016;176(8):1216-1217.";English;"Pattern of Inpatient Laxative Use Waste Not, Want Not";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3973;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Whitaker P. BMJ 2016;353:i2751";English;"A General Practitioner is crucial to both the quality of care and its cost effectiveness. An effective medical interpreter requires sound knowledge of the whole breadth of medicine, excellent consultation skills, and understanding of the psychosocial aspects of illness, as well as the experience, confidence, and pragmatism to handle and explain uncertainty and risk. ";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4229;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Registered Nurses' Colleges ? Pediatric Nursing Area";English;"Don?t reheat several times artificial or breast milk before feeding it to the baby.";"It is common practice to reheat several times both breast and formula milk, using methods that do not guarantee the correct temperature such as pots, bottle warmers, microwave ovens. The preparation of milk before administration can be via baby bottles warmers with a set default temperature. Liquid formula can be warmed in hot water up to 35 �C (95 �F), while the milk powder must be added to water at a temperature of 70 �C (158 �F). Breast milk should be administered at room temperature. At an inadequate temperature many beneficial properties of milk, breast milk especially, vanish. Once heated, milk not consumed within half an hour must be discarded to prevent bacteria proliferation. In the absence of single doses, avoid the entire bottle of milk to cool and then be reheat. Health care providers and parents should be aware of these problems, especially when referring to sick and premature babies.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6789;36;"Choosing Wisely UK";"Royal College of Psychiatrists";English;"It is recommended that the benefits and harms of taking oral versus injection medications in long-term antipsychotic treatment be discussed with all relevant parties in the process.";"Psychosis and the specific diagnosis of schizophrenia represent a major psychiatric disorder (or cluster of disorders) in which a person's perception, thoughts, mood and behaviour are significantly altered. Each person will have a unique combination of symptoms and experiences. Does not address the specific treatment of young people under the age of 18 years, except those who are receiving treatment and support from early intervention in psychosis services. There has been a new emphasis on services for early detection and intervention, and a focus on long-term recovery and promoting people's choices about the management of their condition. Carers, relatives and friends of people with psychosis and schizophrenia are important both in the process of assessment and engagement, and in the long-term successful delivery of effective treatments. The choice of antipsychotic medication should be made jointly by the patient and the healthcare professional, taking into account the opinions of the caregiver if the patient agrees. Information must be provided and the probable benefits and possible side effects of each medication must be discussed, including: metabolic, extrapyramidal, cardiovascular, hormonal, or others such as unpleasant subjective experiences.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3718;6;"Less Is More Collection - JAMA Network";"McKee K. JAMA Intern Med. 2016;176(8):1217-1219.";English;"Habitual Prescribing of Laxatives?It?s Time to Flush Outdated Protocols Down the Drain";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3974;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J.BMJ 2016;353:i2879";English;"It is recommended that for adults aged 75 or older reducing blood pressure to less than 120 mm Hg resulted in significantly lower rates of fatal and non-fatal major cardiovascular events and death from any cause than with a systolic blood pressure target of less than 140 mm Hg.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4230;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Registered Nurses' Colleges ? Pediatric Nursing Area";English;"Don?t heat the milk to inappropriate temperatures to prevent nutrient decomposition and store it properly.";"Exposing milk to high temperatures (over 80 �C [176 �F]) may induce changes in the fatty acid profile if compared to fresh breast milk. To avoid the nutrient destruction, the right preparation must be respected. Evidence shows that the major changes in the overheated milk affect amino acids essential for human growth. The right heating of the milk (in particular powder formulas) must be guaranteed at a temperature not lower than 70 �C (158 �F) to prevent the proliferation of bacteria, of which the most common and feared is E. sakazakii, responsible for meningitis, septicemia and necrotizing enterocolitis. Once the packaging is open, an adequate storage of artificial milk (liquid or prepared) is pivotal: the milk must stay in a refrigerator at 4 �C (39,2 �F) until its following use, since it reduces the bacterial growth if compared with temperatures between 5 - 65 �C. (41 ? 149 �F).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3719;6;"Less Is More Collection - JAMA Network";"Agarwal A. JAMA Intern Med. 2016;176(8):1066-1067.";English;"A Common Cause of Cranial Nerve VI Palsy?Hidden in Plain Sight A Teachable Moment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3975;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2016;353:i2975";English;"It is recommended that for patients especially children and young people with asthmatic conditions make and accurate diagnosis and don't rush on making a decision before subjecting the patient to treatment as corticosteroids.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4231;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Federation of Registered Nurses' Colleges ? Pediatric Nursing Area";English;"Don?t use physical restraint as a first choice during painful procedures in children";"Often, to perform invasive procedures and/or to position devices, we resort to the physical restraint of the child, with insufficient explanation of what will happen, and without an appropriate analgesic coverage. Missing pain control and anxiety management generate rejection, crying, anguish, stress, non-compliance in the little patient and worry and anxiety in his/her parents. In addition to the well known conventional procedures, there are valid alternative methods, such as: comfortable position of the baby, controlled breathing, distraction and encouragement of mother and child, simulation of a story through puppets and, in particular, audiovisual techniques that better influence the cognitive-emotional component of pain. The use of local anesthetics such as lidocaine cream / patch / powder can be taken into account depending on the duration of the procedures. The pain and associated discomfort control for diagnostic / therapeutic procedures is effective in reducing the child's reactions to painful events that should occur over time and can foster the acceptance of any other type of future care intervention.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6791;36;"Choosing Wisely UK";"Royal College of Physicians";English;"When managing patients with fleeting sensory symptoms, investigations should not be performed unless clinically indicated";"It is not recommended to perform investigations when managing patients with fleeting sensory symptoms unless clinically indicated. These are directed by taking a neurological history, examining the patient and having a differential diagnosis. Transient sensory symptoms are extremely common and often have a benign cause, so patients should be referred or investigated onlyn where there is clinical uncertainty of the diagnosis. ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3720;6;"Less Is More Collection - JAMA Network";"Warner S. JAMA Intern Med. 2016;176(8):1219-1221.";English;"The Gold Standard for Current Cancer Treatment";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3976;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hawkes N. BMJ 2016;353:i3064";English;"It is necessary to have statistically significant evidence and run RCTs that have the statistical power to control and epidemic such as the flu. This would avoid the stockpiling of vaccines such as the oseltamivir (Tamiflu) and save money.";"For further information please visit the website of the initiative (link below) ";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4232;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Pediatric Nephrology ? SINePe";English;"In the case of low-grade or asymptomatic proteinuria, it is not necessary to perform blood tests or complex instrumental exams. ";"In paediatric clinical practice, the occasional finding of low-grade proteinuria is frequent, though it is not always an indication of kidney damage or disease. However, the definition of a more appropriate diagnostic approach is useful both for the timely detection of diseases which could potentially compromise renal function if neglected or left unrecognised, and in order to avoid useless and costly treatments. When low-grade proteinuria is detected, a thorough medical history should be taken and a physical exam carried out in order to look for clear signs and symptoms of renal disease (oedema, urinary disorders, macroscopic alterations in urine colour; arterial hypertension, altered height/weight growth and/or particular skin damage); then the persistence of proteinuria should be confirmed. When history and physical exam are negative, the most appropriate diagnostic tool is repeat urinalysis. In the case of triggering events (physical exertion, fever or temporary dehydration with excessive concentration of the urine), proteinuria can be detected with a single urine test. In the absence of a triggering event, urinalysis should be performed on at least two separate occasions, more than a week apart. Conversely, persistent proteinuria requires an in-depth diagnostic approach (microscopic examination of the urinary sediment, urine culture, quantification of proteinuria, blood and instrumental tests).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3977;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Watson R. BMJ 2016;353:i3058";English;"Manufacturers of medical devices will have to respect new rules designed to guarantee the quality, performance, and safety of their products once they are offered for sale. The new legislation will be formally approved before the end of 2016.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4233;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Pediatric Nephrology-SINePe";English;"Urine culture should not be carried out either routinely or in the absence of the typical symptoms of a urinary tract infection; bag urine collection should be avoided.";"Routine urine culture (once a month) is often performed as part of the follow-up of children with congenital nephro-urological malformations or as part of the standard screening tests for children in good clinical condition. In these cases, the finding of bacterial growth, even at high colony counts, is almost certainly due to contamination, given the difficulty involved in collecting a sterile specimen from a child, or the possible presence of asymptomatic bacteriuria, which does not require specific treatment. Bag urine collection, a method widely used in children for the collection of a suitable specimen for urine culture, carries a high risk of contamination and should be replaced by other methods such as the mid-stream clean catch method or urinary catheterisation.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3978;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Ashworth S. BMJ 2016;353:i3028";English;"It is recommended the identification of ASD at the earliest possible stage in the criminal justice system, for better assessment and management of challenging presentations, minimise the risk of additional mental ill health developing in this population, highlight the need for specialist support and services, and ultimately reduce the risk of reoffending.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4234;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Pediatric Nephrology ? SINePe";English;"The indiscriminate use of albumin in children with a first episode of nephrotic syndrome is not recommended.";"In children presenting with a first episode of nephrotic syndrome, albumin infusions (followed by intravenous boluses of furosemide) should be exclusively limited to hypovolemic patients. While in these children albumin infusions can increase intravascular volume, thus improving renal haemodynamics and increasing diuresis, in hypervolemic cases the opposite occurs and hypovolemia can be exacerbated, contributing to hypertension and the risk of causing or worsening pulmonary oedema. Clinical symptoms (hypotension, tachycardia, abdominal pain, headache or dizziness, drowsiness, delayed capillary refill, muscle cramps) and a marked reduction in the fractional excretion of sodium (FENa <0.2) are the evaluation parameters to use in the diagnosis of hypovolemia.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6794;36;"Choosing Wisely UK";"Royal College of Psychiatrists";English;"It is not recommended to routinely use CT scans or MRIs of the head in the diagnosis of psychosis, except when there are signs or symptoms suggestive of neurological problems.";"Don?t routinely order brain neuroimaging (CT or MRI) in first episode psychoses in the absence of signs or symptoms suggestive of intracranial pathology. Signs and symptoms suggestive of intracranial pathology include headaches, nausea and vomiting, seizure-like activity, and later-age of onset of symptoms. Multiple studies have found that routine neuroimaging in first episode psychoses does not yield findings which alter clinical management in a meaningful way. The risks of radiation exposure and delay in treatment also argue against routine neuroimaging. In the Cochrane studies, selecting the population under 45 years of age and in its first episode: they conclude that there is insufficient evidence to use these imaging tests to diagnose schizophrenia in first episodes. The four studies we identified used VBM on adolescents and adults with first episode psychosis, but VBM was used to describe brain structure and not to make a diagnosis. There is no evidence to support the use of VBM to diagnose schizophrenia in patients with first episode psychosis.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3979;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016;353:i3234";English;"A meta-analysis has shown that most currently available antidepressants do not seem to offer a clear advantage in children and teenagers with major depression.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4235;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Pediatric Nephrology ? SINePe";English;"When asymptomatic microhaematuria is detected in a random urine sample, biohumoral or instrumental exams are not necessary.";"The incidence of isolated microhaematuria in random urine testing is about 8% in children of 3 years of age; this percentage falls to 3-4% in schoolchildren. Nevertheless, in both of these paediatric age groups, the incidence of microhaematuria at subsequent urinalysis falls significantly to 0.7-1.5%. Second level exams are only recommended in the case of persistent microhaematuria and results should be considered in combination with medical history, clinical symptoms and erythrocyte morphology in order to guide investigations toward screening for glomerular or urologic diseases.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4236;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Pediatric Nephrology ? SINePe";English;"Children under 6 years of age with primary monosymptomatic enuresis do not need to be seen by a specialist, undergo laboratory (with the exception of urinary dipstick) or instrumental testing or start pharmacological treatment.";"Primary monosymptomatic enuresis in children under 6 years of age does not require specialist treatment or specific diagnostic testing, with the exception of a simple urine dipstick test. When analysing a urine dipstick test, the possible presence of glycosuria and proteinuria should be evaluated and the specific gravity should be checked. No pharmacological treatment is necessary. What is required, however, is a detailed anamnesis of bladder function. After 6 years of age, before any eventual specialist visit, at least six months of behavioural therapy (an hour and a half before bedtime reduce liquid intake to a minimum, empty the bladder before going to bed and no drinking during the night) is recommended, together with keeping a bladder diary. Bowel function should also be corrected. If behavioural therapy should fail (at least 50% dry nights) an 8-week period of associated support therapy (enuresis alarm or 120 mcg desmopressin every evening) can be discussed with the family. The month before starting treatment, a bladder diary must be completed in order to compare results with those taken during the month after the start of treatment. If this approach proves unsuccessful (at least 50% dry nights), a specialist visit is recommended.";2016;;;"Low value";-; 6796;36;"Choosing Wisely UK";"Royal College of Physicians";English;"It is not recommended to use Magnetic Resonance (MRI) head imaging in patients with suspected Parkinson?s disease ";"It is not recommended to use structural MRI to diagnose Parkinson?s disease. If Parkinson's disease is suspected, refer people quickly and untreated to a specialist with expertise in the differential diagnosis of this condition. Structural MRI may be considered in the differential diagnosis of other parkinsonian syndromes. Suspect Parkinson's disease in people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3469;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Apremilast alone or in combination with disease-modifying antirheumatic drug (DMARD) therapy is not recommended within its marketing authorisation for treating adults with active psoriatic arthritis that has not responded to prior DMARD therapy, or such t";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3470;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Avoid undertaking investigations that are unlikely to affect care in the last few days of life unless there is a clinical need to do so, for example, when a blood count could guide the use of platelet transfusion to avoid catastrophic bleeding.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3471;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Consider non-pharmacological management of breathlessness in a person in the last days of life. Do not routinely start oxygen to manage breathlessness. Only offer oxygen therapy to people known or clinically suspected to have symptomatic hypoxaemia.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3983;29;"Choosing Wisely Australia";"Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists";English;"Reconocer y detener la prescripci�n en cascada.";"La prescripci�n en cascada ocurre cuando se prescribe un medicamento nuevo para ""tratar"" una reacci�n adversa a otro medicamento en la creencia err�nea de que se ha desarrollado una nueva afecci�n m�dica que requiere tratamiento. La prescripci�n en cascada debe evitarse debido a que est�n asociadas con resultados adversos debido a el segunda o m�s medicamentos, y ponen al paciente en riesgo. Un ejemplo de una prescripci�n en cascada es cuando se prescribe a un paciente un medicamento no esteroideo para el dolor, y luego se prescribe inhibidores de la bomba de protones (IBP) para reducir el riesgo de efectos secundarios estomacales causados ??por el primer medicamento recetado. Como las prescripci�n en cascada son propiciadas por reacciones adversas a los medicamentos, pueden evitarse mediante la detecci�n temprana de la reacci�n adversa inicial del medicamento. Por ejemplo, muchas reacciones adversas a medicamentos en los ancianos est�n relacionadas con la dosis. Se recomienda que iniciando el tratamiento con dosis bajas y ajustar el efecto, pueda reducir el riesgo. La mayor�a de las reacciones adversas a los medicamentos ocurren a los pocos meses de comenzar a tomar un medicamento. Los m�dicos deben considerar la posibilidad de que una reacci�n adversa a los medicamentos sea la causa de cualquier s�ntoma nuevo, especialmente si un medicamento se ha comenzado o cambiado recientemente. Se debe preguntar a los pacientes acerca de nuevos s�ntomas, ya que muchos pacientes no informan reacciones adversas a los medicamentos. Cuando ocurren tales reacciones, las estrategias de tratamiento no farmacol�gico deben considerarse el tratamiento de primera l�nea m�s apropiado, en lugar de comenzar un segundo medicamento para contrarrestar los efectos adversos.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3472;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use tetrastarch for fluid resuscitation in children and young people.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3984;29;"Choosing Wisely Australia";"Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists";English;"Reduce the use of medicines when there is a safer or more effective non pharmacological management strategy.";"Pharmacological treatments should be avoided or minimised if safer or more effective nonpharmacological alternatives are available. Pharmacological treatments may become a panacea for chronic lifestyle-related problems, and may detract from behaviour management tools that have proven effective in managing these same problems. There is also a risk of adverse effects from particular pharmacological treatments which may be avoidable by using non-pharmacological management strategies. For instance, physiotherapy should be used instead of oxycodone for addressing non-cancer pain, because of the risk of adverse effects. Another example is the use of psychotropic medicines for behavioural and psychological symptoms of dementia when nonpharmacological management strategies are both more effective and safer.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3473;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Be aware that plasma electrolyte concentrations and blood glucose are not routinely measured before elective surgery unless there is a need to do so, based on the child's medical condition or the type of surgery.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3985;29;"Choosing Wisely Australia";"Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists";English;"Avoid using a higher or lower dose than is necessary for the patient to optimize the ?benefit-to-risk? ratio and achieve the patient?s therapeutic goals.";"Therapeutic dosage should be adjusted to optimise the benefit-to-risk ratio of the treatment. Dosage should be no higher or lower than needed to achieve the patient?s therapeutic goals. As patients become more frail, potential harms usually increase and potential benefits usually decrease for a given dosage of pharmacological treatment. For example, carefully assessing the risk and benefits when initiating non-steroidal inflammatory drugs in elderly patients is important, because of the increased risk of stroke associated with NSAID therapy; and use of proton pump inhibitors in the elderly should be stepped down after an initial course of therapy. Related to this, high drug doses are not necessarily more effective than low doses. An example of this is the relationship between doses of a selective serotonin re-uptake inhibitor for patients with major depressive disorder and useful clinical improvements.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6801;36;"Choosing Wisely UK";"Royal College of Radiologists";English;"It is not recommended the use of unlikely beneficial chemotherapy in advanced cancer";"It is not recommended, in cases of advanced cancer, the use of chemotherapy that is unlikely to be beneficial and may cause harm . The use should be minimized. No bibliographical references or sources of information referencing the recommendation are presented.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3474;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not combine an ACE inhibitor with an angiotensin II-receptor antagonist to treat hypertension.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3986;29;"Choosing Wisely Australia";"Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists";English;"Stop medicines when no further benefit will be achieved or the potential harms outweigh the potential benefits for the individual patient.";"Pharmacological treatments should cease when there are no further benefits to be achieved from the treatment, or when the potential harms from the treatment start to outweigh the potential benefits. This is particularly pertinent for elderly patients with a limited life expectancy where the treatments are unlikely to prevent disease events, and may in fact lead to adverse effects that reduce quality of life. These patients are at an increased risk of polypharmacy and increased drug events. For example, bisphosphonate treatment should not be administered to patients living in residential aged care facilities when these patients are already too frail to swallow drugs or have a life expectancy which is significantly less than 12 months.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5778;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Telehealth interventions are recommended to decrease hospitalization and length of hospital stay";"The COVID-19 pandemic is placing a strain on health services. Existing research on the effects of telehealth may provide information to help with this. In this systematic review, the authors searched for research that evaluated the effects of all types of telehealth (e.g. phone calls, videoconferencing, etc.) on hospitalization and length of stay. They restricted their search to articles published in English between January 2005 and November 2013. They included 22 studies (total: 19,086 participants), including 14 randomized trials and 8 observational studies. Telehealth may decrease hospitalizations and length of stay in hospital. Telehealth may be an effective solution for providing healthcare to people with chronic disease.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3475;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer antiplatelet therapy (aspirin or clopidogrel) for adults with type 2 diabetes without cardiovascular disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3987;29;"Choosing Wisely Australia";"Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists";English;"Reduce use of multiple concurrent therapeutics (hyper-polypharmacy)";"Polypharmacy ? defined as five to nine medications taken regularly ? is common among elderly patients. However, patients who are prescribed with multiple, concurrent therapeutics (i.e. hyper polypharmacy) may be on ten or more drugs at time. Research has confirmed a significant association between polypharmacy and adverse outcomes among older people living in the community because the toxicities and side effects associated with prescribed drugs are accrued over many years. Polypharmacy in older people is associated with decreased physical and social functioning; increased risk of falls, delirium and other geriatric syndromes; hospital admissions; and, death.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6291;29;"Choosing Wisely Australia";"Australasian Chapter of Sexual Health Medicine";English;"Do not order herpes serology tests unless there is a clear clinical indication. ";"Herpes serology is not an appropriate screening test in asymptomatic patients and does not accurately confirm whether the person is infected or is a transmission risk to others from asymptomatic shedding. Clinicians also need to consider whether test results will influence treatment or outcomes because, if they do not, then testing is a waste of finite health resources and is not indicated. Herpes serology tests only have good sensitivity and specificity in high prevalence populations. However, selective use of herpes serological tests may be justified for particular groups, such as those at high risk for STIs and human immunodeficiency virus (HIV) infection who are motivated to reduce their sexual risk behaviour; HIV-infected patients; patients with sexual partners with genital herpes; and in cases where a woman appears to have a first episode of herpes simplex virus (HSV) during pregnancy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3476;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with active spinal TB without central nervous system involvement, do not extend treatment beyond 6 months for residual effects (for example, persistent bending of the spine or vertebral loss).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3988;29;"Choosing Wisely Australia";"Australian and New Zealand Society for Geriatric Medicine";English;"Do not use antipsychotics as the first choice to treat behavioral and psychological symptoms of dementia.";"People with dementia may exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, the modest effectiveness of atypical antipsychotics may be offset by the higher risks for adverse events and mortality. Non-pharmacological interventions can be an effective substitute for antipsychotic medications. Use of these drugs should therefore be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5780;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of telemedicine is recommended in Japan with regard to economic efficiency";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research on the use of telemedicine may provide useful information for policy makers. In this systematic review, the authors searched for economic evaluations of telemedicine programs that had been implemented in Japan. They restricted their searches to articles published in English or Japanese and did the search in December 2014. They included 17 economic evaluations, 6 on settings connecting physicians for specialist consultations, and eleven on settings connecting healthcare providers and patients at home. The use of telemedicine in Japan improved economic efficiency. The robustness of the reported benefit-to-cost ratio magnitude is uncertain because of the absence of sensitivity analyses. The impact of public subsidy regulations on the benefit-to-cost ratio is uncertain.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6804;36;"Choosing Wisely UK";"Royal College of Radiologists";English;"It is not recommended to use imaging techniques in cases of minor head injuries. ";"It is not recommended to use imaging techniques in cases of minor head injuries, it is not likely to be useful. Only is recommended in cases of clinically important brain injuries by following the corresponding criteria (different in adults than children). Also in patients having anticoagulant treatment (both, adults and children). ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3477;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"After diagnosis of TB in an aircraft traveller, do not routinely carry out contact tracing of fellow passengers.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3989;29;"Choosing Wisely Australia";"Australian and New Zealand Society for Geriatric Medicine";English;"Do not prescribe benzodiazepines or other sedativehypnotics to older adults as first choice for insomnia, agitation or delirium.";"There is strong evidence that use of sedative-hypnotics (both benzodiazepines and non-benzodiazepines) is associated with various adverse effects in elderly people such as falls and fractures. Older patients, their caregivers and their providers should recognize these potential harms when considering treatment strategies for insomnia, agitation or delirium. Thus these drugs should be prescribed with caution, and their use monitored closely.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5781;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Telemedicine is recommended as a viable and comprehensive component of primary care";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research on the use of telemedicine in primary care may provide information to ease this and to support a safer environment for primary care providers and their patients. In this systematic review, the authors searched for research evaluating the feasibility, acceptability and impact of telemedicine interventions in primary care. They restricted their search to articles published between 2005 and 2015. They included 86 studies, which covered feasibility and acceptance (35 studies), intermediate outcomes (36), health outcomes (7) and cost (8). Telemedicine may be more acceptable to patients than to healthcare providers and outcomes limited suggest that telemedicine interventions are generally as effective and cost-effective as traditional care. Challenges remain in identifying the impact of telemedicine on clinical outcomes and the standardization of methods in relation to cost. The impact of telemedicine for specific demographic groups, (such as based on age, gender and socioeconomic status) is uncertain.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6293;29;"Choosing Wisely Australia";"Australasian Chapter of Sexual Health Medicine";English;"Do not screen for chlamydia using serological tests. ";"There is no role for chlamydia serology as a screening test as antibodies elicited during infection are long-lived, meaning a positive antibody test will not distinguish between a previous and a current infection and are non-specific for genital serovars. Chlamydia serology may be useful in specific circumstances, for example, investigating atypical pneumonia in babies or in identifying late stage Lymphogranuloma Venereum (LGV) infection. Laboratory tests based on nucleic acid amplification (NAAT) technologies remain the first choice for diagnosis of chlamydial infections during pregnancy and in other settings. NAAT testing for identifying LGV serovars of Chlamydia trachomatis has superseded the use of serology for diagnosis but is only available in some specialist settings.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6805;36;"Choosing Wisely UK";"Royal College of Physicians";English;"It is recommended to perform a neurophysiological assessment when managing patients with suspected carpal tunnel syndrome requiring surgery. ";"It is recommended to perform a neurophysiological assessment when managing patients with suspected carpal tunnel syndrome requiring surgery. This recommendation is based on a clinical practice guide only accessible to UK users, so no further information can be obtained.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3478;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Trastuzumab emtansine is not recommended, within its marketing authorisation, for treating adults with human epidermal growth factor 2 (HER2) positive, unresectable locally advanced or metastatic breast cancer previously treated with trastuzumab and a tax";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3990;29;"Choosing Wisely Australia";"Australian and New Zealand Society for Geriatric Medicine";English;"Do not use antimicrobials to treat bacteriuria in older adults where specific urinary tract symptoms are not present.";"Studies have found that asymptomatic bacteriuria frequently resolves without any treatment and frequently reoccurs after treatment. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and, in fact, often show increased adverse antimicrobial effects.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3479;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer self-monitoring of blood glucose levels for adults with type 2 diabetes unless the person is on insulin or there is evidence of hypoglycaemic episodes or the person is on oral medication that may increase their risk of hypoglycaemia";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3991;29;"Choosing Wisely Australia";"Australian and New Zealand Society for Geriatric Medicine";English;"Do not prescribe medication without conducting a drug regimen review.";"Older patients disproportionately use more prescription and non-prescription drugs than other populations, increasing the risk of side effects. Evidence shows that polypharmacy is associated with adverse drug reactions and an increased risk of hospital admissions. Medication review with regular, scheduled follow ups are recommended for improving quality of life in older adults with polypharmacy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6807;36;"Choosing Wisely UK";"Royal College of Radiologists";English;"It is not recommended or required to perform imaging when managing uncomplicated and not associated with ""red flags"" or radicolupathy back pain.";"It is not recommended or required to perform imaging when managing uncomplicated and not associated with ""red flags"" or radicolupathy back pain. Five clinical specialty societies recommend against the use of imaging for nonspecific low back pain. Clinical guidelines state that low back pain can be adequately managed without imaging and instead refer to physical examination, medical history, initial pain management, and physical therapy as the best first course of action. The results of imaging studies are unlikely to alter clinical management for back pain since most findings cannot be tied to a specific anatomic cause. ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3480;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the tuberculosis (TB) index case is an aircraft crew member, contact tracing of passengers should not routinely take place.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3992;29;"Choosing Wisely Australia";"Australian and New Zealand Society for Geriatric Medicine";English;"Do not use physical restraints to manage behavioral symptoms of hospitalized older adults with delirium except as a last resort.";"There is little evidence to support the effectiveness of physical restraints to manage people with delirium who exhibit behaviours that risk injury. Physical restraints can lead to serious injury or death and may worsen agitation and delirium. Restraints should therefore be used as a last resort and should be discontinued at the earliest possible time, particularly given that effective non-pharmacological alternatives are available.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6296;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Obstetricians and Gynaecologists ";Spanish;"Do not treat recurrent or persistent symptoms of vulvovaginal candidiasis with topical and oral anti-fungal agents without further clinical and microbiological assessment. ";"While topical and oral anti-fungal agents are the recommended treatment for candidiasis, an adequate clinical and microbiological assessment should be undertaken before they are prescribed or self-administered by patients for recurrent or persistent symptoms of vulvovaginal candidiasis. It is important to rule out other causes of vulvovaginal symptoms such as bacterial vaginosis or genital herpes first so that the other infections are not left untreated. Moreover, inappropriate use of antifungal drugs can lead to increased fungal resistance, especially in non-albicans species of candida.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3481;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely assess social contacts* of people with tuberculosis (TB), who will include most workplace contacts.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3993;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Radiologists";English;"Don?t initiate whole-breast radiation therapy as a part of breast conservation therapy in women age ?50y with early-stage invasive breast cancer without considering shorter treatment schedules.";"Whole-breast radiation therapy decreases local recurrence and improves survival of women with invasive breast cancer treated with breast conservation therapy. Most studies have utilized ?conventionally fractionated? schedules that deliver therapy over 5-6 weeks, often followed by 1-2 weeks of boost therapy. Recent studies, however, have demonstrated equivalent tumor control and cosmetic outcome in specific patient populations with shorter courses of therapy (~4 weeks). Patients and their physicians should review these options to determine the most appropriate course of therapy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5785;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"It is recommended training and government regulation of private healthcare providers in low- and middle-income countries to improve the quality of care";"The COVID-19 pandemic has placed an increased strain on health systems in low- and middle-income countries (LMICs). Existing research into the effects of public stewardship of private for?profit healthcare providers may provide information for policy makers considering this option. In this Cochrane systematic review, the authors searched for comparative effectiveness research that evaluated public sector regulation, training or co-ordination of the private for-profit health sector in LMICs. They did not restrict their search by date or language of publication and did their most recent searches in 2015 and 2016. They included 6 randomized trials, all of which targeted private for-profit pharmacy workers in Africa and Asia. These included studies of training alone (2 studies); regulation alone (1) and a multifaceted intervention involving training and regulation (3). They also identified 5 further studies that are awaiting assessment. A combination of training and government regulation for private for-profit healthcare providers in low- and middle-income countries may improve quality of care. The effects of government co-ordination on quality of healthcare services are uncertain.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3482;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Unless there is a clear clinical or public health need, such as homelessness, people with suspected infectious or confirmed pulmonary TB should not be admitted to hospital for diagnostic tests or for care.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3994;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Radiologists";English;"Don?t initiate management of low risk prostate cancer without discussing active surveillance.";"Patients with prostate cancer have a number of reasonable management options. These include surgery and radiation, as well as conservative monitoring without therapy in appropriate patients. Shared decision making between the patient and the physician can lead to better alignment of patient goals with treatment and more efficient care delivery. ASTRO has published patient-directed written decision aids concerning prostate cancer and numerous other types of cancer. These types of instruments can give patients confidence about their choices, improving compliance with therapy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6298;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Obstetricians and Gynaecologists ";English;"Do not test for ureaplasma species in asymptomatic patients. ";"Ureaplasma species are part of the normal genital microbiota and there are typically high rates of colonisation of the organism in sexually active adults. Testing or screening for genital infection with ureaplasma species is not recommended outside specialist or research settings as they have not been established as a cause of lower genital tract disease.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 6810;36;"Choosing Wisely UK";"Royal College of Physicians";English;"Is not recomended brain imaging for most patients with suspected migraine.";"When managing patients with migraine only perform neuro-imaging where there are atypical features. It is essential to clarify patient expectations and provide education and explanation about the differential diagnosis of migraine. Patients with new onset headaches should have a neurological examination (including fundoscopy) and assessment of ?red flags? as per NICE guidance. Where, based on clinical need and imaging is required, unless in a history of trauma or suspected subarachnoid, MRI rather than CT is the preferred modality.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3483;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely refer people with spinal tuberculosis (TB) for surgery to eradicate the disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3995;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Radiologists";English;"Don?t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.";"Studies suggest equivalent pain relief following 30 Gy in 10 fractions, 20 Gy in 5 fractions, or a single 8 Gy fraction. A single treatment is more convenient but may be associated with a slightly higher rate of retreatment to the same site. Strong consideration should be given to a single 8 Gy fraction for patients with a limited prognosis or with transportation difficulties.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3484;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with HIV (human immunodeficiency virus) and active TB (tuberculosis) with central nervous system involvement, do not routinely extend treatment beyond 12months";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3996;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Radiologists";English;"Don?t routinely add adjuvant whole-brain radiation therapy to stereotactic radio surgery for limited brain metastases.";"Randomised studies have demonstrated no overall survival benefit from the addition of adjuvant whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) in the management of selected patients with good performance status and brain metastases from solid tumors. The addition of WBRT to SRS is associated with diminished cognitive function and worse patient-reported fatigue and quality of life. These results are consistent with the worsened self-reported cognitive function and diminished verbal skills observed in randomised studies of prophylactic cranial irradiation for small cell or non-small cell lung cancer. Patients treated with radiosurgery for brain metastases are at higher risk of developing metastases elsewhere in the brain. Careful surveillance and the judicious use of salvage therapy at the time of brain relapse allow appropriate patients to enjoy the highest quality of life without a detriment in overall survival. Radiation oncologists should discuss these options with patients, including participation in appropriate clinical trials.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3485;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with HIV (human immunodeficiency virus) and active TB (tuberculosis)without central nervous system involvement, do not routinely extend treatment beyond 6months.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3997;29;"Choosing Wisely Australia";"Royal Australian and New Zealand College of Radiologists";English;"Don?t routinely use extensive loco regional therapy in most cancer situations where there is metastatic disease and minimal symptoms attributable to the primary tumor.";"In the past, extensive local regional therapies (e.g., surgery) were often provided in patients with metastatic disease, regardless of the symptomatology of the primary tumour. However, recent evidence has suggested that in many cases these therapies do not improve outcome and, at times, delay the more important treatment of metastatic disease (e.g., chemotherapy). In general, patients with metastatic disease from solid organ malignancies and a relatively asymptomatic primary tumour should be considered for systemic therapy as a priority; the delay in systemic therapy and potential additional morbidity arising from extensive loco regional therapies should be avoided in these patients.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5277;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended a good control and early diagnosis of pacientes who have a respiratory or laryngeal infection to carry out a good treatment, as well as to reduce the waiting in the consultations to reduce the transmission of the disease. It is not recommended to admit a patient to the hospital or wait for a consultation together with patients who are immunosuppressed.";"In case of entering the patient, isolation conditions are recommended.";2016;;;"High value";Tuberculosis;"https://www.nice.org.uk/guidance/ng33/chapter/Recommendations#infection-control" 6813;36;"Choosing Wisely UK";"Royal College of Physicians";English;"Is not recommended routine imaging in patients with low back pain.";"Do not routinely offer imaging in a non-specialist setting for people with low back pain with or without sciatica. Explain to people with low back pain with or without sciatica that if they are being referred for specialist opinion, they may not need imaging. Consider imaging in specialist settings of care (for example, a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management. For more information consult the NICE guidelines on low back pain.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3486;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anti-TB (tuberculosis) treatment dosing regimens of fewer than 3 times per week.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3998;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists ";English;"Do not assume that bilateral redness and swelling of both lower legs is due to infection unless there is clinical evidence of sepsis such as malaise, fever and neutrophilia, plus an expanding area of redness or swelling over a period of hours to days.";"Bilateral lower leg cellulitis is very rare. Most commonly the redness is due to an underlying inflammatory skin disorder such as venous eczema or a more deeply extending inflammation involving the subcutaneous fat known as lipodermatosclerosis. This condition, which occurs more frequently in patients with venous disease, who are overweight and immobile, may initially present as bilateral redness and swelling, and then progresses over time to produce scarring and hardening of the underlying tissues. A careful history and physical examination should be undertaken. An entry point for infection should be looked for, and swabs taken from open skin wounds. However, microbiological testing from intact overlying skin is usually of little value.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6814;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"It is not recommended to use rheumatoid factor and CCP/ACPA as screening tests for rheumatoid arthritis.";"Patients with suspected inflammatory arthritis should be referred to Rheumatology without delay. Rheumatoid factor and CCP/ACPA are important, but should be avoided as screening tests. A negative result does not exclude rheumatoid arthritis, nor does a positive result equate to a diagnosis of rheumatoid arthritis. Repeat testing is not normally indicated.";2016;;;"Low value";"Detection ";"Link to the recommendation on the website of the initiative" 3487;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with active tuberculosis (TB) of the lymph nodes, do not routinely extend treatment beyond 6 months for newly enlarged lymph nodes or sinus formation, or for residual enlargement of the lymph nodes or sinuses.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3999;29;"Choosing Wisely Australia";" The Australasian College of Dermatologists ";English;"Do not routinely prescribe antibiotics for inflamed epidermoid cysts (formerly called sebaceous cysts) of the skin.";"The inflammation is secondary to an intense foreign body reaction to the cyst contents leaking into adjacent tissues and will respond to incision and drainage. The use of intralesional corticosteroid injections has been suggested, but there are no formal studies to support this practice. Although oral antibiotics are often prescribed, there is no evidence on which to base recommendations for their routine use in this setting.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5023;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pancreatic necrosectomy using transluminal endoscopy is recommended with certain conditions.";" 1.1 Current evidence on the safety of endoscopic transluminal pancreatic necrosectomy shows that there are serious but well?recognised complications. Evidence on efficacy is adequate to support the use of this procedure provided that standard arrangements are in place for clinical governance, consent and audit. 1.2 Patient selection should be done by a multidisciplinary team experienced in the management of the condition. 1.3 Endoscopic transluminal pancreatic necrosectomy should only be done in a specialist centre by a team experienced in the management of complex pancreatic disease.";2016;;;"High value";"Pancreatic surgery";"https://www.nice.org.uk/guidance/ipg567/chapter/1-Recommendations" 3488;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not place part or all of any of the samples in formalin (or other fixative agent) when sending for tuberculosis culture.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4000;29;"Choosing Wisely Australia";" The Australasian College of Dermatologists ";English;"Acute urticaria (i.e. of less than 6 weeks duration) does not routinely require investigation for an underlying cause. Where clinical history and examination suggest the possibility of a bacterial infection or food as a likely trigger, further testing may be warranted. If individual lesions (weals) persist for longer than 24 hours an alternative diagnosis may need to be considered. ";"The individual weals of acute urticaria and angioedema can be widespread and variable in appearance, resolving in 24 hours leaving normal skin. In children, upper respiratory tract and viral infections are the most common cause of acute urticaria. Foods and medications such as antibiotics and nonsteroidal anti-inflammatory drugs are possible triggers in all age groups. Thus the cause of acute urticaria is usually suggested by a patient?s history without the need for routine blood investigations.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6816;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health";English;"It is not recommended further blood tests to check how hormone levels are in women over the age of 45 with typical symptoms of menopause, such as hot flashes and sweats, and if their periods have become irregular, much lighter, or have stopped.";"Menopause is when a woman stops having periods as she reaches the end of her natural reproductive life. This is not usually abrupt, but a gradual process during which women experience perimenopause before reaching postmenopause. The average age of menopause in the UK is 51. However, this varies widely and 1 in 100 women experience premature ovarian insufficiency (menopause occurring before the age of 40 years). The follicle-stimulating hormone (FSH) test is often performed unnecessarily in women aged over 45 years. The evidence underpinning this guideline highlights that hormonal tests should not routinely be used in the diagnosis of menopause and that FSH tests should not be used in women aged over 45 years. This is because FSH fluctuates considerably over short periods of time during the years leading up to menopause and so blood levels are not a helpful addition to what is a clinical diagnosis. If a woman is aged over 45 years and has not had a period for at least 12 months, or has vasomotor symptoms and irregular periods (or just symptoms if she doesn't have a uterus), this is adequate information to diagnose menopause and perimenopause respectively. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3489;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Mantoux testing should not be done routinely before BCG vaccination in children younger than 6 years unless they have a history of residence or prolonged stay (more than 1 month) in a country with a high incidence of tuberculosis.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4001;29;"Choosing Wisely Australia";"The Australasian College of Dermatologists ";English;"Do not prescribe topical or systemic anti-fungal medication for patients with thickened, distorted toenails unless mycological confirmation of a dermatophyte infection has been obtained.";"Fifty percent of thickened distorted toenails are caused by age, pressure from footwear (onychogryphosis) or other trauma, or associated with inflammatory disorders such as psoriasis or lichen planus, and are not due to a fungal infection.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6817;36;"Choosing Wisely UK";"Royal College of Physicians";English;"It is recommended to carry out an adequate neurological and cardiological study in patients with transient loss of consciousness before carrying out other investigations.";"According to the NICE guide of ""NICE guidance on Transient Loss of Consciousness"" a neurological and cardiological study should be done before any other investigation, with some exceptions: - Older people (older than 50 years) with a new onset of epileptic seizures do not need an EEG, unless they have very frequent or continuous seizures. - Repeated standard EEGs may be useful when the diagnosis of epilepsy or syndrome is unclear. However, if the diagnosis has been established, repeat EEGs may not be helpful (per NICE guidance). - Limit the use of 24-hour ambulatory ECG recording in TLoC and use long-term implanted loop ambulatory ECG recording when a cardiac cause is suspected in recurrent TLoC of unclear cause. - If the person with suspected transient loss of consciousness (TLoC) has sustained an injury or has not fully regained consciousness, use clinical judgment to determine appropriate management and urgency of treatment.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3490;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine BCG vaccination is not recommended for children aged 10?14 years.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4002;29;"Choosing Wisely Australia";" The Australasian College of Dermatologists ";English;"Monotherapy for acne with either topical or systemic antibiotics should be avoided.";"In light of concerns about antibiotic resistance, the treatment of acne with topical or oral antibiotics should be in combination with agents such as benzoyl peroxide or retinoids and prolonged use should be avoided.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5282;1;"NICE ";"Diagnostics guidance";English;"There is currently insufficient evidence to recommend the routine adoption in the NHS of the SepsiTest assay for rapidly identifying bloodstream bacteria and fungi. ";"The test shows promise and further research to provide robust evidence is encouraged, particularly to demonstrate the value of using the test results in clinical decision-making.";2016;;;"Low value";Sepsis;"https://www.nice.org.uk/guidance/dg20/chapter/1-Recommendation" 3491;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ramucirumab alone or with paclitaxel is not recommended within its marketing authorisation for advanced gastric cancer or gastro?oesophageal junction adenocarcinoma previously treated with chemotherapy.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4003;29;"Choosing Wisely Australia";"Human Genetics Society of Australasia";English;"Don?t use brain magnetic resonance imagery (MRI) for routine surveillance of asymptomatic neurofibromatosis type 1.";"Neurofibromatosis type I (NF-1) is a tumour disorder caused by the mutation of a gene on chromosome 17 that is responsible for control of cell division. It causes tumours along the nervous system that can grow anywhere in the body. Routine screening investigations are not recommended for the detection of the majority of complications associated with the condition. Baseline brain and spine MRI, and routine imaging of the chest and abdomen to identify asymptomatic tumours, do not influence management and should not be undertaken.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6819;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"It is recommended for everyone to use vitamin D supplementation during winter and fro people who have restricted access to sunlight or have dark skin to use vitamin D supplementation all year round. ";"Everyone should consider vitamin D supplementation all year round. People who have restricted access to sunlight (e.g. those living in institutions or who cover their skin), or have dark skin, should consider supplementation all year round. Vitamin D testing should be reserved for people at high risk from deficiency and avoided as part of routine investigation of widespread pain alone. Repeat testing is not normally indicated in those taking supplements.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3492;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a rigid cast for torus fractures of the distal radius.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4004;29;"Choosing Wisely Australia";"Human Genetics Society of Australasia";English;"Don?t undertake sequential testing for heterogeneous genetic disorders when targeted next generation sequencing (NGS) is available.";"A heterogeneous genetic disorder is one where the same disease or condition can be caused, or contributed to, by a number of different genes. The traditional strategy for genetic testing involves sequential sequencing of individual genes, selected according to the patient?s clinical presentation and family history. By contrast, next generation sequencing (NGS) involves the sequencing of millions of small fragments of DNA at the same time. Reductions in the cost of NGS now make it a more attractive solution for clinical diagnostic testing to identify the disease-causing mutation(s) in patients with genetically heterogeneous disorders than traditional sequential testing. In particular, the targeted NGS approach which restricts analysis to genes known to be implicated in a particular phenotype has been also successfully applied to heterogeneous disorders such as inherited peripheral neuropathy (IP).";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3493;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use gas and air (nitrous oxide and oxygen) on its own when reducing dorsally displaced distal radius fractures in the emergency department.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4005;29;"Choosing Wisely Australia";"Human Genetics Society of Australasia";English;"Don?t undertake genetic testing for methylenetetrahydrofolate reductase (MTHFR), apolipoprotein E (APOE) and other such tests where the clinical utility for diagnostic purposes is extremely low.";"While genetic testing can help indicate susceptibility to particular genetic conditions, there are some conditions where the presence of particular alleles is neither necessary nor sufficient to cause the condition or where the alleles have a higher prevalence in the general population than the condition itself. This is the case for instance with apolipoprotein E as a genetic marker for Alzheimer?s disease and methylenetetrahydrofolate as a marker for venous thromboembolism.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6821;36;"Choosing Wisely UK";"Royal College of Physicians";English;"It is recommended atraumatic lumbar puncture needles for lumbar puncture to reduce the risk of post lumbar punction headache.";"A systematic review ""Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis"" concluded that among patients who underwent lumbar puncture, atraumatic needles were associated with a decreased incidence of subsequent headache. to dural puncture and the need for patients to return to the hospital for additional therapy, and had similar efficacy to conventional needles. These findings offer clinicians and stakeholders a comprehensive assessment and high-quality evidence on the safety and efficacy of atraumatic needles as a superior option for patients requiring lumbar puncture.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3494;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer non-steroidal anti-inflammatory drugs (NSAIDs) to frail or older adults with fractures.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3750;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"O?Dowd A. BMJ 2016; 352:bmj.i87";English;"Potential head of Food Standards Agency would treat antimicrobial resistance as priority";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4006;29;"Choosing Wisely Australia";"Human Genetics Society of Australasia";English;"Don?t undertake carrier state testing for rare recessive disorders where a partner has a family history, the couple is non consanguineous and there are no common causative mutations.";"With a rare recessive disorder, although the individual with the family history will have an increased risk of being a carrier, their unrelated partner will have a low general population risk. Therefore, their a priori combined risk of having a child with this rare recessive condition will generally be less than 1%. If the gene has no known common disease causative mutations then testing the unrelated partner for carrier status has low sensitivity and specificity.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6822;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"It is recommended to review bisphosphonate therapy with every patient after 3-5 years and consider a treatment holiday.";"Bisphosphonate therapy should be reviewed with each patient after 3 to 5 years, and discontinuation of treatment should be considered. This should follow a shared decision-making conversation that includes the risks and benefits of continued treatment. If bisphosphonate treatment is discontinued and no new fracture occurs, use of FRAX can be considered after 18 months for risedronate and ibandronate, 2 years for alendronate, and 3 years for zoledronate to inform whether treatment should be restarted.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3495;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Use whole-body CT (consisting of a vertex-to-toes scanogram followed by CT from vertex to mid-thigh) in adults (16 or over) with blunt major trauma and suspected multiple injuries. Patients should not be repositioned during whole-body CT.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3751;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:i118";English;"Women aged 50 to 74 should have mammogram every two years, say US guidelines";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4007;29;"Choosing Wisely Australia";"Human Genetics Society of Australasia";English;"Don?t undertake genetic testing when clinical diagnostic criteria exist and there are no reproductive or predictive testing implications.";"Like other screening or diagnostic tests, genetic tests do not have inherent utility. It is the adoption of therapeutic or preventive interventions that influences health outcomes. If clinical diagnostic criteria already exist for the condition in question and there are no reproductive or other predictive testing implications as a result of definitively identifying a genetic cause for the condition, then this renders genetic testing unnecessary.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6823;36;"Choosing Wisely UK";"Royal College of Radiologists";English;"It is recommended that when a pulmonary embolism is suspected, imaging should be guided by clinical scoring systems.";"The recommendation does not have more information, evidence, or additional references.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3496;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not base the decision whether to perform limb salvage or amputation on an injury severity tool score.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3752;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:h7029";English;"Oral antifungal is associated with increased risk of miscarriage";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4008;29;"Choosing Wisely Australia";"Gastroenterological Society of Australia";English;"Do not repeat colonoscopies more often than recommended by the National Health and Medical Research Council (NHMRC) endorsed guidelines. ";"Colonoscopy, with or without polypectomy, is an invasive procedure with a small but not insignificant risk of complications, including perforation or major haemorrhage postpolypectomy, depending on size of lesion. Surveillance colonoscopies place a significant burden on endoscopy services. Consequently, surveillance colonoscopy should be targeted at those who are most likely to benefit and at the minimum frequency required to provide adequate protection against the development of cancer. Cancer Council Australia guidelines, endorsed by NHMRC, state that if one to two adenomas less than one cm in diameter are removed via a high quality colonoscopy, a follow up interval of five years is recommended. For larger adenomas, three or more adenomas or adenomas containing villous features or high grade dysplasia, which are removed via a high quality colonoscopy, the recommended follow-up period is three years.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3497;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not irrigate open fractures of the long bones, hindfoot or midfoot in the emergency department before debridement.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3753;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 352:i134";English;"Long term opioid analgesic use is linked to increased risk of depression, study shows";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4009;29;"Choosing Wisely Australia";"Gastroenterological Society of Australia";English;"Do not undertake faecal occult blood testing in patients who report rectal bleeding, or require investigation for iron deficiency or gastrointestinal symptoms.";"The faecal occult blood test (FOBT) was developed for use in the outpatient setting for colorectal cancer screening in asymptomatic patients with average risk of colorectal carcinoma. Studies suggest that it has limited positive impact for hospitalised patients who report rectal bleeding or require investigation for iron deficiency or gastrointestinal symptoms, as it is unlikely to change patient management and may in fact delay investigations while waiting for the results of the test. Inappropriate use of the FOBT may lead to unnecessary additional investigations (e.g. colonoscopy), which also carries risks and may limit the availability of such investigations for more appropriate indications.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3498;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not log roll people with suspected pelvic fractures before pelvic imaging unless: an occult penetrating injury is suspected in a person with haemodynamic instability, log rolling is needed to clear the airway (for example, suction is ineffective in a p";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3754;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:i128";English;"Proton pump inhibitors are associated with risk of chronic kidney disease, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4010;29;"Choosing Wisely Australia";" Gastroenterological Society of Australia";English;"Do not continue prescribing long term proton pump inhibitor (PPI) medication to patients without attempting to reduce the medication down to the lowest effective dose or cease the therapy altogether.";"While proton pump inhibitors (PPIs) are effective drugs for the treatment of gastroesophageal reflux disease (GERD), their use has been linked to increased risk of fractures, pneumonia, enteric infections, vitamin and mineral deficiencies, and acute interstitial nephritis, particularly among older people who make up the largest proportion of PPI users. While there is insufficient evidence to establish causation, these reports deserve consideration when prescribing long term PPI use. This is especially because some patients may be able to stop PPI use immediately after the initial course of therapy without experiencing symptoms. Even though GERD is often a chronic condition, over time the disease may not require acid suppression and it is important that patients do not take drugs that are no longer necessary.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6826;36;"Choosing Wisely UK";"Royal College of Radiologists";English;"It is recommended that the use of routine scanning after cancer treatment be used only when beneficial to the patient.";"After treatment for cancer, the use of routine scanning should only be used where this is beneficial to the patient. The recommendation does not have more information, evidence or additional references.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3499;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use whole-body CT to image children (under 16s). Use clinical judgement to limit CT to the body areas where assessment is needed.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3755;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S.BMJ 2016; 352:i296";English;"Only patients with BP below 160/100 should be referred for surgery to avoid cancellations, guidelines say";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4011;29;"Choosing Wisely Australia";" Gastroenterological Society of Australia";English;"Do not undertake genetic testing for coeliac genes as a screening test for coeliac disease.";"The value of testing for coeliac genes is primarily as a negative test ? if the gene test is negative then coeliac disease may be excluded. However as a coeliac gene can be found in approximately one third of the population, a positive result does not make coeliac disease a certainty. Serological testing, in a patient consuming an appropriate amount of gluten, is the appropriate first line screening test for coeliac disease. A small bowel biopsy is then required if serology is positive.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6827;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"It is recommended that the use of intra-articular and soft-tissue steroid injections for non-inflammatory musculoskeletal conditions should be preceded by consideration of non-invasive alternatives such as exercise and physical therapy.";"The use of intra-articular and soft tissue steroid injections for noninflammatory musculoskeletal conditions should be preceded by consideration of noninvasive alternatives, such as exercise and physical therapy. Consent for any invasive procedure such as this must arise from a shared decision-making conversation with each patient, which includes an assessment of the risks and benefits. Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise but will be beneficial to the joints in the long term.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3500;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not rely on capillary return or Doppler signal to exclude vascular injury.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3756;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2016; 352:i366";English;"Physiotherapy and occupational therapy do not improve early Parkinson?s disease, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4012;29;"Choosing Wisely Australia";"Gastroenterological Society of Australia";English;"Do not perform a follow-up endoscopy less than three years after two consecutive findings of no dysplasia from endoscopies with appropriate four quadrant biopsies for patients diagnosed with Barrett?s Oesophagus.";"Barrett?s Oesophagus (or Barrett?s mucosa) is the term given to a change which occurs in the lining of the lower oesophagus. It occurs in a small proportion of patients with longstanding gastro-oesophageal reflux. The condition requires surveillance because of an increased risk of oesophageal adenocarcinoma (EAC). This usually develops slowly over a period of some years and can be predicted by the finding of pre-cancerous changes (dysplasia) on biopsies. However, systematic surveillance of Barrett?s Oesophagus patients has not been shown to be cost-effective, and no randomised controlled trials have been conducted to compare surveillance with the natural history of Barrett?s Oesophagus. According to currently-accepted guidelines, it is appropriate and safe to examine the oesophagus and check for dysplasia every three years, as cellular changes occur very slowly.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6828;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"It is not recommended to use C3, C4 and double stranded DNA as screening test for Lupus.";"C3, C4, and double-stranded DNA are important tests to aid in the diagnosis and assessment of disease activity in lupus. They should be reserved for specialized monitoring of disease activity and should be avoided as screening tests. In specialist management, if patients have a strong clinical probability of having lupus, a test for anti-double-stranded DNA antibodies should be performed because they are much more specific for lupus, being very rare in other conditions. C3 generally has a higher sensitivity than C4 serum for active nephrogenic lupus, but both tests have modest specificity and their clinical utility lies in their high negative predictive value (>90%) in excluding active disease, especially renal disease.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3501;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not irrigate open fractures of the long bones, hindfoot or midfoot in pre-hospital settings.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3757;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:i315";English;"Real acupuncture for hot flushes is no better than sham, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4013;29;"Choosing Wisely Australia";"Australian and New Zealand Association of Neurologists";English;"Don?t perform imaging of the carotid arteries for simple faints";"Syncope is common, with a lifetime prevalence of 40%. Carotid imaging studies such as carotid duplex are commonly performed in patients presenting with syncope. When symptomatic, occlusive carotid artery disease causes focal neurologic symptoms such as weakness, altered sensation or speech, and not syncope. In addition, studies demonstrate that even elderly patients with syncope are unlikely to have carotid occlusive disease. Therefore, performing carotid imaging studies in patients with syncope increases cost without adding benefit. Furthermore, carotid imaging may identify incidental asymptomatic occlusive carotid artery disease that may be inappropriately assumed to be the cause of the syncope. This can delay the identification of the true cause of syncope and may subject the patient to additional risk-associated procedures such as catheter angiography, carotid endarterectomy (CEA), or carotid stenting.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3502;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use whole-body CT to image children (under 16s). Use clinical judgement to limit CT to the body areas where assessment is needed.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3758;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:i545";English;"Antidepressants may double risk of suicide and aggression in children, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4014;29;"Choosing Wisely Australia";"Australian and New Zealand Association of Neurologists";English;"Don?t perform imaging of the brain for non-acute primary headache disorders.";"Headache is a common disorder with many potential causes. The primary headache disorders, which include migraine and tension headaches, account for the majority of headaches. Secondary headaches, which are those with underlying pathology (e.g., tumour, aneurysm, or giant cell arteritis) are far less common. Most patients presenting with headache will not have a serious underlying condition. Neuroimaging is not usually warranted for patients with recurrent migraine or tension headaches and a normal neurological examination. The likelihood of significant intracranial lesions on CT or MRI in this group ranges from 0.3% to 0.4%. Headache worsened by Valsalva maneuver, headache causing awakening from sleep, new headache in the older population, or progressively worsening headache may indicate a higher likelihood of finding significant abnormalities on CT or MRI as does the presence of abnormal neurological signs on examination.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6830;36;"Choosing Wisely UK";"British Society of Rheumatology";English;"Testing ANA and ENAs is not recommended for patients suspected to have a diagnosis of a connective tissue disease, such as lupus.";"Testing ANA and ENAs should be avoided in the investigation of widespread pain or fatigue alone. Repeat testing is not normally indicated unless the clinical picture changes significantly. Because of the high sensitivity of the ANA for Systemic Lupus Erythematosus (SLE), almost all patients with SLE will have a positive ANA test. However due to its low prevalence in the general population, most people with positive ANAs do not have SLE.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3503;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use FAST (focused assessment with sonography for trauma) as a screening modality to determine the need for CT in patients with major trauma.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3759;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Ochodo E. BMJ 2016; 352:i107";English;"Rapid diagnostic tests for malaria have the potential to reduce the overtreatment of malaria by 95%, but time and extensive logistical, behavioural, and technical interventions may be required to achieve this.";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4015;29;"Choosing Wisely Australia";"Australian and New Zealand Association of Neurologists";English;"Don?t perform epidural steroid injections to treat patients with low back pain who do not have radicular symptoms in the legs originating from the nerve roots.";"Lumbar epidural steroid injections may provide limited short term benefit (less than 3-6 months) for patients with an acute lumbar radiculopathy causing back pain and symptoms in the legs. When there is low back pain alone, the outcomes of epidural steroid injections are poor. Although serious adverse events are rare, catastrophic events can occur and any symptom relief from the injection is typically brief. The inconsequential benefits of epidural steroid injections for low back pain without radicular symptoms do not outweigh its risks, no matter how small they may be.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6319;29;"Choosing Wisely Australia";"College of Intensive Care Medicine of Australia and New Zealand";English;"For patients with limited life expectancy ensure patients have a ?goals of care? discussion at or prior to admission to ICU and for patients in ICU who are at high risk for death or severely impaired functional recovery, ensure that alternative care focused predominantly on comfort and dignity is offered to patients and their families.";"The ANZICS Statement on Care and Decision Making at the End of Life for the Critically Ill states that the goal of intensive care is to return patients to a quality of life that is acceptable to them. In order to achieve this goal, it is essential that clinicians explore the values and preferences of each patient. Engaging with patients and their families in the discussions around treatment limitations or withdrawal can improve the quality of dying and reduce family and staff stress and bereavement.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 6831;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health";English;"It is recommended an examination of the skin around the vagina to rule out other conditions, such as a lack of vaginal estrogen, allergies, or other skin conditions, rather than receiving another course of treatment for yeast infection, in a woman who it is believed that she has recurrent yeast infection. ";"The recommendation does not have more information, evidence, or additional references.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3504;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use FAST (focused assessment with sonography for trauma) or other diagnostic imaging before immediate CT in patients with major trauma.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3760;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 352:i1038";English;"Feedback to GPs reduces antibiotic prescribing, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4016;29;"Choosing Wisely Australia";"Australian and New Zealand Association of Neurologists";English;"Don?t use opioids for the treatment of migraine, except in rare circumstances.";"Migraine is the most frequent cause of headache seen in the medical office, urgent care, or emergency department. Almost all patients should receive migraine-specific medications or non-opioid analgesics because these medications are the most effective migraine treatments. However, many patients continue to receive opioids for migraine treatment. Use of opioids increases the risk of headache and chronic migraine arising from medication overuse. The per capita cost of headache and chronic migraine arising from medication overuse is 3 times that of episodic migraine. When medical conditions such as cardiovascular disease or pregnancy preclude use of migraine-specific treatments, or when migraine-specific treatments fail, opioids are sometimes considered for rescue therapy. In these circumstances, use should be limited to 9 days per month or less to avoid medication overuse headache, and doctors should continue to focus on preventive and behavioural aspects of migraine care. In addition, long-term follow-up is needed to prevent treatment complications.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6832;36;"Choosing Wisely UK";"Faculty of Sexual and Reproductive Health";English;"It is not recommended using a vaginal swab if a women at low risk of having a sexually transmitted infection has abnormal vaginal discharge that is likely to be caused by thrush (also known as candida) or Bacterial vaginosis (BV).";"If a woman has abnormal vaginal discharge that is likely to be caused by thrush (also known as candida) or Bacterial vaginosis (BV) and she is at low risk of having a sexually transmitted infection, a vaginal swab is not usually necessary. The recommendation does not have more information, evidence, or additional references available.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative" 3505;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not rely on a haemorrhagic risk tool applied at a single time point to determine the need for major haemorrhage protocol activation.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3761;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 352:i1527";English;"BMA calls for changes to end of life care";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4017;29;"Choosing Wisely Australia";"Australian and New Zealand Association of Neurologists";English;"Don?t routinely recommend surgery for a narrowed carotid artery (>50% stenosis) that has not caused symptoms.";"Best medical therapy is generally the appropriate management of patients with asymptomatic carotid stenosis. Medical treatment has improved since trials comparing carotid endarterectomy (CEA) plus best medical treatment with best medical treatment in asymptomatic carotid stenosis were conducted. There is evidence that the annual stroke rate in patients with asymptomatic carotid stenosis receiving best medical treatment has fallen to ?1% annually. The effectiveness of CEA compared with current best medical therapy is not established. Additionally, randomised trials suggested equivocal benefit in women and patients aged >75. It may be reasonable to consider CEA for highly selected patient aged <75 years with >70% stenosis of the internal carotid artery. Where the perioperative risk of stroke, death and myocardial infarction is <3% and the patient is estimated to have a life expectancy of more than 3 to 5 years, consultation with a physician with expertise in stroke care is recommended prior to surgery.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3506;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use plasma to reverse a vitamin K antagonist in patients with major trauma.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3762;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 352:i1597";English;"Cervical pessary does not prevent preterm births, study shows";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3507;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use intravenous tranexamic acid* more than 3 hours after injury in patients with major trauma unless there is evidence of hyperfibrinolysis.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3763;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Khullar D. BMJ 2016; 352:i1417";English;"Reducing prognostic errors: a new imperative in quality healthcare";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4019;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners";English;"Don?t order chest x-rays in patients with uncomplicated acute bronchitis.";"Acute bronchitis is the commonest cause of cough presenting to GPs. It is usually viral (>90%) and self-limiting, and antibiotics should not routinely be used. Chest x-rays (CXRs) are the imaging tests most frequently ordered by Australian GPs, and the most common indication is acute bronchitis/ bronchiolitis (140,000 annually, data combined for both conditions).?Uncomplicated? bronchitis refers to cough and sputum lasting less than three weeks in immunocompetent patients without underlying respiratory disease, and no clinical features suggesting pneumonia (heart rate >100, resp rate>24, temp>38.0C, haemoptysis, signs of consolidation). A Cochrane review found routine CXR did not affect outcomes in adults or children presenting to hospital with acute chest infection. Note that purulent (green) sputum is not predictive of bacterial infection and is not in itself an indication for CXR. CXRs may also lead to false positives, further investigation and unnecessary radiation. The threshold for CXR should be lower in patients over 60.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6323;29;"Choosing Wisely Australia";"College of Intensive Care Medicine of Australia and New Zealand";English;"It is recommended that all invasive devices, such as intravascular lines and urinary catheters, be removed as soon as possible in intensive care unit patients.";"Patients in the intensive care unit often require invasive devices as part of their treatment as well as monitoring of therapy. These lines however are a potential source of healthcare related infections. Preventative ?bundles? of care including simple measures such as hand hygiene and aseptic methods of insertion and care of devices have reduced the risk of health care related infections. Infections related to invasive devices are a significant cause of morbidity and mortality. Hence, all invasive devices such as arterial lines, central lines, urinary catheters should be removed as soon as possible.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3508;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use CT for first-line imaging to assess chest trauma in children (under 16s).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3764;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 352:i1609";English;"Paracetamol does not reduce pain or improve function in osteoarthritis, study shows";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4020;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners";English;"Don?t routinely do a pelvic examination with a Pap smear.";"During a routine cervical smear for screening (i.e. no symptoms), a bimanual pelvic examination has no proven benefit, as it has not been shown to improve the detection of ovarian cancer or to benefit other outcomes. In a large study of Australian women undergoing routine screening pelvic examination, no ovarian malignancies were found, and the high prevalence of benign abnormalities (bulky/fibroid uterus in 13%, abnormal adnexal findings in 2%) often led to further investigation. A recent US review concluded that no data supports the effectiveness of speculum or bimanual pelvic examinations in the asymptomatic, average-risk woman. The procedure causes pain, fear, anxiety, and/or embarrassment in a third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures. Pelvic examinations require additional clinician time and, for consultations not otherwise requiring intimate examination, the consideration of a chaperone. Therefore, unnecessary examinations lead to resource and opportunity costs.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3509;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the person has severe bulbar impairment or severe cognitive problems that may be related to respiratory impairment, do not perform the other respiratory function tests (FVC, VC, SNIP and MIP) if interfaces are not suitable for the person.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3765;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2016; 352:i1621";English;"Margaret McCartney: Looking for dementia?in the name of ?awareness?";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4021;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners";English;"Don?t treat otitis media with antibiotics, in non-Indigenous children aged 2-12 years, where reassessment is a reasonable option.";"Avoid the routine use of antibiotics in acute otitis media, except in a child with acute systemic features such as high fever, vomiting or lethargy. Clinical review at 24-48 hours is good practice, if available. Regardless of whether one or both eardrums are red or bulging, antibiotics do not reduce pain at 24 hours, and up to 20 children must be treated to prevent pain in one child at 2 to 7 days. Routine antibiotic use slightly reduces tympanic membrane perforation (NNT = 33) but has no effect on tympanic membrane findings at 3 months, nor on severe complications. One in 14 children will develop antibiotic side effects, particularly rash, diarrhoea, or vomiting. Antibiotic use promotes bacterial resistance, both in the individual and community. Aboriginal and Torres Strait Islander children are at higher risk of complications and should be treated early. Guidelines vary about the value of antibiotic treatment in children aged 6-23 months, but support antibiotics for infants under 6 months.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3510;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ensure the transition planning is developmentally appropriate and takes into account each young person's capabilities, needs and hopes for the future. The point of transfer should: not be based on a rigid age threshold, take place at a time of relative st";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3766;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2016; 352:i1614";English;"Doctors are urged to limit opioid prescribing";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6326;29;"Choosing Wisely Australia";"College of Intensive Care Medicine of Australia and New Zealand";English;"Transfuse red cells for anaemia only if the haemoglobin concentration is less than 70gm/L or if the patient is haemodynamically unstable or has significant cardiovascular or respiratory comorbidity. ";"Numerous studies have highlighted the adverse outcomes that may be associated with blood transfusion. Randomised and other trials have indicated that transfusion of red blood cells for the treatment of anaemia in otherwise haemodynamically stable patients is either of no benefit or even harmful. There appears to be little or no proven benefit of transfusing beyond a threshold haemoglobin level of 70gm/L though the precise threshold for any given patient is unknown. Patients with active cardio-respiratory disease or neurological injury may warrant a higher threshold although harm associated with liberal transfusion in this group has also been reported.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3767;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2016; 353:i1926";English;"Alternatives to statins in intolerant patients do lower cholesterol, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4023;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners";English;"Don?t order colonoscopy as a screening test for bowel cancer in people at average or slightly above average risk. Use faecal occult blood screening instead.";"This recommendation does not apply to people with a bowel symptom such as bleeding. Approximately 98% of Australians are at ?average? or ?slightly above average? risk (e.g. one relative with bowel cancer diagnosed at ? 55yo). RACGP guidelines recommend two-yearly faecal occult blood testing (FOBT) from 50-75 years of age. The best available data to 2011 suggests 13% of this group were instead over-screened using colonoscopy. National Bowel Cancer Screening Program (NBCSP) data shows that, per 10,000 people in this group followed up for an average 18 months, 6 will die from bowel cancer if unscreened. If screened with colonoscopy, 2.3 will die (1.5 from bowel cancer plus 0.8 from colonoscopy complications), compared to just 1.9 deaths for FOBT. A colonoscopy also risks bowel perforation (7 per 10,000), involves bowel preparation, and costs around $3000. NBCSP monitoring shows that a negative FOBT is 99.9% specific in ruling out bowel cancer.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3768;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2016; 353:i1899";English;"Blood pressure lowering does not reduce risk of cardiovascular events in patients at intermediate risk";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6328;29;"Choosing Wisely Australia";"College of Intensive Care Medicine of Australia and New Zealand";English;"Undertake daily attempts to lighten sedation in ventilated patients unless specifically contraindicated and deeply sedate mechanically ventilated patients only if there is a specific indication. ";"Critically ill patients requiring mechanical ventilation are frequently treated with sedatives and analgesics, to treat pain, anxiety, dyspnoea and reduce tissue oxygen consumption. However prolonged or excessive sedation can be associated with delirium, critical illness weakness, prolonged ventilation and length of stay. Protocol-based approaches to limit deep sedation, by explicating titrating the sedation to a sedation goal, and daily interruptions of sedation, have been shown to improve patient outcomes, including a reduction in mortality. Exceptions to the daily sedation holiday are for patients requiring muscle paralysis, who should not be woken until the paralytic agent has worn off.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3257;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Avoid using robotic assisted laparoscopic surgery for benign gynecologic disease when it is feasible to use a conventional laparoscopic or vaginal approach.";"Robotic-assisted and conventional laparoscopic techniques are comparable with respect to perioperative outcomes, intraoperative complications, length of hospital stay and rate of conversion to open surgery. However, evidence shows that robotic-assisted laparoscopic surgery has similar or longer operating times and higher associated costs. Therefore, the limited available data does not show any benefits of robotic surgery for patients with benign gynecologic disease.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3513;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"The CTFPHC recommends not performing a screening pelvic examination to screen for noncervical cancer, pelvic inflammatory disease, or other gynecological conditions in asymptomatic women.";"The recommendation applies to screening pelvic examination in asymptomatic, nonpregnant, adult women. However, it should be noted that pelvic examination is appropriate in other clinical situations, such as for diagnosis of gynecological conditions when women present with symptoms or for follow up of a previously diagnosed condition.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3769;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2132";English;"Fusion adds little value to decompression for lumbar spinal stenosis, studies show";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3258;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t perform prenatal ultrasounds for non-medical purposes, for example, solely to create keep sake videos or photographs.";"Prenatal ultrasounds are an integral part of a woman?s prenatal care. While obstetric ultrasound has an excellent safety record, the U.S. Food and Drug Administration considers keep sake imaging as an unapproved use of a medical device. The American Institute of Ultrasound in Medicine also discourages the non-medical use of ultrasound for entertainment purposes. Keepsake ultrasounds are not medical tests and should not replace a clinically performed sonogram.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3514;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for syphilis infection in persons who are at increased risk for infection.";"Recommendation grade A";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3770;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2016; 353:i1958";English;"Healthy people need fewer preoperative tests for elective surgery, says NICE";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3259;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7?8 grams.";"Multiple factors need to be considered in transfusion decisions, including the patient?s clinical status and oxygen delivery ability. Arbitrary hemoglobin or hematocrit thresholds should not be used as the only criterion for transfusions of packed red blood cells.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3515;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years.";"Recommendation grade A";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3771;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2163";English;"Long term use of proton pump inhibitors may increase risk of impaired kidney function";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6331;29;"Choosing Wisely Australia";"College of Intensive Care Medicine of Australia and New Zealand";English;"De-escalation of daily antibiotics is recommended, especially in patients who require intensive care.";"Infection can precipitate a need for intensive care admission and can occur as a complication of an ICU admission. The earliest administration of the most appropriate antibiotic and source control confer mortality benefit. However, antibiotics are also frequently used for the presumptive management of patients with ?sepsis? that may later prove to not have an infectious aetiology. In most circumstances, data regarding the appropriate duration of antibiotic administration are very difficult to interpret. In some conditions such as endocarditis or osteomyelitis longer courses of antibiotics have been recommended. However, there is increasing evidence that shorter courses of antibiotics for common infections such as hospital acquired pneumonia do not confer worse outcomes or increased mortality than longer courses. Moreover, shorter courses probably help to prevent the development of antibiotic resistance. In the absence of microbiological evidence of ongoing infection and with an improvement in clinical status, consideration should be given to discontinuing antibiotics at the earliest opportunity possible.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative" 3260;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t perform pelvic ultrasound in average risk women to screen for ovarian cancer.";"Although the mortality rate associated with ovarian cancer is high, the disease occurs infrequently in the general U.S. population, with an age-adjusted incidence of 13 cases per 100,000 women. As a result, the positive predictive value of screening for ovarian cancer is low, and most women with a positive screening test result will have a false-positive result. Annual screening with transvaginal ultrasonography in women does not reduce the number of ovarian cancer deaths.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3516;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t promote induction or augmentation of labor and don?t induce or augment labor without a medical indication; spontaneous labor is safest for woman and infant, with benefits that improve safety and promote short- and long-term maternal and infant healt";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3772;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kamerow D. BMJ 2016; 353:i2060";English;"HPV vaccine: effective but underused in the US";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4540;33;"Choosing Wisely � : Things we do for no reason";"Pahwa. A. J. Hosp. Med. 2016 January;11(1):77-80";English;"The measurement of fractional excretion of sodium (FeNa) can aid in the diagnosis of hepatorenal syndrome. Otherwise, the routine use of FeNa and fractional excretion of urea (FeUr) in the diagnosis and management of acute kidney injury should be avoided.";"For further information please visit the website of the initiative (link below) ";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3261;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t routinely recommend activity restriction or bed rest during pregnancy for any indication";"Bed rest or activity restriction has been commonly recommended for a variety of conditions in pregnancy including multiple gestation, intrauterine growth restriction, preterm labor, premature rupture of membranes, vaginal bleeding and hypertensive disorders in pregnancy. However, information to date does not show an improvement in birth outcome with the use of bed rest or activity restriction, but does show an increase in loss of muscle conditioning and thromboembolic disease.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3517;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t prescribe opioid pain medication in pregnancy without discussing and fully weighing the risks to the woman and her fetus.";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3773;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2197";English;"Risk of meningitis is higher in people treated with antimicrobials in previous year, study shows";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4541;33;"Choosing Wisely � : Things we do for no reason";"Pahwa. A. J. Hosp. Med. 2016 January;11(1):77-80";English;"In pre?renal azotemia, therapeutic intervention is guided by etiology of the disorder (e.g., intravenous crystalloid support based on a history of hypovolemia and ongoing hypoperfusion, diuresis and/or inotropic support in setting of decompensated heart failure, etc.), without regard to baseline fractional excretion of sodium and fractional excretion of urea.";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3262;2;"Choosing Wisely�";"HIV Medicine Association";English;"Avoid unnecessary CD4 tests.";"A CD4 count is not required in conjunction with every viral load test. Viral load testing is a better indicator of a patient?s response to therapy. CD4 monitoring is not necessary for patients who have stable viral suppression. For the first two years after treatment initiation, the CD4 count should be monitored every three to six months. After two years, if the viral load is undetectable, the CD4 count should be measured yearly if it is 300?500 cells/mm3. If it is consistently above >500 cells/mm3 then further monitoring is optional.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3518;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t separate mothers and their newborns at birth unless medically necessary. Instead, help the mother to place her newborn in skin-to-skin contact immediately after birth and encourage her to keep her newborn in her room during hospitalization after the";"For further information please visit the website of the initiative (link below";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3774;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2016; 353:i2151";English;"Too much scrutiny is bad for general practice";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4542;33;"Choosing Wisely � : Things we do for no reason";"Dittmar P. J. Hosp. Med. 2016 February;11(2):117-119";English;"Carotid artery ultrasound should not be included in the diagnostic evaluation of patients suspected of syncope in the absence of other neurologic symptoms.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3263;2;"Choosing Wisely�";"HIV Medicine Association";English;"Don?t order complex lymphocyte panels when ordering CD4 counts.";"Order only CD4 counts and percentages rather than ordering other lymphocyte panels. For example, CD8 testing, including the CD4/CD8 ratio, adds cost without providing useful information. More complex lymphocyte panels are unnecessary and increase costs even more.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3519;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t administer ?prn? (i.e., as needed) sedative, antipsychotic or hypnotic medications to prevent and/or treat delirium without first assessing for, removing and treating the underlying causes of delirium and using nonpharmacologic delirium prevention a";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3775;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hawkes N. BMJ 2016; 353:i2316";English;"Stigma is leading to under-treatment of mental health conditions, says leading psychiatrist";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4543;33;"Choosing Wisely � : Things we do for no reason";"Dittmar P. J. Hosp. Med. 2016 February;11(2):117-119";English;"It is recommended to use postural blood pressures in the initial evaluation of syncope as an inexpensive and high?value component of the physical examination.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3264;2;"Choosing Wisely�";"HIV Medicine Association";English;"Avoid quarterly viral load testing of patients who have durable viral suppression, unless clinically indicated.";"Viral load testing should be conducted before initiation of treatment, two to eight weeks after initiation or modification of therapy, and then every three to four months to confirm continuous viral suppression. In clinically stable patients who have durable virological suppression for more than two years, clinicians may extend the interval to six months.2";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3520;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t assume a diagnosis of dementia in an older adult who presents with an altered mental status and/or symptoms of confusion without assessing for delirium or delirium superimposed on dementia using a brief, sensitive, validated assessment tool.";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3776;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 353:i2363";English;"No increased heart failure risk is reported with DPP-4 inhibitors";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4544;33;"Choosing Wisely � : Things we do for no reason";"Barbieri J. J. Hosp. Med. 2016 May;11(5):366-368";English;"Lipase should be ordered alone rather than ordering either amylase alone or amylase and lipase together, in patients suspected of having acute pancreatitis.";"For further information please visit the website of the initiative (link below) ";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3265;2;"Choosing Wisely�";"HIV Medicine Association";English;"Don?t routinely test for CMV IgG in HIV-infected patients who have a high likelihood of being infected with CMV.";"Cytomegalovirus (CMV) IgG testing is recommended only in patients who are at lower risk for CMV to detect latent CMV infection. CMV IgG testing is not necessary in patients at higher risk for CMV, including men who have sex with men and injection drug users, because they can be assumed to be CMV positive. Testing for CMV antibody in low-risk populations is recommended to foster patient counseling in avoidance of CMV infection through practicing safe sex and to avoid transfusion except with CMV-negative blood products. Patients at lower risk for CMV infection, e.g., patients who are heterosexual and have not injected drugs, should be tested for latent CMV infection with an anti-CMV IgG upon initiation of care.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3521;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Don?t order blood tests at regular intervals (such as every day) or routine extensive lab panels including X-rays without specific clinical questions.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3777;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2577";English;"Doctors are urged to measure blood pressure in both arms";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4545;33;"Choosing Wisely � : Things we do for no reason";"Barbieri J. J. Hosp. Med. 2016 May;11(5):366-368";English;"Pancreatic enzymes should not be repeated after making the diagnosis of acute pancreatitis, as this practice does not provide additional information that is of clinical utility.";"For further information please visit the website of the initiative (link below) ";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3266;2;"Choosing Wisely�";"HIV Medicine Association";English;"Don?t routinely order testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency for patients who are not predisposed due to race/ethnicity.";"G6PD deficiency testing is recommended upon entry into care or before starting therapy with an oxidant drug only in HIV-infected patients who are predisposed to this genetic disorder that can cause hemolytic anemia. G6PD most frequently occurs in populations of African, Asian and Mediterranean descent and is most likely to affect HIV-infected patients with one of these racial or ethnic backgrounds.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3522;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Don?t place, or leave in place, urinary catheters for incontinence, convenience or monitoring of output for non-critically ill patients";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3778;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2571";English;"Giving patients rosuvastatin before surgery does not prevent complications, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4546;33;"Choosing Wisely � : Things we do for no reason";"Narayan A. J. Hosp. Med. 2016 June;11(6):435-437";English;"Seafood and other food allergies do not represent contraindications to obtaining contrast?enhanced CT scans and should not prompt a change in management. ";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3267;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t perform routine cervical length screening for preterm birth risk assessment in asymptomatic women before 16 weeks of gestation or beyond 24 weeks of gestation.";"The predictive ability of cervical length measurement prior to 16 weeks of gestation for preterm birth risk assessment is limited. It should be performed, when indicated, between 16 and 24 weeks of gestation. Routine cervical length screening for preterm birth risk assessment in asymptomatic women beyond 24 weeks of gestation has not been proven to be effective.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3523;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Don?t transfuse more than the minimum number of red blood (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe haemoglobin range.";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3779;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2609";English;"NICE recommends PCSK9 inhibitors for patients not responding to statins";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4547;33;"Choosing Wisely � : Things we do for no reason";"Wood J. J. Hosp. Med. 2016 July;11(7):505-508";English;"Previously healthy children with acute hematogenous osteomyelitis, without endovascular complications, should be transitioned to enteral antibiotics when they are showing signs of clinical improvement, as defined by: resolution of fever, improving physical exam, ability to take oral medications, and decreasing C?reactive protein.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3268;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t perform antenatal testing on women with the diagnosis of gestational diabetes who are well controlled by diet alone and without other indications for testing.";"Monitoring of glucose levels and maintaining adequate glycemic control for gestational diabetes are paramount to decreasing adverse outcomes, including stillbirth. If nutritional modification and glucose monitoring alone control maternal glycemic status such that pharmacological therapy is not required, the risk of stillbirth due to uteroplacental insufficiency is not increased. Thus, the use of routine antepartum testing (e.g. biophysical profile (BPP) or nonstress test (NST)) in the absence of other co-morbidities is not indicated.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3524;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Don?t let older adults lie in bed during their hospital stay. In addition, individual therapeutic goals should be established considering the patients? values and preferences.";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3780;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 353:i2655";English;"Many people receive suboptimal care after myocardial infarction, research shows";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4548;33;"Choosing Wisely � : Things we do for no reason";"Gunderson C. J. Hosp. Med. 2016 August;11(8):587-590";English;"Antibiotics should be directed at ?hemolytic streptococci and methicillin?susceptible S aureus, with a suggested antibiotic by the Infectious Disease Society of America including, penicillin, ceftriaxone, cefazolin, or clindamycin in patients hospitalized with nonpurulent cellulitis who are not severely immunocompromised or severely ill and for whom necrotizing soft tissue infection is not suspect";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3269;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t place women, even those at high-risk, on activity restriction to prevent preterm birth.";"There are no studies documenting an improvement in outcomes in women at risk for preterm birth who are placed on activity restriction, including bed rest. There are multiple studies documenting untoward effects of routine activity restriction on the mother and family, including negative psychosocial effects. Therefore, activity restriction should not be routinely prescribed as a treatment to reduce preterm birth.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3525;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Don?t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium and avoid prescription at discharge.";"For further information please visit the website of the initiative (link below";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3781;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2617";English;"Probiotics have no effect on gut microbiota in healthy people, review suggests";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4549;33;"Choosing Wisely � : Things we do for no reason";"Petrilli C. J. Hosp. Med. 2016 November;11(11):801-804";English;"Clinicians should avoid ordering thrombophilia testing for hospitalized patients with unprovoked VTE.";"For further information please visit the website of the initiative (link below) ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3270;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t order serum aneuploidy screening after cfDNA aneuploidy screening has already been performed.";"Serum biochemistry and cell free DNA (cfDNA) are both screening tests for fetal aneuploidy. When low-risk results have been reported on either test, there is limited clinical value of also performing the other screen. While serum screening may identify some aneuploidies not detected by cfDNA, the yield is too low to justify this test if cfDNA screening has already been performed.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3526;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely use whole-body CT to image children (under 16s). Use clinical judgement to limit CT to the body areas where assessment is needed.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3782;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2654";English;"Ticagrelor is no better than aspirin at preventing cardiovascular events after acute stroke or TIA, study finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3271;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t perform maternal serologic studies for cytomegalovirus and toxoplasma as part of routine prenatal laboratory studies.";"Routine serologic screening of pregnant women for CMV and toxoplasmosis is not recommended due to poor predictive value of these tests and potential for harm due to false positive results. Serologic screening during pregnancy for both diseases should be reserved for situations in which there is clinical or ultrasound suspicion of maternal or fetal infection.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3527;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use medications in the acute stage after traumatic spinal cord injury to prevent neuropathic pain from developing in the chronic stage.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3783;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i2876";English;"Aspirin after stroke reduces further events but benefits decline with time, analysis shows";"For further information please visit the website of the initiative (link below)";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3528;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use the methylprednisolone, nimodipine or naloxone to provide neuroprotection and prevention of secondary deterioration, in the acute stage after acute traumatic spinal cord injury.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3784;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i3066";English;"European drug agency recommends limiting colistin use in animals to cut resistance in patients";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3529;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not carry out or maintain full in-line spinal immobilisation in people if they have low-risk factors for cervical spine injury as identified and indicated by the Canadian C-spine rule, are pain free and are able to actively rotate their neck 45 degrees";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3785;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2016; 353:i3234";English;"Most antidepressants are ineffective in children and teenagers, study shows";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3530;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not transport people with suspected acute traumatic spinal cord injury (with or without column injury), with full in-line spinal immobilisation, directly to a spinal cord injury centre from the scene of the incident.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3786;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2016; 353:i3541";English;"Do not prescribe antibiotics for bronchiolitis in children, doctors are reminded";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3531;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Patients with blunt major trauma and suspected multiple injuries should not be repositioned during whole-body CT.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3787;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2016; 353:i3634";English;"Routine pelvic examinations in asymptomatic, nonpregnant adult women have no confirmed benefits.";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3532;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use a tiered team response in trauma units";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3788;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2016; 353:i3613";English;"Doctors give patients potentially harmful procedures at end of life, global review finds";"For further information please visit the website of the initiative (link below)";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5836;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The relationship between regulations on the scope of practice of nursing professionals and the costs of medical care is not clear";"The COVID-19 pandemic is placing a strain on healthcare workers. Existing research on expanding the role of nurse practitioners may provide useful information for policy makers. In this systematic review, the authors searched for studies evaluating the impact of scope-of-practice regulations on the delivery of primary health care by nurse practitioners. They restricted their searches to articles published in English and did the search in January 2015. They included 9 time-series analyses and 6 cross-sectional studies. Less restrictive restrictions on nurse practitioners scope-of-practice may improve primary care capacity. A large supply of nurse practitioners does not increase healthcare use, unless it is combined with scope-of-practice regulation that allow nurse practitioners to function independently.";2016;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3533;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Pomalidomide, in combination with dexamethasone, is not recommended within its marketing authorisation for treating relapsed and refractory multiple myeloma in adults who have had at least 2 previous treatments, including lenalidomide and bortezomib, and ";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3789;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"No se recomienda la utilizaci�n de benzodiacepinas ante cambios conductuales y/o cognitivos agudos en pacientes ancianos con riesgo de padecer delirium.";"(Recomendaci�n en proceso de traducci�n).";2016;;;"Low value";Benzodiazepines; 3534;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer people with myeloma or smouldering myeloma routine skeletal surveys for disease monitoring.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3790;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital Sant Pau";Spanish;"1) No se recomienda analizar de forma rutinaria la presencia de sustancias de abuso en orina. 2) No se recomienda analizar la presencia de sustancias farmacol�gicas susceptibles de abuso (benzodiacepinas, metadona, etc.) si el paciente se encuentra en tr";"RECOMMENDATION IN TRANSLATION PROCESS";2016;;;"Low value";"Drugs of abuse";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3535;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer fixed low-dose vitamin K antagonists for thromboprophylaxis to people with myeloma who are starting immunomodulatory drugs.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3791;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"En mujeres con c�ncer de mama metast�sico se sugiere no administrar Bevacizumab ni con Taxanos ni con Capecitabina como tratamiento de primera l�nea.";"(Recomendaci�n en proceso de traducci�n).";2016;;;"Low value";"Bevacizumab, Cancer, Breast"; 3536;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use serum protein electrophoresis, serum immunofixation, serum-free light-chain assay or urine electrophoresis (urine Bence?Jones protein assessment) alone to exclude a diagnosis of myeloma.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3792;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"- La implantaci�n de una v�lvula a�rtica percut�nea (TAVI) en pacientes con estenosis a�rtica con elevado riesgo quir�rgico podr�a potencialmente incrementar el riesgo de ictus. - No se recomienda la implantaci�n de una TAVI en forma rutinaria en paciente";"(Recomendaci�n en proceso de traducci�n).";2016;;;"Low value";"Aortic stenosis"; 3537;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use isotope bone scans to identify myeloma-related bone disease in people with a plasma cell disorder suspected to be myeloma.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3793;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"No se recomienda la utilizaci�n de los p�ptidos natriur�ticos (BNP, NT-proBNP) para confirmar o descartar el diagn�stico de insuficiencia cardiaca ante la ausencia de una duda razonable del origen cardiaco de los s�ntomas y signos.";"The use of natriuretic peptides (BNP, NT-proBNP) to confirm or rule out the diagnosis of heart failure in the absence of a reasonable doubt of cardiac symptoms and signs is not recommended.";2016;;;"Low value";"Natriuretic peptides";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3538;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not perform plasma exchange for myeloma-induced acute renal disease.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3794;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"No se recomienda realizar electroforesis de prote�nas plasm�ticas en suero (proteinograma) fuera del contexto del diagn�stico y seguimiento de las enfermedades asociadas a gammapat�a monoclonal.";"The use of electrophoresis of plasma proteins in serum (serum protein) outside the context of diagnosis and monitoring of diseases associated with monoclonal gammopathy is not recommended.";2016;;;"Low value";"Serum protein";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3539;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"There is currently insufficient evidence to support the routine adoption of the Vibe and G4 PLATINUM CGM system in the NHS for managing blood glucose levels in people with type 1 diabetes.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3795;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"No se recomienda el uso sistem�tico de oxigenoterapia domiciliaria en pacientes con enfermedad cr�nica avanzada sin insuficiencia respiratoria.";"(Recomendaci�n en proceso de traducci�n).";2016;;;"Low value";"Oxygen therapy"; 3540;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Anti-epileptic drug therapy should only be started once the diagnosis of epilepsy is confirmed, except in exceptional circumstances that require discussion and agreement between the prescriber, the specialist and the child, young person or adult and their";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3796;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"- En el reci�n nacido prematuro que respira espont�neamente se recomienda la estabilizaci�n en sala de partos con CPAP nasal para la prevenci�n de la displasia broncopulmonar. - Se recomienda el uso de surfactante pulmonar en aquellos reci�n nacidos prema";"(Recomendaci�n en proceso de traducci�n).";2016;;;"High value";"Premature, Bronchopulmonary dysplasia"; 3541;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"There is insufficient evidence to recommend the routine use of joint epilepsy and obstetric clinics, although they may be convenient for mothers and healthcare professionals.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3797;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"- No se recomienda la utilizaci�n de dosis �nica anual de Vitamina D porque incrementa la mortalidad y el riesgo de ca�das. - No se recomienda la administraci�n conjunta de Vitamina D y calcio ya que puede incrementar el riesgo de infarto de miocardio.";"(Recomendaci�n en proceso de traducci�n).";2016;;;"Low value";Vitamin; 3542;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Only prescribe buccal midazolam or rectal diazepam for use in the community for children, young people and adults who have had a previous episode of prolonged or serial convulsive seizures.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3798;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"En pacientes sometidos a cirug�a cardiaca, se recomienda el uso de la ecograf�a Doppler como cribado de estenosis de car�tida ante la presencia de 3 o m�s factores de riesgo cardiovascular (arteriopat�a perif�rica, tabaquismo activo o historia prolongada ";"In patients undergoing cardiac surgery, the use of Doppler ultrasound is recommended as a screening of carotid stenosis in the presence of 3 or more cardiovascular risk factors (peripheral arterial disease, active smoking or prolonged history of smoking, hypertension, Diabetes mellitus, dyslipidemia).";2016;;;"High value";"Carotid Ultrasound";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3543;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Regular blood test monitoring in children and young people is not recommended as routine, and should be done only if clinically indicated and recommended by the specialist.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3799;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pediatria";Spanish;"In children younger than 2 years with mild traumatic brain injury, routine skull radiography is not recommended. It should be replaced by scales that include clinical data and the traumatic mechanism to assess the risk of intracranial injury.";"The most recent systematic reviews establish the scales of the CATCH (Canada), Chalice (UK) groups, and the Pediatric Emergency Care Applied Research Network (PECARN) study in the United States. The best to predict the presence of an intracranial injury in children with mild traumatic brain injury. The PECARN study has separately assessed more than 4,500 children younger than 2 years and has identified the following independent risk factors for severe intracranial injury: altered mental status, cephalohematoma outside the frontal region, transient loss of consciousness for 5 seconds Or more, high-energy mechanism, palpable cranial fracture or abnormal parental attitude of the child. The absence of these 6 factors makes the risk of clinically relevant intracranial injury very low (0.02%). On the other hand, skull radiography has limitations (it is often difficult to interpret, has a low sensitivity to diagnose intracranial injury), and subjects the patient to no less than negligible ionizing radiation. However, a Canadian study of pediatric emergency professionals has shown great variability in the application of skull radiography (between 20% and 80% of cases). ";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3544;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"An electroencephalogram (EEG) should be performed only to support a diagnosis of epilepsy in children and young people. If an EEG is considered necessary, it should be performed after the second epileptic seizure but may, in certain circumstances, as eval";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3800;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Societat Catalana de Medicina Familiar i Comunit�ria";Spanish;"In patients with asymptomatic hyperuricemia, it is not recommended to treat with drugs, unless the figures are very high, in cancer treatments or in the presence of urinary excretion of uric acid above 1,100 mg / day.";"Hyperuricemia (uric acid levels above 7 mg / dL in men and 6 mg / dL in women) has a prevalence of approximately 5% of the general population. It increases with obesity, alcohol intake, foods with high content of purines (seafood and red meat) and transplanted solid organs. Plasma determination of uric acid is very widespread because it is assumed that, apart from gout, it is associated with renal, cardiovascular and metabolic alterations, although the evidence of its clinical utility is scarce. The most frequent cause is decreased renal excretion (less than 330 mg / day) due to renal impairment or drugs that make renal clearance difficult (loop diuretics, thiazides, ASA). Currently, there is insufficient evidence to recommend the treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease or cardiovascular events. Clinical trials comparing allopurinol with placebo do not show differences in glomerular filtration rate, serum creatinine or proteinuria between the allopurinol group and untreated patients, although they are small, short in duration and have a high risk of bias. The decision to initiate hypuricemic treatment (eg Allopurinol, febuxostat) should be evaluated individually for potential benefits and risks. It should be noted that, sometimes, serum uric acid levels return to normal without the need for pharmacological treatment, only with modifications in the patient's lifestyle (weight loss, decreased alcohol intake or poor diet in Purines) and substitution of the causative drug, where possible. There is evidence in favor of the use of allopurinol to treat asymptomatic hyperuricemia in the following situations: The persistence of levels above 13 mg / dl in men or 10 mg / dl in women, so that these values ??may entail a risk of nephrotoxicity. In the presence of urinary excretion of uric acid above 1,100 mg / day, because it is associated with an increased risk of 50% calculi, and can be prevented by reducing excretion below 800 mg / day. In patients who should receive radiation therapy or chemotherapy to prevent uric acid nephropathy and other manifestations of tumor lysis syndrome. Also, allopurinol may be the trigger for different adverse effects, the most frequent being rashes, digestive discomfort, and alterations of the liver profile. Hypersensitivity to allopurinol may occur between 0.1 and 1% of those taking it. In Catalonia, according to data from Sisapo 2015, 9% of people between 14 and 90 years old, with a diagnosis of asymptomatic hyperuricemia, are found to be hypouricemic. In conclusion, in patients with asymptomatic hyperuricemia, it is not recommended to treat with drugs, unless the figures are very high (from 13 mg / dl in men, and 10 mg / dl in women), oncological treatments or in the presence of excretion Urinary uric acid levels above 1,100 mg / day. The treatment of choice is allopurinol and in cases of intolerance or contraindication febuxostat should be considered.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3545;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"An EEG should be performed only to support a diagnosis of epilepsy in adults in whom the clinical history suggests that the seizure is likely to be epileptic in origin.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3801;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT head scans in adult patients with simple syncope in the absence of high-risk predictors.";"Patients commonly present to the emergency department with syncope. Syncope is a transient loss of consciousness followed by a spontaneous return to baseline neurologic function that does not require resuscitation. The evaluation of syncope should include a thorough history and physical exam to identify high-risk clinical predictors for CT head abnormalities. These high-risk predictors include, but are not limited to: trauma above the clavicles, headache, persistent neurologic deficit, age over 65, patients taking anticoagulants, or known malignancies. Many patients with syncope receive a CT scan of the head; however, in the absence of these predictors, a CT head is unlikely to aid in the management of syncope patients. CT scans can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. Unwarranted imaging also increases length of stay and misdiagnosis.";2016;;;"Low value";-;"Link to the recommendation in the website of the initiative/Enlace a la recomendaci�n en la p�gina de la iniciativa" 3546;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely monitor anti-epileptic drug (AED) levels during pregnancy. If seizures increase or are likely to increase, monitoring AED levels (particularly levels of lamotrigine and phenytoin, which may be particularly affected in pregnancy) may be us";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3802;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a physical performance tool to assess frailty in a person who is acutely unwell.";-;2016;;;"Low value";-;"Link to the recommendation in the website of the initiative/Enlace a la recomendaci�n en la p�gina de la iniciativa" 3547;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Psychological interventions may be used as adjunctive therapy in epilepsy. They have not been proven to affect seizure frequency and are not an alternative to pharmacological treatment.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3803;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"It is not recommended a prolonged use of benzodiazepines, of more than 4 weeks, for the treatment of anxiety disorders in adults due to the risk of tolerance, dependence, and serious side effects (cognitive and memory impairment, drowsiness, increased risk Of falls and traffic accidents) associated with these drugs.";"Anxiety disorders represent one of the most common mental health problems among the general population and often appear in association with other mental illnesses. According to data from 2014, 18.2% of people in Catalonia report problems of depression or anxiety and are the second health problem that most affects the quality of life related to health. In this context, the consumption of benzodiazepines in our environment has continued to grow progressively in recent years, remaining in many cases as a long-term treatment. By December 2015, 84 out of every 1,000 inhabitants had been prescribed a defined daily dose (DDD) of anxiolytic-hypnotics in Catalonia, one of the highest rates in the world. In addition, the consumption of these drugs is concentrated in the elderly. For the initial treatment of anxiety disorders, excluding obsessive-compulsive disorders (OCD) and post-traumatic stress disorder, current clinical practice guidelines (CPG) recommend the use of other drugs, mainly antidepressants, or individual or Group therapy, through cognitive-behavioral therapy, cognitive based on mindfullness, or others. These strategies have demonstrated similar efficacy in the treatment of most anxiety disorders. The NICE CPGs, the Canadian Agency for Drugs and Technologies in Health and the CPG of the National Quality Plan recommend the use of benzodiazepines only as an adjuvant treatment, especially in those situations where a faster response is required, for example anxiety, agitation or during the initial period of antidepressant treatment, when these drugs are not yet effective. However, the guidelines agree not to recommend its prolonged use (beyond 4 weeks) for the risk of drug dependence, abuse and tolerance, and the risk of adverse effects, which can be serious, for example cognitive and memory impairments, drowsiness, increased risk of falls and traffic accidents, and even increased mortality. It should be noted that these effects are more frequent and especially relevant in the elderly population, where the prescription of benzodiazepines has exploded in recent years. On the other hand, there is abundant evidence that benzodiazepine withdrawal is possible in patients taking these drugs in a chronic manner. The method for doing so will depend on the situation of each patient. In general, it is recommended to switch to a long acting benzodiazepine, gradually reduce the dose of benzodiazepine and support the process with psychological interventions. In Catalonia, 28% of the 818,337 people over the age of 18 years with an active diagnosis of anxiety disorder have been prescribed a benzodiazepine for more than 4 weeks. Likewise, 51% of 190,254 people over 65 years of age with any of these diagnoses have been using this prescription for more than 4 weeks. In addition, the total expenditure on benzodiazepines in 2015 was 6,697,311 ?, and the long-term prescription represents a very important part of this expenditure (SISAP-Sistema de Informa��o de Servicios de Atenci�n Primaria, SISAP 2016). In conclusion, prolonged use of benzodiazepines in the treatment of anxiety disorders in adults is not recommended because of the risk of tolerance, dependence and serious side effects associated with these drugs and because there are other effective and safer therapeutic alternatives.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3548;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Regular blood test monitoring in adults with epilepsy is not recommended as routine, and should be done only if clinically indicated.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3804;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"CAMFIC-Sociedad Catalana de Medicina Familiar y Comunitaria";Spanish;"It is not indicated to conduct blood tests routinely every year in the healthy and asymptomatic adult population.";"The conduction of health reviews in the general population is a phenomenon that began decades ago and has continued to grow as a result of a growing demand from patients but also from the health professionals, partly backed by the existence of review and screening programs implemented. Although the components of these reviews are not consensual and may vary, they usually include performing a blood test, usually on an annual basis. The goal of routine health checks and blood tests performed on the healthy population would be to detect undiagnosed diseases or risk factors and to try to prevent or delay their initiation and improve their prognosis through an early approach. However, as early as the 1970s and 1980s, evidence had not shown clear benefits in the morbidity and mortality of this widespread practice. A Cochrane review of 2012 concluded that health reviews do not reduce overall morbidity and mortality, nor does that related to cancer or cardiovascular disease, although they increase the number of new diagnoses. Most of the studies selected in this review did not provide sufficient data on possible damages resulting from the reviews, such as the use of more diagnostic procedures or their psychological effects. Therefore, the authors concluded that general health reviews are not advisable. Two reviews published in 2014, with studies conducted in the field of primary care, found that health reviews are associated with a statistically significant, though clinically insignificant, increase in the control of secondary or subrogated variables, especially among patients at high risk, but unable to demonstrate morbidity or mortality benefits. Therefore, both the U.S. Preventive Service Task Force (USPSTF) and the Canadian Task Force have for years discouraged this practice. Semfyc, in its ""Do not Do Recommendations"", advises against conducting systematic health checks for asymptomatic people; And the Choosing Wisely Canada initiative of the Canadian Medical Association recommends that annual screening tests should not be performed unless indicated by the patient's risk profile. In this regard, the USPSTF, the Canadian Task Force and the Semfyc recommend screening for diseases or risk factors only in people at high risk of presenting them. This mainly includes screening for chronic kidney disease, thyroid dysfunction, vitamin D deficiency and infectious diseases (hepatitis B and C and HIV). With regard to diabetes and dyslipidemia, the recommendations are similar, although there is no such clear consensus about the age and patients profile to whom screening would be recommended. The PAPPS recommendations of 2016 propose screening every four years, starting at age 18 in the case of dyslipidemia and starting at age 40 in diabetes. In the case of cancer, there is currently no tumor marker with sufficient evidence to be used in population screening. In sum, scientific evidence has not shown that routine health and analytical reviews are beneficial in terms of health and quality of life. The data regarding cost-effectiveness, potential damages or risks inherent to unnecessary tests, such as overdiagnosis and overtreatment, are scarce. In Catalonia, more than 322,442 general examinations, including potential routine blood tests, have been done in primary care in 2000, in healthy adults without reported diagnoses (data from the Primary Health Care Information System - SISAP- ). In conclusion, routine blood tests is not indicated to be performed annually in the healthy and asymptomatic adult population, except in cases where there is a high risk for presenting some of the diseases, since there is no evidence of its benefits and there are potential risks that have not been adequately evaluated.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3549;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with childhood absence epilepsy, juvenile absence epilepsy or other absence epilepsy syndrom";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3805;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Sociedad Catalana de Psiquiatr�a";Spanish;"The determination of serotonin plasma levels should not be performed since this practice has no value as a diagnostic marker or predictor of therapeutic response.";"Major depressive disorder (MDD) is a disease of complex etiology with a marked personal and socioeconomic burden. Currently the diagnosis and choice of treatment is made only based on the evaluation and clinical examination of the patient. In this context, an important effort has been devoted to the search of biological markers in the diagnosis and prediction of response to antidepressant treatments. Among the different markers, those related to the serotonergic system have been one of the most extensively evaluated. Regarding the plasma determination of serotonin levels, it should be noted that the main recent meta-analyses, controlled studies or expert consensus analysing potential markers for major depression do not include in their discussions or recommendations the value of plasmatic serotonin as a potential biomarker of this pathology. The measurement of circulating serotonin is complex and requires very specific and careful evaluation to ensure accuracy and reproducibility. In addition, numerous environmental, dietary and pharmacological factors may influence plasma levels of serotonin. Serotonin that is measured in plasma does not cross the blood-brain barrier and therefore there is no evidence that it can be a representative measure of the serotonergic function of the central nervous system. These factors determine that plasma serotonin measurement is of no utility in clinical practice or in the evaluation of major depressive disorder in particular. It does not provide any information to the clinician regarding the existence of a depressive disorder, nor about the prediction of response to a particular therapeutic strategy. It only represents an unnecessary cost and subjects the patient to an ineffective examination. In Catalonia, according to data from the Primary Health Care Information System (SISAP), 3,107 serotonin analyses have been requested in primary care from the ICS since 2005, observing an increase since 2010 (n = 116) compared to year 2015 (n = 530). The diagnosis of depression and the beginning of an antidepressant drug treatment should be established according to clinical criteria and following the recommendations of the clinical guidelines. In no case should the determination of serum levels of serotonin be performed as this practice has no value as a diagnostic marker or predictor of therapeutic response.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3550;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as Adjunctive treatment in children, young people and adults with juvenile myoclonic epilepsy (JME).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3551;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with Idiopathic Generalized Epilepsies (IGE).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3552;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Levetiracetam is not cost effective at June 2011 unit costs";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3808;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT pulmonary angiograms or VQ scans in patients with suspected pulmonary embolism until risk stratification with decision rule has been applied and when indicated, D-dimer biomarker results are obtained.";"Many adults present to the emergency department with chest pain and/or shortness of breath. The majority of adult patients with these symptoms do not have a pulmonary embolism (PE) that requires investigation with a CT pulmonary angiogram (CTPA) or ventilation perfusion (VQ) lung scan. CTPAs or VQ scans expose patients to ionizing radiation that has the potential to increase patients? lifetime risk of cancer. CTPAs also place patients at risk for potential allergic reaction and acute kidney injury from the intravenous contrast required for the CTs. Imaging also increases length of stay and may contribute to misdiagnosis. Evidence demonstrate that physicians should not order CTPAs or VQ scans to diagnose PE until risk stratification with a clinical decision rule (Wells score, PERC rule) has been applied and d-dimer biomarker results are obtained for those patients where it is indicated. For high-risk populations in which the clinical decision rules have not been validated (i.e., pregnancy, hypercoagulability disorders), physicians are urged to exert their clinical judgment.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3553;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with Lennox?Gastaut syndrome.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3809;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t use antibiotics in adults and children with uncomplicated sore throats.";"Adults and children frequently present to the emergency department with sore throats (pharyngitis). The vast majority of cases of pharyngitis are caused by self-limiting viral infections that do not respond to antibiotics. The benefit of antibiotics for the approximately 10% of cases in adults (25% in children), caused by bacteria (principally Group A Streptococcus (GAS)) is modest at best, although is associated with fewer complications and a slightly shorter course of illness. There is strong evidence to suggest that antibiotics (penicillin, or 1st generation cephalosporin or macrolide if allergic to penicillin) should only be used in patients with high clinical prediction scores for GAS (CENTOR or FeverPAIN score), or intermediate clinical scores AND positive throat cultures. Rapid antigen detections tests do not offer advantage over clinical scores. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3554;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Only offer felbamate in centres providing tertiary epilepsy specialist care and when treatment with sodium valproate, lamotrigine, rufinamide and topiramate have proven ineffective or not tolerated.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3810;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order ankle and/or foot X-rays in patients who have a negative examination using the Ottawa ankle rules.";"Foot and ankle injuries in children and adults are very common presentations to emergency departments. The Ottawa Ankle Rules (OAR) have been validated in both children (greater than 2 years old) and adult populations, and have been shown to reduce the number of X-rays performed without adversely affecting patient care. In alert, cooperative and sensate patients with blunt ankle and/or foot trauma within the previous ten days and who are not distracted by other injuries, only those who fulfill the OAR should undergo ankle and/or foot X-rays. Imaging of the ankle and/or foot in patients who are negative for the OAR does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3555;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with Dravet syndrome.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3811;19;"Choosing Wisely Canada";"The Canadian Association of Emergency Physicians";English;"Don?t use antibiotics in adults and children with uncomplicated acute otitis media.";"Both adults and children commonly present to the emergency department with symptoms of a middle ear infection, or acute otitis media (AOM). The symptoms of AOM include fever, earache, discharge from ear, and/or decreased hearing. Evidence suggests that adults and children with uncomplicated AOM do not need antibiotics. Treatment should focus on analgesia and the use of antibiotics should be limited to complicated or severe cases. A watch and wait approach (analgesia and observation for 48 to 72 hours) should be considered for healthy, non-toxic appearing children older than six months of age with no craniofacial abnormalities, mild disease (mild otalgia, temperature < 39�C without antipyretics), and who have reliable medical follow-up. Antibiotics should be considered if the child?s illness does not improve during the observation period, and for those children who are < 24 months of age with infection in both ears, and in those with AOM and ear discharge. Similarly, antibiotics should not be used for the initial treatment of uncomplicated AOM in adults. Delayed antibiotics are an effective alternative to immediate antibiotics to reduce antibiotic use. Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash and diarrhea), and increase overall antibiotic resistance in the community.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3556;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with tonic or atonic seizures.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4068;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Continuous passive motion following total knee arthroplasty in people with arthritis.";"NICE summary of Cochrane review conclusions Evidence shows that continuous passive motion following total knee arthroplasty in people with arthritis is not effective and should not be used. Reducing or stopping continuous passive motion following total knee arthroplasty in people with arthritis will reduce the use of ineffective treatments and may be of value in terms of productivity savings although this is difficult to quantify. The Implications for practice section of the Cochrane review stated: ?The effects of continuous passive motion (CPM) on range of motion (ROM), pain, function and quality of life are too small to justify its use and costs but the effects of CPM on participants? global assessment of treatment effectiveness are unclear. This review provides very low-quality evidence that CPM reduces the risk of manipulation under anaesthesia; however, these findings need to be interpreted with caution because they are inconsistent with the moderate-quality evidence indicating that CPM has no effect on knee ROM even though the main indication for manipulation under anaesthesia is joint stiffness.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3557;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with myoclonic seizures.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3558;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin as adjunctive treatment in children, young people and adults with absence seizures.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3559;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin if there are absence or myoclonic seizures, or if Juvenile myoclonic epilepsy (JME) is suspected.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5607;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"Re-expansion maneuvers are recommended in ARDS participants to reduce mortality in the intensive care unit of patients with COVID-19";"Significant clinical heterogeneity was identified in the 10 included trials. Results are based on findings from several trials (five) that included an ""expanded lung respiratory support strategy"", whereby the intervention group was different from the control group in addition to the re-expansion maneuver (including co-interventions such as PPFE higher, different modalities of respiratory assistance and higher plateau pressure), making it difficult to interpret the results. A respiratory support strategy that included re-expansion maneuvers in ARDS participants reduced mortality in the intensive care unit without increasing the risk of barotrauma, although it had no effect on day 28 mortality and hospital mortality. The quality of the evidence was lowered to low, as most of the included trials provided co-interventions as part of an expanded lung respiratory support strategy, and this may have affected the results.";2016;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5863;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - apoyo para el bienestar de los trabajadores sanitarios";Spanish;" it is not possible to determine whether shift workers' sleepiness can be reduced or if their sleep length or quality can be improved with these interventions: various exposures to bright light; various opportunities for napping; and other interventions, such as physical exercise or sleep education";"We need better and adequately powered RCTs of the effect of bright light, and naps, either on their own or together and other non?pharmacological interventions that also consider shift workers? chronobiology on the investigated sleep parameters. ";2016;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3560;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Measurement of serum prolactin is not recommended for the diagnosis of epilepsy.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3305;29;"Choosing Wisely Australia";"Australasian Society for Infectious Diseases";English;"Do not use antibiotics in asymptomatic bacteriuria";"Antibiotic treatment of patients with asymptomatic bacteriuriais generally not indicated as it does not decrease the incidence of symptomatic urinary tract infection. This also includes patients with indwelling urinary catheters. Exceptions to this are pregnant women and those undergoing an urological procedure.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3561;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Neuroimaging should not be routinely requested when a diagnosis of idiopathic generalised epilepsy has been made.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5609;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"A semi-recumbent versus supine position is recommended for the prevention of ventilator-associated pneumonia in adults under mechanical respiratory support";"A semi-recumbent position (? 30 �) can reduce clinically presumed NAR compared to the supine position from 0 � to 10 �. However, the tests have important limitations, with a high risk of bias. Insufficient evidence is available to draw definitive conclusions about other outcomes or to compare alternate semi-recumbent positions. Adverse events, particularly venous thromboembolism, were insufficiently reported.";2016;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3306;29;"Choosing Wisely Australia";"Australasian Society for Infectious Diseases";English;"Do not take a swab or use antibiotics for the management of a leg ulcer without clinical infection";"Lower leg ulcers, most commonly venous ulcers are often treated with oral antibiotics, even in the absence of evidence of clinical infection. There is no evidence to support this use, except if screening for carriage of multi-resistant organisms. Also a swab for microscopy and culture, in the absence of signs of infection is not recommended. Unnecessary antibiotics and swabbing will add to healthcare costs, antimicrobial resistance and patient allergy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3562;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Repeated standard EEGs should not be used in preference to sleep or sleepdeprived EEGs.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5610;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (desconexi�n de la ventilaci�n mec�nica)";Spanish;"All relevant ICU staff will benefit from general respirator removal training as well as specific mechanical ventilation removal protocols for critically ill adults and children.";"There is a clear need for withdrawal protocols to take into account the social and cultural environment in which they will be implemented. Regardless of the inherent strengths, the protocol will not be used if it does not satisfy these complexities. In terms of protocol development, comprehensive interprofessional input will help ensure broad understanding and a sense of 'ownership'. Regarding implementation, all relevant UCI personnel will benefit from general training on respirator removal as well as specific protocols; This will not only help ensure a relevant clinical knowledge base and operational understanding, but will also demonstrate to others that this knowledge and understanding is appropriate. To maximize relevance and acceptability, protocols should be designed taking into account the profile of the patient and the requirements of the ICU studied. It is foreseeable that an ICU with few resources will have a negative impact on the implementation of the protocols, since the staff will prioritize the treatment of patients with acute deterioration and in critical condition.";2016;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3307;29;"Choosing Wisely Australia";"Australasian Society for Infectious Diseases";English;"Avoid prescribing antibiotics for upper respiratory tract infection";"Most uncomplicated upper respiratory infections are viral in aetiology and antibiotic therapy is not indicated. Oral antibiotic therapy of presumed URTI in febrile young infants is not only 'low value' but can be actively dangerous, in delaying presentation to hospital (inappropriately reassuring parents and confounding investigations of sepsis). This is a major issue for paediatrics primary care and ED presentations. Patient education is an important component of management together with symptomatic treatment. Infections with Streptococcus pyogenes and Bordetella pertussis do require antibiotic therapy.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3563;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"An electroencephalogram (EEG) should not be used to exclude a diagnosis of epilepsy in a child, young person or adult in whom the clinical presentation supports a diagnosis of a nonepileptic event.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3308;29;"Choosing Wisely Australia";"Australasian Society for Infectious Diseases";English;"Do not investigate or treat for faecal pathogens in the absence of diarrhoea or other gastro-intestinal symptoms";"Testing of faeces for microscopy and culture or by PCR methods should not be performed in the absence of diarrhoea or other gastro-intestinal symptoms. Similarly antimicrobial treatment for a gastrointestinal pathogen is not indicated in the absence of symptoms. For immunocompetent non-traveller children with acute gastroenteritis, there are very few circumstances when a stool test for infection would alter clinical management. Possible exceptions include refugee screening and some neurological syndromes such as enteroviral testing for acute flaccid paralysis.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3564;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"An electroencephalogram (EEG) should not be performed in the case of probable syncope because of the possibility of a false-positive result.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3309;29;"Choosing Wisely Australia";"Australasian Society for Infectious Diseases";English;"In a patient with fatigue, avoid performing multiple serological investigations, without a clinical indication or relevant epidemiology";"Multiple serological testing as investigation for a patient with fatigue, is not recommended. If such testing is not clinically indicated there is a risk of false positive results leading to further unnecessary investigations and useless treatments.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3565;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely continue antipsychotic treatment in young people for longer than 12 weeks.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4077;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Urolog�a";Spanish;"Do not perform staging CT or bone scintigraphy in patients with clinically localized prostate cancer if the PSA is less than 10 and the Gleason score is less than 8.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3566;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use questionnaires in primary care to identify bipolar disorder in children or young people.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4078;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Urolog�a";Spanish;"Do not treat overactive bladder without excluding other pathologies that may cause similar symptoms.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5614;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento con l�quidos y vasopresores)";Spanish;"It is advisable to better individualize and base on clinical variables that reflect hypoperfusion for the selection of vasopressors for hypotensive shock.";"No evidence of significant differences in total mortality was found between various vasopressors. Dopamine increases the risk of arrhythmia compared to norepinephrine and could increase mortality. On the other hand, evidence of other differences between any of the six vasopressors examined is not sufficient. Low risk of bias and high quality evidence were identified for the norepinephrine versus dopamine comparison and moderate to very low quality evidence for all other comparisons, mainly because single comparisons were sometimes based on only a few participants. Increasing evidence indicates that the most frequently used treatment goals are of limited clinical value. Results indicate that no major changes are needed in clinical practice.";2016;;;"Low value";"Management co-morbilitites ";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3567;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely measure plasma lamotrigine levels unless there is evidence of ineffectiveness, poor adherence or toxicity.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4079;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Urolog�a";Spanish;"Do not restrict calcium intake in patients with recurrent calcium renal lithiasis if their diet is considered adequate.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3568;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not routinely measure plasma valproate levels unless there is evidence of ineffectiveness, poor adherence or toxicity.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4080;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Urolog�a";Spanish;"Do not perform PSA determinations in intervals less than 1 year, in asymptomatic patients with PSA levels lower than normal, .";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3569;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not start regular combined antipsychotic medication, except for short periods (for example, when changing medication)";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4081;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Urolog�a";Spanish;"Do not perform fertility studies, both in women and men, without having at least two semengrams that do not meet normal parameters.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3314;29;"Choosing Wisely Australia";"The Royal Australian College of General Practitioners List 2";English;"Don?t test thyroid function as population screening for asymptomatic patients";"This ?screening? recommendation does not apply to people with symptoms suggestive of thyroid disease. The prevalence in adults of subclinical hypothyroidism is about 4.3% (0.7% for subclinical hyperthyroidism), and prevalence is higher in older adults and women. About 2-5 percent of people with subclinical hypothyroidism and 1-2 percent with subclinical hyperthyroidism will develop overt thyroid disease per year. However, many patients with subclinical thyroid dysfunction revert to normal when followed over time. A 2014 systematic review of screening for thyroid dysfunction found that clear evidence on the benefits and harms of screening is unavailable, and recommended against population-based screening. In the absence of evidence that early treatment reduces symptoms, lipid levels, or the risk of cardiovascular disease in patients with mild thyroid dysfunction detected by screening, the RACGP Guidelines for preventive activities in general practice does not recommend screening for thyroid disease in asymptomatic populations.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3570;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer gabapentin or topiramate to treat bipolar disorder.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4082;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Bioqu�mica Cl�nica y Patolog�a Molecular";Spanish;"Do not request multiple tests in the initial assessment of a patient with suspected thyroid disease. Request first for thyroid stimulating hormone (TSH) and if abnormal, continue with additional evaluation or treatment according to the findings.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3315;29;"Choosing Wisely Australia";"Australian and New Zealand Intensive Care Society";English;"For patients with limited life expectancy (such as advanced cardiac, renal or respiratory failure, metastatic malignancy, third line chemotherapy) ensure patients have a ?goals of care? discussion at or prior to admission to ICU and for patients in ICU wh";"The ANZICS Statement on Care and Decision Making at the End of Life for the Critically Ill states that the goal of intensive care is to return patients to a quality of life that is acceptable to them. In order to achieve this goal, it is essential that clinicians explore the values and preferences of each patient. Engaging with patients and their families in the discussions around treatment limitations or withdrawal can improve the quality of dying and reduce family and staff stress and bereavement.";2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3571;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not offer lamotrigine to treat mania";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4083;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Bioqu�mica Cl�nica y Patolog�a Molecular";Spanish;"Do not recommend the determination of total KC or KC-MB, nor AST, nor LDH, nor myoglobin for the diagnosis of myocardial damage (or infarction).";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3316;29;"Choosing Wisely Australia";"Australian and New Zealand Intensive Care Society";English;"Remove all invasive devices, such as intravascular lines and urinary catheters, as soon as possibl";"Patients in the intensive care unit often require invasive devices as part of their treatment as well as monitoring of therapy. These lines however are a potential source of healthcare related infections. Preventative ?bundles? of care including simple measures such as hand hygiene and aseptic methods of insertion and care of devices have reduced the risk of health care related infections. Infections related to invasive devices are a significant cause of morbidity and mortality. Hence, all invasive devices such as arterial lines, central lines, urinary catheters should be removed as soon as possible.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3572;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not start valproate in primary care to treat bipolar disorder";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4084;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Bioqu�mica Cl�nica y Patolog�a Molecular";Spanish;"Do not determine specific IgE for allergens without symptoms of adverse reactions in the clinical history or without previous ""in vivo"" tests. In any case, do not perform systematic studies of several immunoglobulins against allergens without an exhaustive review of the patient's medical history.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3317;29;"Choosing Wisely Australia";"Australian and New Zealand Intensive Care Society";English;"Transfuse red cells for anaemia only if the haemoglobin concentration is less than 70gm/L or if the patient is haemodynamically unstable or has significant cardiovascular or respiratory comorbidity";"Numerous studies have highlighted the adverse outcomes that may be associated with blood transfusion. Randomised and other trials have indicated that transfusion of red blood cells for the treatment of anaemia in otherwise haemodynamically stable patients is either of no benefit or even harmful. There appears to be little or no proven benefit of transfusing beyond a threshold haemoglobin level of 70gm/L though the precise threshold for any given patient is unknown. Patients with active cardio-respiratory disease or neurological injury may warrant a higher threshold although harm associated with liberal transfusion in this group has also been reported.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3573;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not start lithium to treat bipolar disorder in primary care for people who have not taken lithium before, except under shared-care arrangements.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4085;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Bioqu�mica Cl�nica y Patolog�a Molecular";Spanish;"Do not perform population screening for Vitamin D deficiency, by serum concentration of 1,25-dihydroxy Vitamin D (Calcidiol).";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3318;29;"Choosing Wisely Australia";"Australian and New Zealand Intensive Care Society";English;"Undertake daily attempts to lighten sedation in ventilated patients unless specifically contraindicated and deeply sedate mechanically ventilated patients only if there is a specific indication";"Critically ill patients requiring mechanical ventilation are frequently treated with sedatives and analgesics, to treat pain, anxiety, dyspnoea and reduce tissue oxygen consumption. However prolonged or excessive sedation can be associated with delirium, critical illness weakness, prolonged ventilation and length of stay. Protocol-based approaches to limit deep sedation, by explicating titrating the sedation to a sedation goal, and daily interruptions of sedation, have been shown to improve patient outcomes, including a reduction in mortality. Exceptions to the daily sedation holiday are for patients requiring muscle paralysis, who should not be woken until the paralytic agent has worn off.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3574;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not use questionnaires in primary care to identify bipolar disorder in adults.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4086;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Bioqu�mica Cl�nica y Patolog�a Molecular";Spanish;"Do not request the Globular sedimentation rate (ESR) or erythrosedimentation to assess inflammation in patients with an undefined diagnosis. To detect the proinflammatory state in acute phase, request C-reactive protein (CRP).";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3319;29;"Choosing Wisely Australia";"Australian and New Zealand Intensive Care Society";English;"Consider antibiotic de-escalation daily.";"Infection can precipitate a need for intensive care admission and can occur as a complication of an ICU admission. The earliest administration of the most appropriate antibiotic and source control confer mortality benefit. However, antibiotics are also frequently used for the presumptive management of patients with ?sepsis? that may later prove to not have an infectious aetiology. In most circumstances, data regarding the appropriate duration of antibiotic administration are very difficult to interpret. In some conditions such as endocarditis or osteomyelitis longer courses of antibiotics have been recommended. However, there is increasing evidence that shorter courses of antibiotics for common infections such as hospital acquired pneumonia do not confer worse outcomes or increased mortality than longer courses. Moreover, shorter courses probably help to prevent the development of antibiotic resistance. In the absence of microbiological evidence of ongoing infection and with an improvement in clinical status, consideration should be given to discontinuing antibiotics at the earliest opportunity possible.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3575;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"In children and young people whose ADHD is unresponsive to methylphenidate, atomoxetine and dexamfetamine, further treatment should only follow after referral to tertiary services. The use of medication unlicensed for ADHD (such as bupropion, clonidine, m";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4087;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Calidad Asistencial";Spanish;"Do not use permanent urinary catheters in patients without appropriate indication.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3320;29;"Choosing Wisely Australia";"Australian College of Nursing";English;"Don?t replace peripheral intravenous catheter unless clinically indicated";"Peripheral intravenous catheters (IV) are routinely used for vascular access. The unnecessary removal and replacement of a functional IV catheter breaches skin integrity, posing an increased risk of healthcare-associated infection and trauma to patients. This in turn, frequently results in increased length of stay, less than optimal health care outcomes and unnecessary use of health resources. Evidence suggests there is no significant difference in cases of phlebitis if peripheral IV catheters are replaced only when clinically indicated. Common clinical indications for replacement include phlebitis, infiltration and blockage. Catheter related trauma and infection may also be minimised by vigilant monitoring of the insertion site by health care staff and removal of catheters as soon as it is no longer required.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3576;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Liver damage is a rare and idiosyncratic adverse effect of atomoxetine and routine liver function tests are not recommended.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4088;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Calidad Asistencial";Spanish;"Do not routinely use antiseptics or topical antibiotics for the treatment of a pressure ulcer in adults.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3321;29;"Choosing Wisely Australia";"Australian College of Nursing";English;"Don?t restrict the ability of people with diabetes to self-manage blood glucose monitoring unless there is a clinical indication to do so";"Imposing unnecessary blood glucose monitoring regimes that needlessly change a person?s routine, and are random, low frequency or do not provide patients or health care professionals with information that is of value in managing diabetes, will not enhance therapeutic goals. Glycaemic control is pertinent to the management of Diabetes Mellitus (DM), with self-management a valuable tool in reducing the incidence of complications, improving HbA1c levels*, enhancing quality of life and reducing related health care costs. The ability to self-care also empowers people and helps to engage them in developing and maintaining behaviours and lifestyle choices that result in improved long-term health outcomes. Blood glucose monitoring should provide feedback relevant to a person?s management plan, including frequency of timing and testing. In addition, unclear or inconsistent monitoring interventions can be needlessly traumatic, may confuse patients and even discourage them from the self-management process. *The glycosylated haemoglobin (HbA1c) test shows an average blood glucose level over 10-12 weeks.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3577;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"For people taking methylphenidate, dexamfetamine and atomoxetine, routine blood tests and ECGs are not recommended unless there is a clinical indication.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4089;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Calidad Asistencial";Spanish;"Do not use abbreviations on prescription.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3322;29;"Choosing Wisely Australia";"Australian College of Nursing";English;"Don?t routinely administer antipyretics with the sole aim of reducing body temperature in un-distressed children";"Fever is defined as a rise in body temperature above the normal range of approximately 37.8 degrees Celsius and is commonly seen as a primary indication of illness in children. It is a normal physiological response to infection and illness and will not place a generally healthy child at harm. The benefits of fever in slowing the growth and replication of bacteria and viruses are well documented within the literature, however the administration of pharmacological antipyretic therapy to reduce fever remains a common clinical intervention. Current evidence does not support the routine use of antipyretics solely to reduce body temperature but to maximise the comfort and well-being of the distressed child as an adjunct to the investigation and management of the cause of fever. Antipyretic therapy is not effective in managing adverse symptoms of fever such as febrile convulsion. Supportive care that includes parental education is also important to increase understanding and to decrease anxiety.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3578;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Antipsychotics are not recommended for the treatment of ADHD in adults.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4090;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Calidad Asistencial";Spanish;"Do not separate the mother from the child after the birth, without there being any medical cause that justifies it.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3323;29;"Choosing Wisely Australia";"Australian College of Nursing";English;"Don?t use urinary catheters to manage urinary incontinence unless all other appropriate options have proved to be ineffective or to prevent wound infection or skin breakdown";"Urinary tract infections (UTIs) are the most common healthcare associated infection, the majority of which can be associated with the use of indwelling urinary catheters (IDC). Urinary tract infections in hospitalised patients increase morbidity and mortality, antibiotic exposure and often prolong length of hospital stay. The use of indwelling urinary catheters to manage incontinence is not recommended unless as a last resort or to prevent wound infection or skin breakdown and should be removed as soon as possible.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3579;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Antipsychotics are not recommended for the treatment of ADHD in children and young people.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4091;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Calidad Asistencial";Spanish;"Do not use standard documents of informed consent without providing adequate discussion and personalized information of the problems.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3324;29;"Choosing Wisely Australia";"Australian College of Nursing";English;"Don?t initiate plain X-ray for foot and ankle trauma unless criteria of the Ottawa Ankle Rules are met";"Traumatic injury to the foot and ankle are a common reasons for presentation to the emergency department. The Ottawa Ankle Rules (OAR) are an effective screening tool to guide the use of plain x-ray in the evaluation of these injuries. Validation studies have found that the OARs have an almost 100% sensitivity in many studies in a number of clinical settings. The correct application of the OARs can identify patients who are likely to have a clinically significant fracture and reduce unnecessary use of diagnostic imaging resources by 30-40%.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3580;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Drug treatment is not indicated as the first-line treatment for all school-age children and young people with ADHD. It should be reserved for those with severe symptoms and impairment or for those with moderate levels of impairment who have refused non-dr";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4092;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cirug�a Oral y Maxilofacial";Spanish;"Do not perform the extraction of wisdom teeth in young people and adolescents when there is adequate space for their eruption, and they may have a functional position in the dental arch; or in children although they appear impacted, as they can change of position.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3325;29;"Choosing Wisely Australia";"The Society of Hospital Pharmacists of Australia";English;"Don?t initiate and continue medicines for primary prevention in individuals who have a limited life expectancy";"Frail, elderly patients are more susceptible to the adverse effects of medicines. There is limited evidence to support the use of many medicines in elderly patients as they are typically excluded from clinical trials. One study has estimated the cost to the PBS of potentially inappropriate medication in older patients is between $240 and $450 million each year. The use of medicines used to prevent a condition, or disease, or those with a long ?time to benefit? profile may not be consistent with the life expectancy of the patient and their goals of care. The proactive de-prescribing of medicines that no longer provide a benefit to the patient is integral to end-of-life care and advance care planning. Patients or their carer, or designated guardian, should be involved in the decision to review treatment and the ongoing need for each medicine.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3581;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Drug treatment is not recommended for pre-school children with ADHD.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3837;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology-Head & Neck Surgery";English;"Don?t order specialized audiometric and vestibular neurodiagnostic tests in an attempt to screen for peripheral vestibular disease.";"The diagnosis of the dizzy patient should be guided by the presenting symptoms and office examination. Tests such as ABR (auditory brainstem response), ECOG (electrocochleography), ENG/VNG (electronystagmography/ videonystagmography), VEMP (vestibular evoked myogenic potential), vHIT (video head impulse test), CDP (computerized dynamic posturography) and RCT (rotational chair testing) should only be ordered if clinically indicated. In general, advanced balance tests should be ordered and interpreted by otolaryngologists with specialized training in the diagnosis and treatment of vestibular disorders (otologists/neurotologists). Clinical indications for testing can include: side localization and stage of progression for Meniere?s disease, assessment of central compensation for acute vestibular loss and confirmation of superior semicircular canal dehiscence syndrome. Specialized tests are rarely indicated in the management of benign paroxysmal positional vertigo.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4093;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cirug�a Oral y Maxilofacial";Spanish;"Do not perform the extraction of deeply impacted wisdom teeth without evidence of pathology, when they are completely covered with bone and / or soft tissue.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3326;29;"Choosing Wisely Australia";"The Society of Hospital Pharmacists of Australia";English;"Don?t initiate an antibiotic without an identified indication and a predetermined length of treatment or review date";"Antibiotics may be prophylactic, empirical or targeted against a known organism. Prolonged duration of antibiotics is associated with: an increased risk of adverse reactions, Clostridium difficile infection, candidiasis, selection of antibiotic resistant organisms as well as unnecessary cost. Therefore the shortest possible duration of therapy should be used. For the majority of infections treatment should not exceed 7 days. The most appropriate duration of therapy may be difficult to identify in some circumstances. In these instances treatment duration must be individualised for the patient on the basis of clinical, microbiological or radiological parameters. If ongoing treatment is required a date for review should be identified. Patients should be advised that using antibiotics when they don?t need them can contribute to the problem of antibiotic resistance. They should be advised, when the antibiotic is prescribed and dispensed, when the antibiotic is to finish, or the date to be reviewed.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3582;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"Do not advise or offer dietary fatty acid supplementation for treating ADHD in children and young people.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3838;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology-Head & Neck Surgery";English;"Don?t perform computed tomography or blood work in the evaluation of a patient with sudden sensorineural hearing loss (SSNHL) given its presumed viral etiology.";"Blood work which typically would consist of a CBC, differential and electrolytes along with an autoimmune panel are often normal and would not change initial clinical management if abnormal. The CT scan which is done to rule out central causes is not sensitive enough to pick up most cases of retrocochlear pathology. MRI scans should be considered instead. If verified to be sensorineural with audiometric testing, urgent treatment with steroid therapy can be initiated. There is no role for antiviral treatment, thrombolytics or vasoactive substances.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4094;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cirug�a Oral y Maxilofacial";Spanish;"Do not perform excisional biopsy without margin of safety in the oral mucosa lesions suspected of being cancer.";-;2016;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3327;29;"Choosing Wisely Australia";"The Society of Hospital Pharmacists of Australia";English;"Don?t initiate and continue antipsychotic medicines for behavioural and psychological symptoms of dementia for more than 3 months";"Behavioural and psychological symptoms of dementia (BPSD) are often temporary. The mainstay treatment of BPSD is non-pharmacological. Antipsychotic medicines should only be considered when non-pharmacological interventions have failed and the patient has symptoms that are distressing for them, their family or co-residents. Patients or their carer, or designated guardian, should be involved in the decision to begin treatment with an antipsychotic medicine. Consideration needs to be given to the patient?s ability to appreciate the consequences of refusing, or agreeing to, treatment. If used, the dose of the antipsychotic medicine should be increased as slowly as necessary with the goal of using the lowest effective dose for the shortest possible time. The effectiveness of the medicine and the occurrence of delirium, sedation, or anti-cholinergic side effects should be assessed at least weekly. Treatment should be reviewed after no more than 3 months and the dose should be reduced and then stopped wherever possible.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3583;1;"NICE ";"(National Institute for Health and Clinical Excellence (NICE))";English;"A diagnosis of ADHD should not be made solely on the basis of rating scale or observational data. However rating scales such as the Conners' rating scales and the Strengths and Difficulties questionnaire are valuable adjuncts, and observations (for exampl";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3839;19;"Choosing Wisely Canada";"Canadian Society of Otolaryngology-Head & Neck Surgery";English;"Don?t perform auditory brainstem responses (ABR) in patients with asymmetrical hearing loss.";"Asymmetrical hearing loss is defined as bone conduction threshold difference of: - 20 dB threshold difference at a single frequency - 15 dB threshold difference at 2 frequencies - 10 db threshold difference at 3 frequencies If there is no obvious cause of the asymmetry such as unilateral trauma or unilateral noise exposure like gun blasts, a MRI should be ordered. MRI scans are superior in sensitivity for detecting retrocochlear pathologies such as vestibular schwannoma when compared to ABR testing.";2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4095;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Cirug�a Oral y Maxilofacial";Spanish;"Do not use guided bone regeneration techniques in non-critical bony defects in jaws, for example in post-extraction alveoli or cystic cavities when only one wall is missing.";-;2016;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2560;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform screening mammographies in women under 40 years with no risk factors";"The indication of early diagnosis mammography in a particular group of women depends on its possible risks and benefits. In women under 40, the incidence of breast cancer is lower, mammography has less sensitivity and specificity, and workup and breast biopsy are frequently needed. Therefore, in this age group, potential benefits do not outweigh potential risks. Performing workup and biopsies resulting from early diagnosis mammographies in this group of age would involve a significant use of resources, costs and morbility for women.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2816;2;"Choosing Wisely�";"American Society for Metabolic and Bariatric Surgery";English;"Avoid routine postoperative antibiotics.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Antibiotics, Postoperative";"Link to the recommendation in the Choosing Wisely website" 3072;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not dose oral corticosteroids for over 7-10 days in patients with exacerbation of chronic obstructive pulmonary disease, in which case a tapering schedule is not necessary.";-;2015;;;"Low value";"COPD, Corticoids";"Link to the recommendation in the semFYC website" 2561;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out imaging in patients with a first episode of non traumatic frozen shoulder";"The estimated prevalence of shoulder pain is around 10% of the population, and it is the third musculoskeletal pain in terms of frequency, after low back pain and neck pain. Imaging techniques would not be indicated in the absence of: 1) previous traumatic event or fall, 2) acute inflammatory signs or sudden onset pain, 3) palpable mass or deformity, 4) pain at rest, and 5) unlimited mobility.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2817;2;"Choosing Wisely�";"American Society for Metabolic and Bariatric Surgery";English;"Don?t routinely remove the gallbladder unless clinically indicated.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Gallbladder;"Link to the recommendation in the Choosing Wisely website" 3073;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not systematically prescribe low-molecular-weight heparin for preventing deep vein thrombosis in patients with lower limb trauma that do not require surgery nor inmobilisation.";-;2015;;;"Low value";"Deep Venous Thrombosis, Heparin";"Link to the recommendation in the semFYC website" 2562;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not systematically take simple radiographies in ankle trauma";"Ankle sprain is one of the most frequent joint injuries. Only around 15% will present bone fracture, while the request of simple radiography represents over 85% on routine practice. Ankle radiography is only recommended if there is pain in the ankle joint plus bone tenderness in the last six centimetres of the posterior part of the inter or extern malleolus, or inability to walk four consecutive steps in the examination immediately following trauma. For the midfoot, criteria are pain in the area plus bone tenderness in the base of the fifth metatarsal bone or in the region of the tarsal scaphoid or inability to walk four steps during post-traumatic examination.";2015;;;"Low value";X-ray;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2818;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a head injury clinical decision rule).";"Head injuries in children and adults are common presentations to the emergency department. Minor head injury is characterized by: Glasgow Coma Scale (GCS) 13-15, associated with either witnessed loss of consciousness, definite amnesia, or witnessed disorientation. Most adults and children with minor head injuries do not suffer from serious brain injuries that require hospitalization or surgery. CT head scans performed on patients without signs of significant injuries can expose patients to unnecessary ionizing radiation that has the potential to increase patients? lifetime risk of cancer. They also increase length of stay and misdiagnosis. There is strong evidence that physicians should not order CT head scans for patients with minor head injury unless validated clinical decision rules suggest otherwise (i.e., Canadian CT head rule for adults, and CATCH or PECARN rules for children). Despite their validity, these rules are never 100% sensitive and are meant to assist and not replace, clinical judgement.";2015;;;"Low value";"Tomography, Head CT";"Link to the recommendation in the Choosing Wisely Canada website" 3074;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not perform cytological screening annually.";-;2015;;;"Low value";"Cytology, Screening";"Link to the recommendation in the semFYC website" 2563;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out conventional radiology studies to dismiss bone metastasis";"Bone scan detects most of the metastatic bone lesions and has less cost and better diagnostic yield than the metastatic bone series. Simple radiology detects lytic bone lesions when over 50% of mineralised bone has been destroyed, whereas other techniques such as CT scan detect 20-30% bone destruction. It is much more sensible to conduct a bone scan and complete the study, when required by the case, with radiographies of uncertain or suspicious areas instead of conducting a complete metastatic bone series. Full-body MRI is useful as a second choice study in uncertain cases or negative to bone scan. Clinical and economic relevance is that bone scan is a cheap and readily available technique, especially compared to full-body MRI. MRI and PET are similarly effective in the diagnosis of bone metastasis, being PET more expensive and less readily available.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2819;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis.";"Respiratory distress from bronchospasm/wheezing is a common presentation in both children (i.e., bronchiolitis) and adults (i.e., bronchitis/asthma) seen in the emergency department. Most patients with symptoms do not have bacterial infections that require antibiotic treatment or influence outcomes (i.e., hospitalization). Inappropriate administration of antibiotics can expose patients to unnecessary risks (i.e., allergies, rash, diarrhea and other side-effects) and has the potential to increase patients? risk of antibiotic induced diarrhea, including infections with C. Difficile. These prescriptions also increase overall antibiotic resistance in the community, and limit the effectiveness of standard antibiotics in the treatment of legitimate bacterial infections. There is strong applied research evidence to recommend that physicians should not prescribe antibiotics in children (i.e., bronchiolitis) and adults (i.e., bronchitis and asthma) with wheezing presentations.";2015;;;"Low value";"Bronchospasm, Wheezing";"Enlace a la recomendaci�n en la p�gina web Choosing Wisely Canada" 3075;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not perform imaging for uncomplicated headache.";-;2015;;;"Low value";Headache;"Link to the recommendation in the semFYC website" 2564;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform surgery as an initial treatment of osteoid osteoma; instead use percutaneous techniques";"Osteoid osteoma may be successfully treated using different percutaneous techniques (radiofrequency, thermoablation, cryoablation, etc.) with CT monitoring. The use of percutaneous techniques reduces the length of the hospital stay, the risk of complications, and the length of the postoperative period.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2820;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators.";"Adults with non-specific lumbosacral (low back) pain, in the absence of significant trauma (i.e., car crash, acute axial loading, acute hyperflexion, etc.), commonly present to the emergency department. The evaluation of patients presenting with non-traumatic low back pain should include a complete focused history and physical examination to identify ?red flags? that may indicate significant pathology. These may include, but are not limited to: features of cauda equina syndrome, weight loss, history of cancer, fever, night sweats, chronic use of systemic corticosteroids, chronic use of illicit intravenous drugs, patients with first episode of low back pain over 50 years of age and especially if over 65, abnormal reflexes, loss of motor strength or loss of sensation in the legs. In the absence of red flags, physicians should not order radiological images for patients presenting with non-specific low back pain. Imaging of the lower spine for symptomatic low back pain does not improve outcomes, exposes the patient to unnecessary ionizing radiation and contributes to flow delays without providing additional value.";2015;;;"Low value";"Lumbosacral Pain";"Link to the recommendation in the Choosing Wisely Canada website" 3076;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not perform mammograms in the diagnosis of probable acute bacterial sinusitis.";-;2015;;;"Low value";Rhinosinusitis;"Link to the recommendation in the semFYC website" 2565;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform surgery as an initial treatment on patients with calcifying tendinitis of the shoulder";"Chronic shoulder pain resulting from calcifying tendinitis may be successfully treated with non-invasive or minimally invasive techniques. Minimally invasive techniques include different type of interventions such as extracorporeal shockwave treatment or imaging techniques, such as puncture-aspiration-washout or dry needling with ultrasound guidance. Their clinical and economic relevance is that both percutaneous techniques and shockwave treatment have higher success rates and lower costs than surgical treatment, avoid hospital admission and reduce postoperative length of time.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM /Enlace a la recomendaci�n en la p�gina web de la SERAM" 2821;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Cervical Imaging";"Link to the recommendation in the Choosing Wisely Canada website" 3077;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not prescribe biphosphonates to patients at low fracture risk.";-;2015;;;"Low value";Bisphosphonates;"Link to the recommendation in the semFYC website" 2566;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out imaging with ionising radiation to assess the sacroiliitis activity";"Bone oedema is the radiological sign associated with active acute sacroiliitis. Radiographies and CT scans are not sensitive enough to assess bone oedema in patients with clinical suspicion of acute sacroiliitis. MRI is the most sensitive and specific imaging technique in the study of acute and chronic sacroiliitis. MRI allows the early diagnosis of sacroiliitis. Assessing the signs of radiologic activity in patients for which sacroiliitis is suspected allows choosing the treatment and monitor the response to the treatment.";2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2822;19;"Choosing Wisely Canada";"Canadian Association of Emergency Physicians";English;"Don?t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Abscess, Antibiotics";"Link to the recommendation in the Choosing Wisely Canada website" 3078;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not sistematically suspend anticoagulation treatment with dicoumarin derivatives in patients that will undergo minimally-invasive diagnostic or therapeutic procedures.";-;2015;;;"Low value";"Anticoagulation Treatment";"Link to the recommendation in the semFYC website" 5382;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Water, sanitation and hygiene (WASH) interventions focused on handwashing and provision of soap directly to households may be effective and cost-effective for controlling diarrhea";"The COVID-19 pandemic, like other humanitarian crises, may leave people without proper access to clean water and soap. It is important to have reliable evidence on the effects of water, sanitation and hygiene (WASH) interventions on health outcomes to inform decisions in such situations. In a systematic review, the authors searched for quantitative studies on the effects of WASH interventions on health outcomes during humanitarian crises occurring from 1980 to 2014. They restricted their search to articles published in English or French between 1980 and 2013. They included 6 studies, all of which assessed the effects of point-of-use water quality interventions on diarrheal disease. Five studies were done in Sub-Saharan Africa and 1 was done in Latin America. There is a lack of epidemiological evidence on the impact of WASH interventions in humanitarian crises, so their effects on health outcomes are uncertain.";2015;;;"High value";"Prevention Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2567;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not approach central venous access without an ultrasound guidance";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2823;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"Avoid requesting computed tomography (CT) imaging of kidneys, ureters and bladder (KUB) in otherwise healthy emergency department patients, age <50 years, with a known history of kidney stones, presenting with symptoms and signs consistent with uncomplica";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3079;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"No pautar paracetamol en dosis de 1 g de forma sistem�tica. La dosis de 650 mg es m�s segura e igual de eficaz.";-;2015;;;"Low value";Acetaminophen;"Link to the recommendation in the semFYC website" 2568;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform an arteriography at the initial diagnosis of low GI bleeding; instead perform a TC angiography";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2824;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"Avoid coagulation studies in emergency department patients unless there is a clearly defined specific clinical indication, such as for monitoring of anticoagulants, in patients with suspected severe liver disease, coagulopathy, or in the assessment of sna";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3080;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not use medical treatment for asymptomatic hyperuricemia (without gout), unless uric acid levels are very high (from 13 mg/dl in men, and from 10 mg/dg in women) or in oncological treatments.";-;2015;;;"Low value";Hyperuricemia;"Link to the recommendation in the semFYC website" 2569;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform an arteriography at the initial diagnosis and therapeutic planning of peripheral artery disease";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2825;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"Avoid blood cultures in patients who are not systemically septic, have a clear source of infection and in whom a direct specimen for culture (e.g. urine, wound swab, sputum, cerebrospinal fluid, or joint aspirate) is possible";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3081;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do prescribe a new drug to the elderly patients without consulting the treatments they are already on.";-;2015;;;"Low value";"Overtreatment, Medication";"Link to the recommendation in the semFYC website" 2570;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take simple radiographies when intussusception is suspected on paediatric patients";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 3082;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not perform systematic checkups (regular health exams) in asymptomatic individuals.";-;2015;;;"Low value";"General Health Checks";"Link to the recommendation in the semFYC website" 2571;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take simple pelvic radiographies when hip dysplasia is suspected on infants under 4 months";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 3083;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not systematically perform x-rays for ankle or foot sprains.";-;2015;;;"Low value";"Foot Ankle Sprains";"Link to the recommendation in the semFYC website" 2572;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not systematically carry out imaging studies on children with uncomplicated bacterial acute sinusitis";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 3084;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not rule out acute coronary syndrome just on the basis of a normal electrocardiogram performed outside a chest pain event situation.";-;2015;;;"Low value";"Acute Coronary Syndrome";"Link to the recommendation in the semFYC website" 2573;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not systematically take lateral radiographies of the skull on children with sleep apnoea-hypopnoea syndrome";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 3085;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"Do not use hypolipemic drugs in primary prevention of cardiovascular disease without assessing the total cardiovascular risk, except in patients with familial or hereditary hyperlipemia.";-;2015;;;"Low value";"Cardiovascular Prevention, Hyperlipidemia";"Link to the recommendation in the semFYC website" 2574;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform neuroimaging studies on paediatric patients with primary headaches";" clear volume_up 877 / 5000 Translation results The possibility of detecting clinically significant intracranial abnormalities in a patient without symptoms, signs, or suspicious neurological examination is very low. In addition, there is the possibility of detecting incidental findings that require additional evaluation or follow-up, the risk of exposure to ionizing radiation in the case of performing CT and the risk due to anesthesia if the child is not old enough to collaborate in the study. The possibility of detecting clinically significant intracranial abnormalities in a patient without symptoms, signs, or suspicious neurological examination is very low. In addition, there is the possibility of detecting incidental findings that require additional evaluation or follow-up, the risk of exposure to ionizing radiation in the case of performing CT and the risk due to anesthesia if the child is not old enough to collaborate in the study. ";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2575;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out barium studies at diagnostic evaluation on paediatric patients with inflammatory bowel disease (IBD)";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2576;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take pelvic radiographies of polytraumatised patients undertaking a full-body CT scan";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2577;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take abdominal radiographies when acute diverticulitis is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2578;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform CT scans on patients with acute pancreatitis with unambiguous presentation and with high levels of amylases and lipases";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2579;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform an intravenous urography (IVU) as first-choice study on patients when these present acute flank pain and renal colic is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2835;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Performing tests for pulmonary embolism without reasonable clinical suspicion has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 3091;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Olmesartan has shown a negative harm-benefit balance in patients with arterial hypertension";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2580;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take abdominal radiographies when acute pyelonephritis is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2836;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"For emergency department patients approaching end-oflife, ensure clinicians, patients and families have a common understanding of the goals of care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Enlace a la recomendaci�n en la p�gina web de Choosing Wisely Australia" 3092;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Natalizumab have shown a negative harm-benefit balance in patients with multiple sclerosis (Rev Prescrire n� 330, 333, 374).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2581;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take abdominal radiographies on acute abdomen unless intestinal obstruction or perforation is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2837;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"Don?t request imaging of the cervical spine in trauma patients, unless indicated by a validated clinical decision rule";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3093;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Pegloticase has shown a negative harm-benefit balance in patients with severe gout";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2838;29;"Choosing Wisely Australia";"Australasian College for Emergency Medicine";English;"Don?t request computed tomography (CT) head scans in patients with a head injury, unless indicated by a validated clinical decision rule";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3094;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Teriflunomide has shown a negative harm-benefit balance in patients with Multiple sclerosis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2583;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Culturale Pediatri (ACP)/The Cultural Association of Pediatricians - ACP";Spanish;"Avoid routine use of inhaled corticosteroids in upper respiratory tract illness in children.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2839;19;"Choosing Wisely Canada";"Canadian Society of Hospital Medicine";English;"Don?t place or leave in place a urinary catheter without reassessment.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Urinary Catheter";"Link to the recommendation in the Choosing Wisely Canada website" 3095;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Naphazoline and other oral and nasal vasoconstrictive decongestants may have more risks than benefits in treating cold symptoms";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 5655;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"It is encouraged the telemedicine to improve blood glucose control in people with diabetes.";"The cost of a health service and the acceptability of patients and healthcare professionals are unclear due to the limited data reported for these outcomes. The effectiveness of TM may depend on a few different factors, including those related to the study population eg the severity of the condition and the disease history of the participants, the role of the intervention eg if used to manage a chronic condition, or to provide access to diagnostic services, as well as the healthcare professional and healthcare system interested in providing the intervention.";2015;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative" 2584;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Culturale Pediatri (ACP)/The Cultural Association of Pediatricians - ACP";Spanish;"Avoid formula supplement in the first days of life for healthy, full term, breast- fed newborns without proved medical contraindications.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2840;19;"Choosing Wisely Canada";"Canadian Society of Hospital Medicine";English;"Don?t prescribe antibiotics for asymptomatic bacteriuria (ASB) in non-pregnant patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Asymptomatic Bacteriuria";"Link to the recommendation in the Choosing Wisely Canada website" 3096;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Oxymetazoline and other oral and nasal vasoconstrictive decongestants may have more risks than benefits in treating cold symptoms";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2585;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Culturale Pediatri (ACP)/The Cultural Association of Pediatricians - ACP";Spanish;"Don?t prescribe antibiotics to treat respiratory infections probably due to viral agents in children (pharyngitis, sinusitis, bronchitis).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 2841;19;"Choosing Wisely Canada";"Canadian Society of Hospital Medicine";English;"Don?t use benzodiazepines and other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Insomnia, Agitation, Delirium, Elderly";"Link to the recommendation in the Choosing Wisely Canada website" 3097;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Pseudoephedrine and other oral and nasal vasoconstrictive decongestants may have more risks than benefits in treating cold symptoms";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2586;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Culturale Pediatri (ACP)/The Cultural Association of Pediatricians - ACP";Spanish;"Don?t prescribe Chest Radiography to confirm diagnosis and to follow up in a not complicated pneumonia in children.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en italiano)

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en ingl�s)

" 2842;19;"Choosing Wisely Canada";"Canadian Society of Hospital Medicine";English;"Don?t routinely obtain neuro-imaging studies (CT, MRI scans, or carotid Doppler ultrasonography) in the evaluation of simple syncope in patients with a normal neurological examination.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Syncope, Neuro-imaging";"Link to the recommendation in the Choosing Wisely Canada website" 3098;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;English;"Tuaminoheptane and other oral and nasal vasoconstrictive decongestants may have more risks than benefits in treating cold symptoms";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2587;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Medicina Nucleare e Imaging Molecolare (AIMN)/ Italian Association of Nuclear Medicine";Spanish;"Do not use the PET-CT with 18F-FDG as a cancer screening technique in healthy subjects.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2843;19;"Choosing Wisely Canada";"Canadian Society of Hospital Medicine";English;"Don?t routinely obtain head computed tomography (CT) scans, in hospitalized patients with delirium in the absence of risk factors.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Delirium, CT scans";"Link to the recommendation in the Choosing Wisely Canada website" 3099;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h3049";English;"Allergy myths lead to underdiagnosis and overdiagnosis, say specialists";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2588;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Medicina Nucleare e Imaging Molecolare (AIMN)/ Italian Association of Nuclear Medicine";Spanish;"No studies PET-CT with 18F-FDG for the diagnosis of peripheral osteomyelitis or for the differential diagnosis between acute vs chronic inflammation.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2844;19;"Choosing Wisely Canada";"The Canadian Association of Nuclear Medicine";English;"Don?t perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Stress Cardiac Imaging, Coronary Angiography";"Link to the recommendation in the Choosing Wisely Canada website" 3100;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h2906";English;"US guideline may have led to drop in PSA testing among primary care physicians, PSA screening should be based on a shared decision making process for men aged 55 to 69 years.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";screening;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina de TheBMJ" 2589;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Medicina Nucleare e Imaging Molecolare (AIMN)/ Italian Association of Nuclear Medicine";Spanish;"Do lymphoscintigraphy and biopsy Radioguided ""sentinel node"" in patients with melanoma of the skin with a thickness of less than 0.75 mm, not ulcerated and a number of mitosis <1 / mm2.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2845;19;"Choosing Wisely Canada";"The Canadian Association of Nuclear Medicine";English;"Don?t use nuclear medicine thyroid scans to evaluate thyroid nodules in patients with normal thyroid gland function.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Thyroid Nodules, Nuclear Medicine";"Link to the recommendation in the Choosing Wisely Canada website" 3101;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h2688";English;"US physicians? group releases guidelines for ?high value? cancer screening";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2590;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Medici Diabetologi (AMD)";Spanish;"Do not use insulin therapy as needed ""(mobile scheme) for the treatment of hyperglycemia in hospitalized patients";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2846;19;"Choosing Wisely Canada";"The Canadian Association of Nuclear Medicine";English;"Don?t use a computed tomography angiogram (CTA) to diagnose pulmonary embolism in young patients, particularly women, with a normal chest radiograph; consider a radionuclide lung study (?VQ study?) instead.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Pulmonary Embolism, Nuclear Medicine";"Link to the recommendation in the Choosing Wisely Canada website" 3102;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ 2015;350:h1370";English;"Can healthy people benefit from health apps?";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 2591;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Medici Diabetologi (AMD)";Spanish;"Do not prescribe blood glucose daily routine at home in people with type 2 diabetes treated with medications that do not cause hypoglycemia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2847;19;"Choosing Wisely Canada";"The Canadian Association of Nuclear Medicine";English;"Don?t do routine bone scans in men with low-risk prostate cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Prostate Cancer";"Link to the recommendation in the Choosing Wisely Canada website" 3103;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ 2015;350:h1370";English;"Preventing overdiagnosis: the myth, the music, and the medical meeting";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2592;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Medici Diabetologi (AMD)";Spanish;"Don?t prescribe screenings for diabetes complications that are not in accordance with the national guidelines.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2848;19;"Choosing Wisely Canada";"The Canadian Association of Nuclear Medicine";English;"Don?t repeat DEXA scans more often than every two years in the absence of high risk or new risk factors.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"DEXA scans";"Link to the recommendation in the Choosing Wisely Canada website" 3104;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Cohen D. BMJ 2015;350:h258";English;"GPs are told to treat with scepticism advice on anti-flu drugs from Public Health England";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 2593;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Medici Diabetologi (AMD)";Spanish;"Do not treat diabetic patients receiving antiplatelet indiscriminately.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2849;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t order a routine ultrasound for umbilical and/or inguinal hernia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Inguinal Hernia, Umbilical Hernia, Ultrasound";"Link to the recommendation in the Choosing Wisely Canada website" 3105;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Godlee F. BMJ 2015;350:h226";English;"Think hard before expanding cancer screening";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 5665;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"Are recommended structured telephone support and non-invasive home telemonitoring in patients with heart failure.";"In patients with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and hospitalizations related to heart failure; These interventions also demonstrated improvements in health-related quality of life, as well as in knowledge of heart failure and self-care behavior. The studies also demonstrated participant satisfaction with most of the interventions that evaluated this outcome.";2015;;;"High value";"Prevention of patients";"Link to the recommendation on the website of the initiative" 2594;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Medici Diabetologi (AMD)";Spanish;"Not routinely perform dosing blood C-peptide in patients with diabetes.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2850;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t order C-reactive protein (CRP) levels in children with suspected appendicitis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Appendicitis, CRP";"Link to the recommendation in the Choosing Wisely Canada website" 3106;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2015;350:h417";English;"Don?t be bullied into prescribing Tamiflu*";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 2595;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione per un?assistenza appropriata in ostetricia e ginecologia - ANDRIA";Spanish;"No cord clamping in the first minute after birth in babies who do not need immediate assistance. (The Italian Association for the Promotion of appropriate care in Obstetrics, Ginecology and Perinatal Medicine)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2851;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Appendicitis, Ultrasound, TC";"Link to the recommendation in the Choosing Wisely Canada website" 3107;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h250";English;"Most screening tests do not save lives, researchers argue";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2596;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione per un?assistenza appropriata in ostetricia e ginecologia - ANDRIA";Spanish;"Do not use continuous cardiotocography (CTG) routine labor in low risk pregnancies hypoxia. (The Italian Association for the Promotion of appropriate care in Obstetrics, Ginecology and Perinatal Medicine)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2852;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t order a routine ultrasound for children with undescended testes.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Undescended Testes";"Link to the recommendation in the Choosing Wisely Canada website" 3108;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2015;350:h139";English;"Avoid expanding the age of mammography screening from the appropriate age.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 2597;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione per un?assistenza appropriata in ostetricia e ginecologia - ANDRIA";Spanish;"No request a gynecological or pelvic examination before prescribing oral contraceptives. (The Italian Association for the Promotion of appropriate care in Obstetrics, Ginecology and Perinatal Medicine)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2853;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t delay referral for undescended testes beyond 6 months of age.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Undescended Testes, Orchiopexy";"Link to the recommendation in the Choosing Wisely Canada website" 3109;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h113";English;"Headache is often over-investigated and overtreated, US study shows";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3621;6;"Less Is More Collection - JAMA Network";"Abou Ziki M.JAMA Intern Med. 2015;175(12):1901-1902.";English;"The Value of the History and Physical Examination?Sailing Through Medicine With Modern Tools A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2598;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione per un?assistenza appropriata in ostetricia e ginecologia - ANDRIA";Spanish;"Do not schedule elective inductions or cesarean section without medical indication before 39 + 0 weeks of gestation. (The Italian Association for the Promotion of appropriate care in Obstetrics, Ginecology and Perinatal Medicine)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2854;19;"Choosing Wisely Canada";"Canadian Association of Paediatric Surgery";English;"Don?t delay testing for total and conjugated (direct) bilirubin in any newborn with persistent jaundice beyond 2 weeks of age.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Biliary Atresia";"Link to the recommendation in the Choosing Wisely Canada website" 3622;32;"Otros art�culos/Other articles on this topic";"Howells J.JAMA Intern Med. 2015;175(12):1902-1903.";English;"When interpreting the Serum Ammonia levels, it is potentially recommended to consider the clinical context of the patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2599;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";Spanish;"In the evaluation of transient loss of consciousness and a normal neurological examination, don?t perform an EEG.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2855;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use atypical antipsychotics as a first-line intervention for insomnia in children and youth.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Insomnia, Children, Young";"Link to the recommendation in the Choosing Wisely Canada website" 3111;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hawkes N. BMJ 2014;349:g4380";English;"Six professors back NICE guidance on extending use of statins [article about the extended use of statins in patients without a high risk of cardiovascular events]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 3623;6;"Less Is More Collection - JAMA Network";"Larson C.JAMA Intern Med. 2015;175(11):1750-1751.";English;"Hospice Diagnosis: Polypharmacy A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2600;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";Spanish;"Don?t perform vertebral-carotid color-coded duplex ultrasound studies for transient loss of consciousness without other neurological symptoms.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2856;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use SSRIs as the first-line intervention for mild to moderately depressed teens.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Depression, Teens";"Link to the recommendation in the Choosing Wisely Canada website" 3624;32;"Otros art�culos/Other articles on this topic";"Sennesael A.JAMA Intern Med. 2015;175(10):1608-1609.";English;"Optimizing the Safe Use of Direct Oral Anticoagulants in Older Patients A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2601;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t prescribe prescribe acid suppressant suppressant therapy therapy in order to prevent prevent stress ulcers in hospitalized hospitalized patients, unless there is a high risk of bleeding.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2857;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use atypical antipsychotics as a first-line intervention for Attention Deficit Hyperactivity Disorder (ADHD) with disruptive behaviour disorders.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Attention Deficit Hyperactivity Disorder";"Link to the recommendation in the Choosing Wisely Canada website" 3625;6;"Less Is More Collection - JAMA Network";"Sharma A.JAMA Intern Med. 2015;175(10):1610-1611.";English;"Don't perform Preoperative Stress Tests in low to intermediate non-cardiac elective surgery.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2602;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t treat a bacteriuria with antibiotics in elderly patients without urinary symptoms.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2858;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use psychostimulants as a first-line intervention in preschool children with ADHD.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Attention Deficit Hyperactivity Disorder";"Link to the recommendation in the Choosing Wisely Canada website" 3626;32;"Otros art�culos/Other articles on this topic";"Kuhn S.JAMA Intern Med. 2015;175(9):1448-1449.";English;"Downstream Complications of Total Parenteral Nutrition?The Domino Effect A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2603;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t repeat chemistry chemistry testing testing in the face of clinical clinical and laboratory laboratory stability";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2859;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely use antipsychotics to treat primary insomnia in any age group.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Insomnia;"Link to the recommendation in the Choosing Wisely Canada website" 3371;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco.";"Recommendation grade A";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3627;6;"Less Is More Collection - JAMA Network";"Baxi S.JAMA Intern Med. 2015;175(8):1272-1273.";English;"Preoperative Testing?A Bridge to Nowhere A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2604;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t transfuse red blood cells for arbitrary Hb levels, without symptoms of active coronary artery disease, heart failure, stroke.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2860;29;"Choosing Wisely Australia";"Australasian Society of Clinical Immunology and Allergy";English;"Don?t use antihistamines to treat anaphylaxis ? prompt administration of adrenaline is the only treatment for anaphylaxis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3372;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)?approved pharmacotherapy for cessation to adults who use tobacco.";"Recommendation grade A";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3628;32;"Otros art�culos/Other articles on this topic";"Harrison W.JAMA Intern Med. 2015;175(7):1087-1088.";English;"Patient Preferences and End-of-Life Care A Teachable Moment. (EN PROCESO DE TRADUCCI�N)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2605;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t use benzodiazepines benzodiazepines in elderly elderly patients patients as a first choice for insomnia, insomnia, agitation, agitation, delirium.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2861;29;"Choosing Wisely Australia";"Australasian Society of Clinical Immunology and Allergy";English;"Alternative/unorthodox methods should not be used for allergy testing or treatment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3117;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Interventions for treating pain and disability in adults with complex regional pain syndrome- an overview of systematic reviews";-;2015;;;"Low value";-;"Link to the NICE website" 3373;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for high blood pressure in adults aged 18 years or older. The USPSTF recommends obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment.";"Recommendation grade A";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3629;32;"Otros art�culos/Other articles on this topic";"Nguyen L.JAMA Intern Med. 2015;175(7):1089-1090.";English;"It is recommended to clarify a patient's goal of care before conducting an unnecessary surveillance CT of an asymptomatic tumor.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2606;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t delay palliative cares in the dying patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2862;29;"Choosing Wisely Australia";"Australasian Society of Clinical Immunology and Allergy";English;"Allergen immunotherapy should not be used for routine treatment of food allergy ? research in this area is ongoing";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3118;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Nystatin prophylaxis and treatment in severely immunodepressed patients";-;2015;;;"Low value";-;"Link to the NICE website" 3374;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"The USPSTF recommends screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40 to 70 years who are overweight or obese. Clinicians should offer or refer patients with abnormal blood glucose to intensive behavioral c";"Recommendation grade B";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3630;32;"Otros art�culos/Other articles on this topic";"Brown D.JAMA Intern Med. 2015;175(7):1090-1091.";English;"The Recommendation for Stenting in Stable Coronary Artery Disease?Ignoring the Evidence, Excluding the Patient A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2607;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t routinely prescribe lipid lowering drugs in patients with a limited life expectancy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2863;29;"Choosing Wisely Australia";"Australasian Society of Clinical Immunology and Allergy";English;"Food specific IgE testing should not be performed without a clinical history suggestive of IgE mediated food allergy";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3119;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Stopping perioperative antibiotics for post-tonsillectomy morbidity";-;2015;;;"Low value";-;"Link to the NICE website" 3631;6;"Less Is More Collection - JAMA Network";"Matta S.JAMA Intern Med. 2015;175(11):1746-1747.";English;"In patients with Clostridium difficile?Positive Stool who continue Diarrhea after appropriate treatment, repeated stool examination and laboratory tests are unnecessary. Seek for the other cause of Diarrhea.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2608;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t use non-steroid anti-inflammatory drugs (NSAID) in subjects with arterial hypertension, hypertension, heart failure, failure, renal insufficiency insufficiency from any cause, including including diabetes diabetes.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2864;29;"Choosing Wisely Australia";"Australasian Society of Clinical Immunology and Allergy";English;"Don?t delay introduction of solid/complementary foods to infants ? ASCIA Infant Feeding Advice recommends early introduction of solid foods to infants, from 4-6 months old";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de Choosing Wisely Australia" 3120;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For women with a pregnancy of unknown location, when using serial serum hCG measurements, do not use serum progesterone measurements as an adjunct to diagnose either viable intrauterine pregnancy or ectopic pregnancy.";-;2015;;;"Low value";-;"Link to the recommnedation on the website of NICE / Enlace a la p�gina web de la NICE" 3632;6;"Less Is More Collection - JAMA Network";"Gupta A.JAMA Intern Med. 2015;175(11):1748-1749.";English;"Inappropriate Antibiotic Therapy in a Patient With Heart Failure and Prolonged QT Interval A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2609;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t perform PET/CT for cancer screening in healthy subjects.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2865;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the Rules)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3121;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anti-D rhesus prophylaxis to women who: receive solely medical management for an ectopic pregnancy or miscarriage or have a threatened miscarriage or have a complete miscarriage or have a pregnancy of unknown location.";-;2015;;;"Low value";-;"Link to the recommendation on the webstie of the initiative / Enlace a la p�gina web de la iniciativa" 3633;32;"Otros art�culos/Other articles on this topic";"Enomoto L.JAMA Otolaryngol Head Neck Surg. 2015;141(12):1066-1074.";English;"The Cost of Hospice Services in Terminally Ill Patients With Head and Neck Cancer";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2610;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Genetica Umana (SIGU)";Spanish;"No genetic testing for mutations in the methylenetetrahydrofolate reductase enzyme (MTHFR).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2866;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t request duplex compression ultrasound for suspected lower limb deep venous thrombosis in ambulatory outpatients unless the Wells Score (deep venous thrombosis risk assessment score) is greater than 2, OR if less than 2, D dimer assay is positive.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3122;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a Kleihauer test for quantifying feto?maternal haemorrhage.";-;2015;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la p�gina web de la NICE" 3378;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend not screening asymptomatic adults (?65 years of age) for cognitive impairment";"This recommendation applies to community dwelling older adults (?65 years of age) who do not have noticeable symptoms suggestive of mild cognitive impairment or dementia. This recommendation does not apply to men or women who are concerned about their own cognitive performance (i.e. the patient has raised complaints about cognitive changes with their clinician or others) or who are suspected of having mild cognitive impairment or dementia by clinicians or non-clinicians (caregivers, family, or friends) and/or have symptoms suggestive of mild cognitive impairment or dementia (such as loss of memory, language, attention, visuospatial, or executive functioning, or behavioural or psychological symptoms that may either mildly or significantly impact a patient?s day-to-day life or usual activities).";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3634;32;"Otros art�culos/Other articles on this topic";"Polage C.JAMA Intern Med. 2015;175(11):1792-1801.";English;"Don't rely on Molecular tests for Clostridium difficile Infection (CDI) without tests for toxins among hospitalized adults to determine the treatment.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2611;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Genetica Umana (SIGU)";Spanish;"No offer genetic tests directly to people through websites, pharmacies, gyms or institutions beauty, without the prescription of a physician.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2867;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t request any diagnostic testing for suspected pulmonary embolism (PE) unless indicated by Wells Score (or Charlotte Rule) followed by PE Rule-out Criteria (in patients not pregnant)*.";"*Low risk patients in whom diagnostic testing is indicated should have PE excluded by a negative D dimer, not imaging";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3635;32;"Otros art�culos/Other articles on this topic";"Ross J.JAMA Intern Med. 2015;175(9):1564.";English;"Promoting Evidence-Based High-Value Health Care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2612;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Genetica Umana (SIGU)";Spanish;"No genetic testing for the diagnosis of monogenic diseases in the physiological process of procreation or medically assisted (WFP).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2868;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t perform imaging for patients with non-specific acute low back pain and no indicators of a serious cause for low back pain";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3636;32;"Otros art�culos/Other articles on this topic";"Ralston S.JAMA Pediatr. 2015;169(9):805-806.";English;"Benchmarking Overuse of Medical Interventions for Bronchiolitis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2613;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Genetica Umana (SIGU)";Spanish;"No HLA typing performed before the diagnosis of celiac disease or disease screening";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";*;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2869;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t request imaging of the cervical spine in trauma patients, unless indicated by a validated clinical decision rule";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3637;32;"Otros art�culos/Other articles on this topic";"Lin J.JAMA Intern Med. 2015;175(7):1092-1093.";English;"Addressing Overuse of Medical Services One Decision at a Time";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2614;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"The routinary use of belts or lumbar supports is not recommended for the treatment, primary or secondary prevention, in patients with mechanical non-specific low back pain.";-;2015;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2870;29;"Choosing Wisely Australia";"The Royal Australian and New Zealand College of Radiologists";English;"Don?t request computed tomography (CT) head scans in patients with a head injury, unless indicated by a validated clinical decision rule";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely Australia website" 3638;32;"Otros art�culos/Other articles on this topic";"Maraka S.JAMA Intern Med. 2015;175(11):1873.";English;"Don't routinely use the cut-off TSH levels in pregnancy. It seems to be an upper trimester specific TSH limit higher than 2.5 or 3 mIu/L based on population.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2871;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely order qualitative toxicology (urine drug screen) testing on all psychiatric patients presenting to emergency rooms.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Qualitative Urine Toxicology";"Link to the recommendation in the Choosing Wisely Canada website" 3639;6;"Less Is More Collection - JAMA Network";"O?Brien M.JAMA Intern Med. 2015;175(10):1606-1607.";English;"Avoid ordering tests that are not clinically indicated.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5687;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is insufficient evidence on the efficacy of telerehabilitation for the improvement of functional activities, fatigue and quality of life in adults with multiple sclerosis.";"Several telerehabilitation interventions could be an alternative method of service delivery in populations with MS. There is insufficient evidence to support what types of telerehabilitation interventions are effective and in what context. More consistent trials are needed to build evidence for the clinical effectiveness and cost-effectiveness of these interventions.";2015;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 2872;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely use antidepressants as first-line treatment for mild or subsyndromal depressive symptoms in adults.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Antidepressant;"Link to the recommendation in the Choosing Wisely Canada website" 3640;6;"Less Is More Collection - JAMA Network";"Manasco A.JAMA Intern Med. 2015;175(8):1267.";English;"Does My Mother Really Need That Central Line?";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2873;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely order brain neuroimaging (CT or MRI) in first episode psychoses in the absence of signs or symptoms suggestive of intracranial pathology.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Neuroimaging, Psychoses";"Link to the recommendation in the Choosing Wisely Canada website" 3641;32;"Otros art�culos/Other articles on this topic";"Chamberlain E.JAMA Intern Med. 2015;175(8):1271-1272.";English;"When Medical Care Leads to Harm?Difficulty Finding Words A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2874;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely continue benzodiazepines initiated during an acute care hospital admission without a careful review and plan of tapering and discontinuing, ideally prior to hospital discharge.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Benzodiazepines;"Link to the recommendation in the Choosing Wisely Canada website" 3642;32;"Otros art�culos/Other articles on this topic";"Juthani-Mehta M.JAMA Intern Med. 2015;175(7):1127-1129.";English;"Changing Clinicians? Behavior To Order or Not to Order a Urine Culture";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6714;36;"Choosing Wisely UK";"Royal College of Anaesthetists & Royal College of Surgeons England";English;"It is recommended that day surgery be considered as the default option for many elective surgical procedures. Variation in the use of day surgery for these operations should be measured and this information made available to patients.";"The increase in the proportion of operations performed as day cases in recent decades has been good for patients and has meant a much more efficient use of NHS resources and the ability to treat large numbers of additional patients. The recommendations are based on the opinion of an economic expert in an article on the internet.";2015;;;"High value";-;"Link to the recommendation on the website of the initiative" 2875;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely prescribe antidepressants as first-line treatment for depression comorbid with an active alcohol use disorder without first considering the possibility of a period of sobriety and subsequent reassessment for the persistence of depressive";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Antidepressant treatment, Alcohol, Depression";"Link to the recommendation in the Choosing Wisely Canada website" 3387;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults";"There is no good evidence that flushing central venous catheters (CVCs) with heparin is better than flushing with normal saline solution (sodium choride 0.9%). Heparin may cause undesirable side effects and gives no benefit over normal saline, which has virtually no side effects. Heparin did not offer additional protective effects against complications associated with CVC use; namely, sepsis, thrombosis and haemorrhage. Therefore, intermittent flushing of CVCs with heparin is not recommended.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3643;32;"Otros art�culos/Other articles on this topic";"Goffin J.JAMA Oncol. 2015;1(6):807-813.";English;"Lung cancer screening with low dose computed tomography in smokers or former smokers aged 55-74 is recommended.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2876;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not routinely prescribe high-dose or combination antipsychotic treatment strategies in the treatment of schizophrenia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Schizophrenia, Antipsychotics";"Link to the recommendation in the Choosing Wisely Canada website" 3388;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Robot-assisted surgery (RAS) for hysterectomy or sacrocolpopexy should be limited to clinical research settings at present as it is unclear whether it is safer and more effective than conventional laparoscopic surgery (CLS).";"Robot-assisted surgery (RAS) for hysterectomy or sacrocolpopexy should be limited to clinical research settings at present as it is unclear whether it is safer and more effective than conventional laparoscopic surgery (CLS). Ongoing trials are likely to have an important impact on evidence related to the use of robot-assisted surgery in gynaecology.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3644;32;"Otros art�culos/Other articles on this topic";"Noureldin S.JAMA Otolaryngol Head Neck Surg. 2015;141(12):1082-1088.";English;"Don't routinely order Gene Expression Classifier Molecular Testing on the Surgical Decision-Making Process for Patients With Thyroid Nodules.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2877;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Antypsychotics, Dementia";"Link to the recommendation in the Choosing Wisely Canada website" 3645;32;"Otros art�culos/Other articles on this topic";"Grady D.JAMA Intern Med. 2015;175(7):1234.";English;"A Simple Approach to Reducing Inappropriate Use of Central Venous Catheters";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2878;19;"Choosing Wisely Canada";"Canadian Psychiatry Association";English;"Do not use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Benzodiazepines, Older Adults, Insomnia";"Link to the recommendation in the Choosing Wisely Canada website" 3646;32;"Otros art�culos/Other articles on this topic";"Smetana G.JAMA Intern Med. 2015;175(8):1359-1361.";English;"Don't routinely order Preoperative Testing for patients undergo low risk surgery unless there is a clinical indication.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2879;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t perform fusion surgery to treat patients with mechanical axial low back pain from multilevel spine degeneration in the absence of: - leg pain with or without neurologic symptoms and/or signs of concordant neurologic compression - structural patholog";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Spinal Fusion Surgery, Back Pain";"Enlace a la recomendaci�n en la p�gina web Choosing Wisely Canada" 3647;32;"Otros art�culos/Other articles on this topic";"Plovanich M.JAMA Dermatol. 2015;151(9):941-944.";English;"Routine Potassium Monitoring is unnecessary Among Healthy Young Women Taking Spironolactone for Acne";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2880;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t routinely image patients with low back pain regardless of the duration of symptoms unless: - there are clinical reasons to suspect serious underlying pathology (i.e., red flags) - imaging is necessary for the planning and/or execution of a particula";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Low Back Pain, Imaging";"Link to the recommendation in the Choosing Wisely Canada website" 3392;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Catalan Society of Paediatrics";Spanish;"Bronchiolitis in infants should not be routinely treated with beta 2 adrenergic bronchodilators.";"Bronchiolitis is a viral respiratory infection of the lower airways that is very frequent in infants, especially in the first year of life. The use of beta 2 adrenergic bronchodilators, such as salbutamol, is common and generalised in our health care system. The use of bronchodilators is not recommended in bronchiolitis in infants, since it has no proven benefit. Avoiding the use of bronchodilators prevents adverse effects from this drug, and also an unnecessary expenditure.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2881;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t use epidural steroid injections (ESI) for patients with axial low back pain who do not have leg dominant symptoms originating in the nerve roots.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Axial Low Back Pain, Epidural Steroid Injections";"Link to the recommendation in the Choosing Wisely Canada website" 3393;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pediatria.";Spanish;"Acute rhinosinusitis should not be systematically treated with antibiotics, except when clinical criteria support a probable bacterial cause, especially in severe cases, worsening cases or persistent symptoms";"Clinical criteria should be used to differentiate a bacterial rhinosinusitis from a viral infection of the upper airways. The systematic use of antibiotics in acute rhinosinusitis is not recommended, except when it meets the clinical criteria of severe bacterial rhinosinusitis, it has worsened, or with the persistence of important symptoms in the upper airways. The unjustified use affinity antibiotics fosters the development of antibiotic-resistant infections, thus contributing to avoidable adverse effects and unnecessary costs.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 5697;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"Evidence that mobile phone interventions can improve contraceptive use is limited.";"Although evidence indicates that a series of interactive voice messages and counselor support can improve the use of contraceptive methods after an abortion, and that a mix of one-way and interactive daily educational text messages can improve compliance with contraceptive, the relationship between cost-effectiveness and the long-term effects of these interventions are still unknown. Additional high quality trials are needed to consistently establish the effects of mobile phone interventions to improve the use of contraceptive methods.";2015;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 2882;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t miss the opportunity to brace the skeletally immature patient with adolescent idiopathic scoliosis (AIS) who has more than one year of growth remaining and a curve magnitude greater than 20 degrees.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Bracing, Scoliosis";"Link to the recommendation in the Choosing Wisely Canada website" 2883;19;"Choosing Wisely Canada";"Canadian Spine Society";English;"Don?t order peri-operative antibiotics beyond a 24-hour post-operative period for non-complicated instrumented cases in patients who are not at high risk for infection or wound contamination. Administration of a single pre-operative dose for spine cases w";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Peri-Operative Antibiotics, Spinal";"Link to the recommendation in the Choosing Wisely Canada website" 3395;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pediatria";Spanish;"Bronchiolitis in infants should not be routinely treated with antibiotics, except when a bacterial infection is present, or strongly suspected.";"Bronchiolitis is caused by a viral infection affecting the lower respiratory tract of infants. There is not sufficient evidence to grant the use of antibiotics in bronchiolitis. The high use of antibiotics is the main causal factor in the development of resistances, and it endangers the effectiveness of this group of drugs. Given that the aetiology of this disease is viral, the use of antibiotics is not recommended in infants with bronchiolitis; it may only be used exceptionally with a concomitant bacterial infection.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2884;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine";English;"Don?t use immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Immunoglobulin Replacement";"Link to the recommendation in the Choosing Wisely Canada website" 2885;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine";English;"Don?t order unnecessary pre-transfusion testing (type and screen) for all pre-operative patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Pre-transfusion Testing, Pre-operative";"Link to the recommendation in the Choosing Wisely Canada website" 2886;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine";English;"Don?t routinely order perioperative autologous and directed blood collection.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Perioperative Autologous Donation";"Link to the recommendation in the Choosing Wisely Canada website" 5446;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"The use of short-course antibiotic therapy is recommended in severe adult patients with hospital-acquired pneumonia.";"Overall, for patients with ventilator-associated pneumonia (NAR), a short course of seven or eight days of antibiotics compared to a prolonged course of 10 to 15 days increased days without antibiotics within 28 days (2 studies; N = 431; mean difference [DM] 4.02 days; 95% confidence interval [CI]: 2.26 to 5.78) and reduced recurrence of NAR due to multidrug resistant microorganisms (1 study; N = 110 odds ratio [OR] 0.44, 95% CI 0.21 to 0.95), without negatively affecting mortality and other recurrence outcomes. However, in cases of NAR caused specifically by non-fermenting gram-negative bacilli (BGN-NF), recurrence was higher after short-term treatment (2 studies, N = 176; OR 2.18, 95% CI: 1 , 14 to 4.16), although the mortality results were not significantly different. However, in cases where NAR was caused by a particular type of microorganism (""non-fermenting gram-negative bacilli"") that may be difficult to eradicate with antibiotics, the risk of recurrence of pneumonia seemed higher after a course of antibiotics. short duration (three day cycle). A study found that for patients with possible (but unlikely) hospital-acquired pneumonia, short-term (three-day) treatment appeared to be associated with a decreased likelihood of acquiring resistant microorganisms or subsequent infections caused by a microorganism. resistant.";2015;;;"High value";"Treatment COVID-19, Pneumonia, Ventilator?Associated, Cross Infection, Drug therapy, Anti?Bacterial Agents, Intensive Care Units";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2887;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine";English;"Don?t transfuse O negative blood except to O negative patients and in emergencies for female patients of child-bearing potential of unknown blood group.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"O-negative Red Cell Units";"Link to the recommendation in the Choosing Wisely Canada website" 2888;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine";English;"Don?t transfuse group AB plasma to non-group AB patients unless in emergency situations where the ABO group is unknown.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"AB plasma";"Link to the recommendation in the Choosing Wisely Canada website" 5448;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento de la hipoxemia)";Spanish;"No evidence was found of the efficacy of using extracorporeal respiratory membrane oxygenation to improve survival in the adult population compared to conventional cardiac and respiratory support";"Among critically ill adult patients, death rates are as high as 50% for those with acute heart failure and 30% to 40% for those diagnosed with severe respiratory failure. Severe hypoxemia and / or hypercapnia as a result of acute respiratory distress syndrome (ARDS), primary graft dysfunction after lung transplantation, and direct trauma are common conditions treated with support of respiratory extracorporeal membrane oxygenation (OMEC). The use of OMEC in adults has been controversial since it was successfully introduced as a treatment option for critically ill patients. For the cohorts of patients with predominantly respiratory failure, the oldest randomized controlled trials (RCTs) (those published before 2000) do not report any benefit of the intervention compared to conventional treatment strategies. But advances in extracorporeal circuit technology and better patient management are likely to have led to better results in the past. The main objective of this systematic review was to determine if the use of venous-venous OMEC (VV) or veno-arterial OMEC (VA) in adults is more effective in improving survival compared to conventional cardiac and respiratory support. All RCTs comparing adult OMEC versus conventional support were eligible for inclusion in this review. Quasi-randomized controlled trials and group randomized trials were also eligible for inclusion, although crossover trials were not. We included in this review all studies that included adult participants (over 18 years of age) with heart or respiratory failure, or both. All studies involving participants who underwent surgery for whom OMEC was established as a planned procedure for the purpose of surgery were excluded. We include in this review OMEC that uses veno-venous (VV) and veno-arterial (VA) circuits or arteriovenous (AV) circuits without a pump, compared to all conventional forms of treatment (eg, intermittent positive pressure ventilation). Studies comparing other forms of mechanical support specifically designed to support cardiac function, such as ventricular assist devices, were excluded. The primary outcome of this review was the closest all-cause mortality rate at 30, 60, or 90 days and / or at six months. Secondary outcomes were: Length of hospital stay, survival to discharge, disability as reported by the study authors. Adverse outcomes, health-related quality of life, as reported by the study authors, longer-term health and well-being, as reported by the study authors, and cost-effectiveness of the intervention. We included four clinical trials (RCTs) that randomized 389 participants with acute respiratory failure. The risk of bias was low in three RCTs and high in one RCT. No statistically significant difference in all-cause mortality was found at six months (two RCTs) or before six months (for 30 days from randomization in one trial and during hospital stay in another RCT). The quality of the evidence was low to moderate, and further research will likely impact confidence in the calculation of effects because significant changes in OMEC applications and treatment modalities have been observed during the periods. study to the present. Two RCTs provided data on disability. In one RCT, survival was low in both groups, although none of the survivors had limitations in daily activities six months after discharge. The other RCT reported improvement in severe disability-free survival in the intervention group (transfer to an OMEC � OMEC center) six months after study randomization, but no statistically significant difference in quality of life related to health. In three RCTs, participants in the OMEC group received an increased number of blood transfusions. One RCT recorded significantly more non-cerebral hemorrhage in the OMEC group. Another RCT reported two serious adverse events in the OMEC group, and another reported three adverse events in the OMEC group. Clinical heterogeneity between the studies prevented meta-analysis between the results. We did not find any completed RCTs that would have investigated OMEC in the context of heart failure or cardiac arrest. Combining the results of ongoing RCTs with the results of trials conducted after 2000 is recommended if no significant changes in technology or treatment occur. Until these new results become available, data on the use of OMEC in patients with acute respiratory failure remain inconclusive";2015;;;Uncertain;"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2889;19;"Choosing Wisely Canada";"The Canadian Society for Vascular Surgery";English;"Don?t perform percutaneous interventions or bypass surgery as first line therapy in patients with asymptomatic peripheral arterial disease (PAD) and in most patients with claudication.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Peripheral Arterial Disease";"Link to the recommendation in the Choosing Wisely Canada website" 2890;19;"Choosing Wisely Canada";"The Canadian Society for Vascular Surgery";English;"Don?t perform carotid endarterectomies or stenting in most asymptomatic high risk patients with limited life expectancy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Carotid Endarterectomy";"Link to the recommendation in the Choosing Wisely Canada website" 5450;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"There is uncertainty about the effectiveness of physical rehabilitation for patients with critical illness myopathy or polyneuropathy.";"Some patients with COVID-19 will become critically ill and need treatment in an intensive care unit (ICU). Critical illness myopathy (CIM) and polyneuropathy (CIP) weakness are common in ICU patients and physical rehabilitation may be used to try to improve their activities of daily living when they leave the ICU. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials of the effects of physical rehabilitation for people with CIP/CIM on activities of daily living, such as walking, bathing, dressing and eating. They did not restrict their search by date, type or language of publication and did it in July 2014. They did not identify any eligible studies.";2015;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2891;19;"Choosing Wisely Canada";"The Canadian Society for Vascular Surgery";English;"Don?t perform open or endovascular repair in most asymptomatic patients with small abdominal aortic aneurysms (<5cm in women, <5.5cm in men).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Abdominal Aortic Aneurysm";"Link to the recommendation in the Choosing Wisely Canada website" 2892;19;"Choosing Wisely Canada";"The Canadian Society for Vascular Surgery";English;"Don?t perform endovascular repair of abdominal aortic aneurysms in most asymptomatic high-risk patients with limited life expectancy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Asymptomatic Abdominal Aortic Aneurysm";"Link to the recommendation in the Choosing Wisely Canada website" 3148;6;"Less Is More Collection - JAMA Network";"Kasia J. Lipska, et al. JAMA Intern Med. 2015;175(3):356-362";English;"Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Diabetes, Overtreatment";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 5452;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"It is uncertain if there is a difference between pressure-controlled ventilation and volume-controlled ventilation for adults with acute respiratory failure";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but this can cause complications. Techniques used to prevent these complications are different ways for controlling the pressure or volume of air delivered by MV. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials which compared pressure-controlled ventilation (PCV) versus volume-controlled ventilation (VCV) in adults with acute respiratory failure. They did not restrict by language or publication status and did their searches in October 2014. They identified three randomized trials (1089 participants). It is uncertain if there is a difference between PCV and VCV for the following outcomes, for adults with acute respiratory failure: mortality in the ICU, barotrauma, duration of MV, infection during MV or quality of life after discharge.";2015;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2893;19;"Choosing Wisely Canada";"The Canadian Society for Vascular Surgery";English;"Don?t perform unnecessarily frequent ultrasound examinations in asymptomatic patients with small abdominal aortic aneurysms. Aneurysms smaller than 4.5cm in diameter should undergo ultrasound surveillance every 12 months.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Small Abdominal Aortic Aneurysm, Ultrasound";"Link to the recommendation in the Choosing Wisely Canada website" 3149;6;"Less Is More Collection - JAMA Network";"Shun Yu, et al. JAMA Intern Med. 2015;175(3):447-449";English;"Computed Tomographic Pulmonary Angiography. Clinical Implications of a Limited Negative Result";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Computed Tomographic Pulmonary Angiography";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 5453;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The groups of patients for whom prone positioning is not beneficial is uncertain. ";"Some patients with COVID-19 will become critically ill and develop acute respiratory distress syndrome (ARDS). They may require mechanical ventilation (MV) in an intensive care unit (ICU). They might be placed in the prone position for this, rather than in a supine or recumbent position. In this Cochrane systematic review, the authors searched for randomized trials of the effects of using a prone position rather than a supine or semi-recumbent position during conventional MV for adults with acute respiratory failure. They did not restrict by language of publication and did their most recent searches in June 2015. They included 9 studies (2165 participants), and identified a further 5 studies that are awaiting classification in a future update of the review. The studies suggest that patients for whom early implementation of prone positioning or prolonged adoption of prone positioning are used, or who have severe hypoxaemia, are less likely to die. The groups of patients for whom prone positioning is not beneficial is uncertain.";2015;;;Uncertain;"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2894;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h1732";English;"US aims to cut antibiotic use in new five year plan to combat antibiotic resistant bacteria";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Antibiotics;"Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3150;6;"Less Is More Collection - JAMA Network";"Tara Lagu. JAMA Intern Med. 2015;175(3):459-460";English;"?Less Is More? and The House of God. Was The Fat Man Right Again?";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Elderly;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2895;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Warman S. BMJ 2015;350:h1896";English;"How I use health apps.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Health Apps";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3151;6;"Less Is More Collection - JAMA Network";"Philip A. Band. JAMA Intern Med. 2015;175(3):462";English;"Using Medicare Data to Understand Health Care Value. Measures of Incremental Cost and Effectiveness are Both Needed to Estimate Value";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Health Care Value";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2896;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h2036";English;"Don't rely on genomic analysis of only a patient's tissue to guide cancer therapy. Because of the existing of harmless mutations that are also present in the patients normal germ line cells and are unrelated to the cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Genomic Sequencing";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3152;6;"Less Is More Collection - JAMA Network";"Joshua Feblowitz, et al. JAMA Intern Med. 2015;175(4):490-491";English;"What Are the Patient?s Wishes?";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"End Of Live, Choices";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2897;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h2174";English;"US panel reaffirms controversial 2009 mammography recommendations which said it is not recommend mammography screening every 2 years for asymptomatic women from their 40s unless clinically indicated.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Mammography;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3153;6;"Less Is More Collection - JAMA Network";"Paolo Goffredo, et al. JAMA Intern Med. 2015;175(4):638-640";English;"Patterns of Use and Cost for Inappropriate Radioactive Iodine Treatment for Thyroid Cancer in the United States. Use and Misuse";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Thyroid Cancer";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2898;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015;350:h2759";English;"Pregnant women are advised to seek medical advice if they need paracetamol for more than one day.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Pregnancy, Paracetamol";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3154;6;"Less Is More Collection - JAMA Network";"Raed A. Joundi et al. JAMA Intern Med. 2015;175(4):489-490";English;"Antibiotics ?Just-In-Case? in a Patient With Aspiration Pneumonitis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Antibiotics, Aspiration Pneumonitis";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3666;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;351:h3661";English;"Caution should be performed during the use of mammography since Mammography detects more small cancers but results in overdiagnosis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2899;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h2688";English;"US physicians? group releases guidelines for ?high value? cancer screening";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Guidelines, Cancer";"Link to the article of the BMJ Too Much Medicine / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3155;6;"Less Is More Collection - JAMA Network";"Eve A. Kerr, et al. JAMA Intern Med. 2015;175(4):645-647";English;"Don't order Stress test before Low-risk non-cardiac Surgery.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Cardiac Stress Testing";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3667;32;"Otros art�culos/Other articles on this topic";"McCoy R.BMJ 2015;351:h6138";English;"Excessive HbA1c testing is ineffective and inefficient, and could contribute to the growing problem of waste in healthcare and increasing patient burden in the management of type 2 diabetes.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5459;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Courses of antibiotics lasting 7 or 8 days reduce the recurrence of pneumonia compared with courses lasting 10 to 15 days, in patients with ventilator-acquired pneumonia";"Some patients with COVID-19 will become critically ill and need to be treated in an intensive care unit (ICU). Pneumonia is the most common hospital-acquired infection, particularly affecting patients in the ICU. Antibiotic courses of different lengths are used to treat it. In this Cochrane systematic review, the authors searched for randomized trials comparing a ?short? duration of antibiotic therapy versus a ?prolonged? course for hospital-acquired pneumonia in critically ill adults, including those on mechanical ventilation who might develop ventilator-acquired pneumonia (VAP). They did not restrict by date or language of publication and did their searches in June 2015. They identified 6 eligible studies (1088 participants), but with substantial variation in how the included patients? pneumonia was diagnosed or defined. For patients with VAP, courses of antibiotics lasting 7 or 8 days increase the number of antibiotic?free days in the 4 weeks after treatment and reduce the recurrence of pneumonia compared with courses lasting 10 to 15 days, without increasing mortality or other recurrence outcomes. For patients with VAP specifically due to non?fermenting Gram?negative bacilli (NF?GNB), recurrence was greater after 8-day courses compared to courses lasting 10 to 15 days, but mortality outcomes were not significantly different.";2015;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2900;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h2690";English;"Not all women with dense breasts need further imaging after normal mammogram.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Dense Breasts";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3156;6;"Less Is More Collection - JAMA Network";"Say Salomon et al. JAMA Intern Med. 2015;175(4):487";English;"Unnecessary Pacemaker. Care Coordination Problems and Language Barriers";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Pacemaker;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3668;32;"Otros art�culos/Other articles on this topic";"Wiles K.BMJ 2015;351:h4726";English;"Diagnosis and treatment of subclinical hypothyroidism in pregnancy should be based on TSH above the upper limit of a local gestation specific reference range (rather than a universal 2.5 mU/L). Where this reference range is not available, attempts should ";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2901;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Delamothe T. BMJ 2015;350:h2609";English;"We are our choices";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Choices;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3157;6;"Less Is More Collection - JAMA Network";"Ayokunle T. Abegunde, et al. JAMA Intern Med. 2015;175(4):651-652";English;"Evaluating Clinical Management Decisions by Recent Graduates in the Era of High-Value, Cost-Conscious Care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"High-Value Care";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3669;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Melnick E.BMJ 2015;351:h5831";English;"How to make less more: empathy can fill the gap left by reducing unnecessary care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2902;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h2824";English;"No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Blood pressure lowering agents, Diabetes, Kidney Disease";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3158;6;"Less Is More Collection - JAMA Network";"Kevin Selby, et al. JAMA Intern Med. 2015;175(4):640-642";English;"Creating a List of Low-Value Health Care Activities in Swiss Primary Care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Low-Value Health Care, Primary Care";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3670;32;"Otros art�culos/Other articles on this topic";"McCarthy M. BMJ 2015;351:h5261";English;"CT and D-dimer testing are overused in patients with suspected pulmonary embolism, US college says";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6742;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"The current test for dementia, which is a form of questionnaire, is not recommended as it does not accurately identify people who have dementia and those who do not.";"It is not recomended. The Committee concluded that the current test for dementia, which is a form of questionnaire, does not accurately identify those people who have dementia and those who do not. To recommend screening, the Committee would need to be confident that by acting early, treatments would slow or even prevent this serious disease. At the moment these treatments do not exist.";2015;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 2903;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015;350:h2880";English;"Many UK patients with gonorrhoea are given outdated antibiotics.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Gonorrhoea;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3159;6;"Less Is More Collection - JAMA Network";"Kevin Brown, et al. JAMA Intern Med. 2015;175(4):626-633";English;"Hospital Ward Antibiotic Prescribing and the Risks of Clostridium difficile Infection";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Clostridium difficile";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2904;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h3055";English;"Mammography screening is recommended in women aged 50-70 years. Benefits of mammography in these women outweigh risks with reduced cancer mortality.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Mammography;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3160;6;"Less Is More Collection - JAMA Network";"Shlok Gupta et al. JAMA Intern Med. 2015;175(4):642-644";English;"Development of Choosing Wisely Recommendations for an Inpatient Internal Medicine Service";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"High Value Care";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2905;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Roehr B. BMJ 2015;350:h3097";English;"FDA committee recommends approval for ?female Viagra?";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Female Viagra";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3161;6;"Less Is More Collection - JAMA Network";"Elyn H. Wang, et al. JAMA Intern Med. 2015;175(5):792-799";English;"Shared Decision Making and Use of Decision Aids for Localized Prostate Cancer Perceptions From Radiation Oncologists and Urologists";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Prostate Cancer";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2906;29;"Choosing Wisely Australia";"Royal Australian College of General Practitioners";English;"Don?t use proton pump inhibitors (PPIs) long term in patients with uncomplicated disease without regular attempts at educing dose or ceasing";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3162;6;"Less Is More Collection - JAMA Network";"Emily G. McDonald, et al. JAMA Intern Med. 2015;175(5):784-791";English;"Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Proton Pump Inhibitor, Clostridium Difficile";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 6746;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"Ultrasonography (transabdominal and transvaginal) is recommended as the main imaging test in the evaluation of ovarian masses in the female population.";"Ovarian masses are very common in pre- and postmenopausal women and are typically an incidental finding. Although ultrasonography is the best mode of imaging we have for assessment of ovarian pathology, its sensitivity and specificity for the diagnosis of ovarian cancer is only 86?91% and 68?81% respectively.";2015;;;"High value";Diagnostic;"Link to the recommendation on the website of the initiative" 2907;29;"Choosing Wisely Australia";"Royal Australian College of General Practitioners";English;"Don?t commence therapy for hypertension or hyperlipidaemia without first assessing the absolute risk of a cardiovascular event";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3163;6;"Less Is More Collection - JAMA Network";"Mallika L. Mendu, et al. JAMA Intern Med. 2015;175(5):853-856";English;"Multiple diagnostic testing and procedures in the Initial Evaluation of Chronic Kidney Disease are not necessary. Caution should be performed when ordering and interpreting several diagnostic tests.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Chronic Kidney Disease";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2908;29;"Choosing Wisely Australia";"Royal Australian College of General Practitioners";English;"Don?t advocate routine self-monitoring of blood glucose for people with type 2 diabetes who are on oral medication only";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3164;6;"Less Is More Collection - JAMA Network";"Mona Beier, et al. JAMA Intern Med. 2015;175(5):864-865";Spanish;"Educating Residents Why Less Is More With Telemetry";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Residence, Telemetry";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3420;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology";English;"Don?t perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2909;29;"Choosing Wisely Australia";"Royal Australian College of General Practitioners";English;"Don?t screen asymptomatic, low-risk patients (<10% absolute 5-year CV risk) using eCg, stress test, coronary artery calcium score, or carotid artery ultrasound";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de Choosing Wisely Australia" 3165;6;"Less Is More Collection - JAMA Network";"Kleper N. F. de Almeida, JAMA Intern Med. 2015;175(5):861";English;"Insertion Site for Central Venous Catheters";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Central Venous Catheter";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3421;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology";English;"Don?t perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2910;29;"Choosing Wisely Australia";"Royal Australian College of General Practitioners";English;"Avoid prescribing benzodiazepines to patients with a history of substance misuse (including alcohol) or multiple psychoactive drug use";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3166;6;"Less Is More Collection - JAMA Network";"Ian A. Scott, et al. JAMA Intern Med. 2015;175(5):827-834";English;"Reducing Inappropriate Polypharmacy. The Process of Deprescribing";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Polypharmacy;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3422;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology";English;"Don?t perfom Holter electrocardiographic monitoring in patients suffering from syncope, near syncope o dizziness, in whom a non arrhytmic origin has been documented";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2911;29;"Choosing Wisely Australia";"Royal College of Pathologists of Australasia";English;"Do not perform surveillance urine cultures or treat bacteruria in elderly patients in the absence of symptoms or signs of infection";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3167;6;"Less Is More Collection - JAMA Network";"Adrian C. Traeger, et al. JAMA Intern Med. 2015;175(5):733-743";English;"Effect of Primary Care?Based Education on Reassurance in Patients With Acute Low Back Pain. Systematic Review and Meta-analysis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Acute Low Back Pain";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3423;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology";English;"Don?t routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding profilaxis in patient with single drug antiplatelet therapy in absence of additional risk factors";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2656;6;"Less Is More Collection - JAMA Network";"Giuseppe�Colloca, et al. JAMA Intern Med. 2015;175(2):315.";English;"Inappropriate Drug Use in Advanced Dementia.";"The quality of prescribing in Nursing Home residentes with advanced dementia is far from optimal and that implementation of criteria specifically designed to identify medications of questionable benefit in this sample, as the Holmes criteria, might be helpful to improve quality of prescribing and reduce polypharmacy and may ultimately lead to improve patient outcomes at a lower cost. "" Inappropriate Drug Use in Advanced Dementia?Reply"" Jennifer Tjia et al. JAMA Intern Med. 2015;175(2):315-316. Lower prescribing of antidementia and lipid-lowering drugs in the European sample likely reflects differences in medication policies, pharmaceutical marketing, and physician attitudes. Cultural differences in family expectations may also play a role, and this deserves further exploration. Taken together, we believe that this is the time to focus investments in a coordinated effort to develop a rational approach to curtailing nonbeneficial and potentially harmful medications late in life.";2015;;;"High value";"Dementia, Drugs";"Link to the recommendation on the website of JAMA ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2912;29;"Choosing Wisely Australia";"Royal College of Pathologists of Australasia";Spanish;"Do not perform PSA testing for prostate cancer screening in men with no symptoms and whose life expectancy is less than 7 years";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3168;6;"Less Is More Collection - JAMA Network";"Kim A. Eagle, et al. JAMA Intern Med. 2015;175(5):835-839";English;"Perioperative Cardiovascular Care for Patients Undergoing Noncardiac Surgical Intervention";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Perioperative Cardiovascular Care";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3424;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology";English;"Avoid routine use of Infective endocarditis profilaxis in mild to moderate native valve disease";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1633;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of catumaxomab (Removab�) has shown more risks than benefits in the treatment of malignant ascites";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Monoclonal antibody";"

Link to the website of the initiative

" 2657;6;"Less Is More Collection - JAMA Network";"Prachi�Sanghavi, et al. JAMA Intern Med. 2015;175(2):196-204.";English;"Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support.";"Patients with out-of-hospital cardiac arrest who received Basic Life Support had higher survival at hospital discharge and at 90 days compared with those who received Advanced Life Support and were less likely to experience poor neurological functioning.";2015;;;"High value";"Arrest, Life Support";"Link to the article in the collection ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2913;29;"Choosing Wisely Australia";"Royal College of Pathologists of Australasia";English;"Do not perform population based screening for Vitamin D deficiency";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3169;6;"Less Is More Collection - JAMA Network";"Niven D. JAMA Intern Med. 2015;175(5):801-809";English;"Tight glycemic control among adult ICU patients is not a completely reliable test in order to decline mortality.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3425;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Pharmacy and Therapy (SIFACT)";English;"Don?t use costly drugs when low-cost generics with the same composition are available and try to convey a correct information to citizens on this point.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1634;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of panitumumab (Vectibix�) has shown more risks than benefits in the treatment of metastasized colorectal cancer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2658;6;"Less Is More Collection - JAMA Network";"Miriam�Kuppermann, et al. JAMA Intern Med. 2015;175(2):167-168.";English;"Shared Decision-Making Easy to Evoke, Challenging to Implement.";"A central component of patient-centered care is missing: elicitation of patient preferences and values as part of a shared decision-making process.

For further information please visit the website of the initiative (link below)";2015;;;"High value";"Shared Decision-Making";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2914;29;"Choosing Wisely Australia";"Royal College of Pathologists of Australasia";English;"Do not perform serum tumour marker tests except for the monitoring of a cancer known to produce these markers";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3170;6;"Less Is More Collection - JAMA Network";"Wang M. JAMA Intern Med. 2015;175(5):845-848.";English;"Responses of Specialist Societies to Evidence for Reversal of Practice";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3426;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Pharmacy and Therapy (SIFACT)";English;"Don?t propose any type of palliative chemotherapy in the end-of-life setting.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3682;6;"Less Is More Collection - JAMA Network";"Sigmund A. JAMA Intern Med. 2015;175(8):1352-1359.";English;"Use of Preoperative Testing and Physicians? Response to Professional Society Guidance";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1635;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of trabectedin (Yondelis�) has shown more risks than benefits in the treatment of ovarian cancer and soft tissue sarcoma";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2659;6;"Less Is More Collection - JAMA Network";"Tammy C.�Hoffmann, et al. JAMA Intern Med. 2015;175(2):274-286.";English;"Patients? Expectations of the Benefits and Harms of Treatments, Screening, and Tests. A Systematic Review.";"The majority of participants overestimated intervention benefit and underestimated harm. Clinicians should discuss accurate and balanced information about intervention benefits and harms with patients, providing the opportunity to develop realistic expectations and make informed decisions.";2015;;;"High value";"Benefit, Harm, Risk";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2915;29;"Choosing Wisely Australia";"Royal College of Pathologists of Australasia";English;"Do not routinely test and treat hyperlipidemia in those with a limited life expectancy";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3171;6;"Less Is More Collection - JAMA Network";"Davidoff F. JAMA Intern Med. 2015;175(5):809-811";English;"On the Undiffusion of Established Practices";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3427;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Pharmacy and Therapy (SIFACT)";English;"Don?t prescribe MF-59 adjuvated influenza vaccine in elderly people.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3683;6;"Less Is More Collection - JAMA Network";"Kansara P. JAMA Intern Med. 2015;175(8):1416-1418.";English;"Potential of Missing Life-Threatening Arrhythmias After Limiting the Use of Cardiac Telemetry";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1636;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of vandetanib (Caprelsa�) has shown more risks than benefits in the treatment of metastasized or inoperable medullary cancer of the thyroid.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2660;6;"Less Is More Collection - JAMA Network";"Kenneth K.�Mugwanya, et al. JAMA Intern Med. 2015;175(2):246-254.";English;"Changes in Glomerular Kidney Function Among HIV-1?Uninfected Men and Women Receiving Emtricitabine?Tenofovir Disoproxil Fumarate Preexposure Prophylaxis. A Randomized Clinical Trial.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"HIV, Emtricitabine, Tenofovir, Glomerular";"Link to the recommendation on the website of JAMA ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2916;30;"Choosing Wisely Japan";"The Japan Primary Care Association";English;"Current Status of Choosing Wisely in Japan. [Article where the authors recommend not to perform a PET-CT cancer for screening in asymptomatic adults]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the editorial note of Tokuda, Y. about the recommendation on the journal General Medicine / Enlace a la nota editorial de Yokuda Y sobre la recomendaci�n en la revista General Medicine " 3172;6;"Less Is More Collection - JAMA Network";"Wilhelm-Leen E. JAMA Intern Med. 2015;175(6):1035-1036";Spanish;"Dialysis Plus Do Not Resuscitate?Not a Contradiction [article about dialysis in end-stage renal disease (ESRD)]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3428;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Pharmacy and Therapy (SIFACT)";English;"Don?t prefer bioresorbable coronary stents over traditional drug-eluting stents.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3684;6;"Less Is More Collection - JAMA Network";"Daneman N. JAMA Intern Med. 2015;175(8):1331-1339.";English;"Variability in Antibiotic Use Across Nursing Homes and the Risk of Antibiotic-Related Adverse Outcomes for Individual Residents";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5476;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid�";English;"The patients for whom early implementation of prone positioning or prolonged adoption of prone positioning are used, are less likely to die. ";"Some patients with COVID-19 will become critically ill and develop acute respiratory distress syndrome (ARDS). They may require mechanical ventilation (MV) in an intensive care unit (ICU). They might be placed in the prone position for this, rather than in a supine or recumbent position. In this Cochrane systematic review, the authors searched for randomized trials of the effects of using a prone position rather than a supine or semi-recumbent position during conventional MV for adults with acute respiratory failure. They did not restrict by language of publication and did their most recent searches in June 2015. They included 9 studies (2165 participants), and identified a further 5 studies that are awaiting classification in a future update of the review. The studies suggest that patients for whom early implementation of prone positioning or prolonged adoption of prone positioning are used, or who have severe hypoxaemia, are less likely to die. The groups of patients for whom prone positioning is not beneficial is uncertain.";2015;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1637;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of vinflunine (Javlor�) has shown more risks than benefits in the treatment of advanced or metastasized bladder cancer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2661;6;"Less Is More Collection - JAMA Network";"Anupam B.�Jena, et al. JAMA Intern Med. 2015;175(2):237-244.";English;"Mortality and Treatment Patterns Among Patients Hospitalized With Acute Cardiovascular Conditions During Dates of National Cardiology Meetings.";"High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings. High-risk patients with AMI admitted to teaching hospitals during meetings were less likely to receive percutaneous coronary intervention, without any mortality effect. One explanation for these findings is that the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits.";2015;;;"High value";"Cardiovascular, Failure, Infarction";"Link to the article in the collection ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2917;30;"Choosing Wisely Japan";"The Japan Primary Care Association";English;"Current Status of Choosing Wisely in Japan. [Article where the authors recommend not to perform tumor marker screening for asymptomatic adults]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the editorial note of Tokuda, Y about the recommendation on the journal General Medicine / Enlace a la nota editorial de Tokuda, Y sobre la recomendaci�n en la revista General Medicine " 3173;6;"Less Is More Collection - JAMA Network";"Smucker J. JAMA Intern Med. 2015;175(6):895-896";English;"Overevaluating Chronic Pruritus A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3429;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Pharmacy and Therapy (SIFACT)";English;"Don?t use bevacizumab for its various oncologic indications.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3685;6;"Less Is More Collection - JAMA Network";"Nagaraj H. JAMA Intern Med. 2015;175(11):1867-1868.";English;"The Lariat for Left Atrial Appendage Closure: Rehash of Known Literature or a True Analysis?";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1638;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of aliskiren (Tekturna�) has shown more risks than benefits in the reduction of stroke";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2662;6;"Less Is More Collection - JAMA Network";"Korenstein D, et al. JAMA Intern Med. 2015;175(2):287-288.";English;"Patient Perception of Benefits and Harms. The Achilles Heel of High-Value Care.";"Quantification of benefits and harms must be informed by the best available evidence; the patient?s perspective is central to shaping the interpretation of those benefits and harms and thus is of critical importance in discussions of value. Ultimately, then, high-value care is care for which the evidence suggests maximal benefit and minimal harm in the context of a particular patient?s values and priorities. Whereas there are some interventions with clear benefits and negligible harms that are of high value for nearly all patients and some interventions with clear harms and negligible benefits that are of universally low value, most health care decisions are made either without optimal evidence or with evidence of both benefits and harms that must be balanced. For these decisions, the interplay between the evidence and patient priorities drives shared decision making and ultimately determines the value of the intervention. Patient understanding of evidence, then, is fundamental to improving care value.";2015;;;"High value";"Benefits, Harms, Risks";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2918;30;"Choosing Wisely Japan";"The Japan Primary Care Association";English;"Current Status of Choosing Wisely in Japan. [Article where the authors recommend not to perform a MRI brain screening in asymptomatic adults]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the editorial note of Tokuda, Y. about the recommendation on the journal General Medicine / Enlace a la nota editorial de Yokuda Y sobre la recomendaci�n en la revista General Medicine" 3174;6;"Less Is More Collection - JAMA Network";"�svold B, et al. JAMA Intern Med. 2015;175(6):1037-1047";English;"Don't rely on thyroid function and thyrotropin levels in the upper parts of the reference range to assess the risk of coronary hearth disease.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3430;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Scientific Society of Forensic Medicine of Italian National Health Service Hospitals - (COMLAS)";English;"Don?t promote the culture of ""informed consent"" as a mere bureaucratic and professional self-help tool.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3686;6;"Less Is More Collection - JAMA Network";"Robinson J. JAMA Intern Med. 2015;175(11):1783-1789.";English;"Association of Reference Payment for Colonoscopy With Consumer Choices, Insurer Spending, and Procedural Complications";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6758;36;"Choosing Wisely UK";"Faculty of intensive care medicine";English;"Offering life support to patients at high risk of death or severely impaired functional recovery is not recommended.";"Life support for patients at high risk of death or severely impaired functional recovery should not be offered. A discussion with patients and their families should focus on the goals of comfort care. Life support for patients at high risk of death or severely impaired functional recovery should not be offered. A discussion with patients and their families should focus on the goals of comfort care.";2015;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 1639;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Fenofibrate (Lipanthyl�) has shown more risks than benefits in the treatment of hypercholesterolemia";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2663;6;"Less Is More Collection - JAMA Network";"Mahmood�Al-Abri, et al. JAMA Intern Med. 2015;175(2):163.";English;"A Urinary Catheter Left in Place for Slightly Too Long.";"The use of daily reminders, prewritten advanced directives, or automatic stop orders are each effective methods of ensuring that conversations about urinary catheter appropriateness occur every day.";2015;;;"High value";catheter;"Link to the article in the collection ""Less is More"" / Enlace al articulo de la serie ?Less is More?
" 2919;30;"Choosing Wisely Japan";"The Japan Primary Care Association";English;"Current Status of Choosing Wisely in Japan. [Article where the authors recommend not to perform routine abdominal CT in patients with nonspecific abdominal pain]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the editorial note of Tokuda, Y. about the recommendation on the journal General Medicine / Enlace a la nota editorial de Yokuda Y sobre la recomendaci�n en la revista General Medicine " 3175;6;"Less Is More Collection - JAMA Network";"VanLiere Canzoniero J. JAMA Intern Med. 2015;175(6):1065-1067";English;"Unnecessary Hospitalization and Related Harm for Patients With Low-Risk Syncope";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3431;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Scientific Society of Forensic Medicine of Italian National Health Service Hospitals - (COMLAS)";English;"Don?t prescribe clinical and instrumental tests aimed at the assessment of any disability otherwise already clinically proven.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3687;6;"Less Is More Collection - JAMA Network";"Cremer P. JAMA Intern Med. 2015;175(11):1854-1855.";English;"Myocardial perfusion imaging in asymptomatic patients with Atrial Fibrillation is not recommended.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1640;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Bezafibrate (Befizal�) has shown more risks than benefits in the treatment of hypercholesterolemia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2664;6;"Less Is More Collection - JAMA Network";"Austin�Lammers, et al. JAMA Intern Med. 2015;175(3):341-342.";English;"Don't order Dopamine transporter scan (DAT) to differentiate essential tremor from Parkinson unless there is a clinical indication.";"Exercising restraint in an era of brief visits coupled with diagnostic uncertainty can be difficult. Viewed through the narrowlens of a single encounter, early CT imaging in cases of hearing loss may seem reasonable. However, in this case and many others, an unnecessary test could have been avoided through better communication of diagnostic assessment and evidence-based guidelines between a primary care physician and specialist. Often the path of least resistance for clincians working inside the system may not serve the patient?s best interests.With a dash of courage?typically free?we can still do well by doing less. When the music stops, remember to choose your options wisely.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";Diagnosis;"Link to the article in the collection ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2920;30;"Choosing Wisely Japan";"The Japan Primary Care Association";English;"Current Status of Choosing Wisely in Japan. [Article where the authors recommend not to place urinary catheters simply because it is convenient for the provider]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the editorial note of Tokuda, Y. about the recommendation on the journal General Medicine / Enlace a la nota editorial de Yokuda Y sobre la recomendaci�n en la revista General Medicine" 3176;6;"Less Is More Collection - JAMA Network";"Kumar B, et al. AMA Intern Med. 2015;175(6):892-893.";English;"Nonsteroidal Anti-inflammatory Drug Use in a Patient With Hypertension. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3432;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Scientific Society of Forensic Medicine of Italian National Health Service Hospitals - (COMLAS)";English;"Don?t encourage the use of defensive medicine practices.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3688;6;"Less Is More Collection - JAMA Network";"Lehman C. JAMA Intern Med. 2015;175(11):1828-1837.";English;"Diagnostic Accuracy of Digital Screening Mammography With and Without Computer-Aided Detection";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1641;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Ciprofibrate (Lipanor�) has shown more risks than benefits in the treatment of hypercholesterolemia";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2665;6;"Less Is More Collection - JAMA Network";"Eric C. T.�Geijteman, et al. JAMA Intern Med. 2015;175(3):346.";English;"Sense and Nonsense of Treatment of Comorbid Diseases in Terminally Ill Patients.";"Decreasing or discontinuing medication use at the end of life may run counter to previous management and lead patients to worry that they are being abandoned. Physicians need, therefore, to consider both the physical and psychosocial effects of withdrawing treatment. Pharmacotherapy in terminally ill patients is not a simple task because physicians must adapt drug treatments to new objectives. This case illustrates that such adapted management may improve quality of life and potentially reduce unnecessary and costly pharmacotherapy.

For further information please visit the website of the initiative (link below)";2015;;;"High value";"Palliative, Terminal, Treatment";"Link to the recommendation on the website of JAMA ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2921;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;350:h3042";English;"White House forum promotes responsible use of antibiotics";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Antibiotics;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3177;6;"Less Is More Collection - JAMA Network";"Hsu J, et al. JAMA Intern Med. 2015;175(6):1062-1065";English;"Oral Anticoagulant Prescription in Patients With Atrial Fibrillation and a Low Risk of Thromboembolism. Insights From the NCDR PINNACLE Registry";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3433;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Scientific Society of Forensic Medicine of Italian National Health Service Hospitals - (COMLAS)";English;"Don?t draw advice and expertise without joining forensic criteriology* or lacking thorough technical and scientific analysis of clinical problems.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3689;6;"Less Is More Collection - JAMA Network";"Geijteman E. JAMA Intern Med. 2015;175(10):1724-1725.";English;"Selecting the Optimal Design for Drug Discontinuation Trials in a Setting of Advanced, Life-Limiting Illness";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2666;6;"Less Is More Collection - JAMA Network";"Sunita�Sah, et al. JAMA Intern Med. 2015;175(3):342-343.";English;"Investigations Before Examinations. ?This Is How We Practice Medicine Here?. [article about investigations before examinations]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"History, Physical, Examination";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2922;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Jarvinen T. BMJ 2015;350:h2088";English;"There is a potential risk of overdiagnosis with the current approach to hip fracture prevention.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Bone Fragility, Hip Fracture";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3178;6;"Less Is More Collection - JAMA Network";"Schneider D. JAMA Intern Med. 2015;175(6):896-897";English;"Competing Mortality in Cancer Screening. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3434;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Scientific Society of Forensic Medicine of Italian National Health Service Hospitals - (COMLAS)";English;"Don?t draw biased opinion in terms of health professional responsibilities, which may lead to false expectations in the assisted";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3690;6;"Less Is More Collection - JAMA Network";"Yin P. JAMA Intern Med. 2015;175(10):1711-1713.";English;"Don't routinely order Urinalysis among patients admitted to the general medical services, unless clinically indicated.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1643;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of ivabradina (Procoralan�) has shown more risks than benefits in the treatment of angina or heart failure";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2667;6;"Less Is More Collection - JAMA Network";"Jennifer�Weiskopf, et al. JAMA Intern Med. 2015;175(3):344-345.";English;"Asymptomatic Bacteriuria, What Are You Treating? [article about antibiotics and a higher risk of resistant infections]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Urinary Infection, Antibiotic";"Link to the recommendation on the website of JAMA ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2923;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"D'Souza N. BMJ 2015;350:h3493";English;"Computed tomography may provide a cost effective way to avoid unnecessary appendicectomy.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Appendicitis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3179;6;"Less Is More Collection - JAMA Network";"Goldberg A. JAMA Intern Med. 2015;175(6):891-892";English;"Failure to Cancel Tests: A Case of an Unnecessary Joint Arthrocentesis. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3435;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Doctors of the Hospital Directions - ANMDO in collaboration with SItI - Ital";English;"Don?t replace hand hygiene with the use of non-sterile disposable gloves. Use alcohol-based product as a first choice for hand hygiene routine.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3691;6;"Less Is More Collection - JAMA Network";"DeVoe J. JAMA Intern Med. 2015;175(10):1605-1606.";English;"When Knowing More About a Patient Enables Us to Do Less";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1644;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of nicorandil (Adancor� or other) has shown more risks than benefits in the treatment of angina";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2924;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h3106";English;"Surgery for low grade ductal carcinoma in situ does not improve survival, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Ductal Carcinoma In Situ";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3180;6;"Less Is More Collection - JAMA Network";"Caverly T. JAMA Intern Med. 2015;175(6):898-900.";English;"Don't perform CT screening for lung cancer among low risk patients for lung cancer, or people who are too sick to have surgery or likely to die of other causes.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3436;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Doctors of the Hospital Directions - ANMDO in collaboration with SItI - Ital";English;"Never administer antibiotics for perioperative prophylaxis before 60 minutes prior to surgical incision*; the ideal time is upon induction of anesthesia. * subject to exceptions";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3692;6;"Less Is More Collection - JAMA Network";"Johansen M. JAMA Intern Med. 2015;175(10):1715-1716.";English;"Statin Use in Very Elderly Individuals, 1999-2012";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1645;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of trimetazidina (Vastarel� u otro) has shown more risks than benefits in the treatment of angina";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2925;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2015;350:h3181";English;"Margaret McCartney: Trust the patient";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Trust, Patient";"Link to the article in the BMJ collection / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3181;6;"Less Is More Collection - JAMA Network";"Rogers S. JAMA Intern Med. 2015;175(6):890";English;"The Importance of Cognitive Assessment Before Ventricular Device Placement. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3437;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Doctors of the Hospital Directions - ANMDO in collaboration with SItI - Ital";English;"Never administer antibiotics for perioperative prophylaxis beyond 24 hours after surgery. Antibiotic prophylaxis should be limited to the perioperative period. The choice to continue prophylaxis beyond the first 24 postoperative hours is not justified.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1646;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of tacrolimus (Protopic�) has shown more risks than benfits in the treatment of atopic eczema";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2926;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h3300";English;"England?s chief medical officer asks for review of drug evaluation in wake of statins controversy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Statins;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3182;6;"Less Is More Collection - JAMA Network";"Chen S. JAMA Intern Med. 2015;175(6):894";English;"Behind the Monitor?The Trouble With Telemetry. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3438;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Doctors of the Hospital Directions - ANMDO in collaboration with SItI - Ital";English;"Do not open the doors of the operating room during the surgical activity, except where necessary for the passage of patients, staff and equipment.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1647;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Mequitazine (Primalan�) has shown more risks than benefits in patients with allergies";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2927;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h3246";English;"Routine appendectomy could be abandoned for uncomplicated appendicitis, study finds.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Appendicitis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3183;6;"Less Is More Collection - JAMA Network";"Shah U. JAMA Intern Med. 2015;175(6):884-885";English;"When Documentation Supersedes Patient Communication. An Example From an Endoscopy Unit";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3439;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Association of Doctors of the Hospital Directions - ANMDO in collaboration with SItI - Ital";English;"Do not forget to communicate any positivity to alert* microorganisms in the patient health records (hospital discharge letter or document related to the patient transfer to another facility).";"For further information please visit the website of the initiative (link below";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1648;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of injectable promethazine (Phenergan�) has shown more risks than benefits in the management of severe urticaria";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2928;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S.BMJ 2015;350:h3386";English;"CT of the abdomen and pelvis for occult cancer is unnecessary in people with unexpected venous thromboembolism.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Venous Thromboembolism, Occult Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3184;6;"Less Is More Collection - JAMA Network";"Tapper E. JAMA Intern Med. Published online June 01, 2015";English;"A Decision Support Tool is necessary to Reduce Overtesting for Ceruloplasmin and Improve Adherence With Clinical Guidelines.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3440;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBIOC)";English;"Don?t perform serum protein electrophoresis nor search of urinary Bence-Jones protein as laboratory test before contrast media administration.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1649;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of linagliptine (Trajenta�, associated to metformin in Jentadueto�) has shown more risks than benefits for the prevention of diabetes complications";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2929;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Carr A. BMJ 2015;350:h2983";English;"Arthroscopic surgery for degenerative knee.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Arthroscopic;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3185;6;"Less Is More Collection - JAMA Network";"Nabozny M. JAMA Intern Med. Published online June 15, 2015";English;"When Do Not Resuscitate Is a Nonchoice Choice. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3441;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBIOC)";English;"Don?t ask for AST, LDH, total CK, CK-MB or myoglobin for the diagnosis of acute myocardial infarction";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1650;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of saxagliptine (Onglyza�, associated to metformin in Komboglyze�) has shown more risks than benefits for the prevention of diabetes complications";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2930;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015;350:h3301";English;"Ensure release of all data on alteplase, doctors urge health secretary.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Alteplase;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3186;6;"Less Is More Collection - JAMA Network";"Mansukhani R. JAMA Intern Med. Published online June 22, 2015";English;"Listen Doctor, the Patient Just Might Be Right";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3442;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBIOC)";English;"Don?t perform the determination of urine glucose for the monitoring of diabetes mellitus.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1651;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of sitagliptine (Januvia�, Xelevia�, associated to metformin in Janumet�, Velmetia�) has shown more risks than benefits for the prevention of diabetes complications";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2931;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;351:h3661";English;"Don't forget that mammography screening has the risk of overdiagnosis by the detection of more small cancers with no decline in the detection of large cancers.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Mammography, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3187;6;"Less Is More Collection - JAMA Network";"Jha S. JAMA Intern Med. 2015;175(7):1085-1086.";English;"Radiologists should perform the most appropriate imaging tests and clear communication between physician and radiologist is essential for obtaining the best results at the lowest cost and risk to the patient.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3443;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBIOC)";English;"Don?t ask for the determination of serum biomarkers like CEA, CA-125, HE4, CA-15.3, ?-fetoprotein or CA-19.9 for the diagnosis of neoplastic disease in asymptomatic individuals.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1652;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of vildagliptine (Galvus�, associated to metformin in Eucreas�) has shown more risks than benefits for the prevention of diabetes complications";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2932;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;351:h3902";English;"Use of controversial ACC/AHA guidelines for statin therapy is supported by US studies";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Statin;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3188;6;"Less Is More Collection - JAMA Network";"Trautner B. JAMA Intern Med. 2015;175(7):1120-1127";English;"Effectiveness of an Antimicrobial Stewardship Approach for Urinary Catheter?Associated Asymptomatic Bacteriuria";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3444;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBIOC)";English;"Do not ask for the measurement of pancreatic enzymes in people who have no suspicion of acute pancreatic disease and, in the case of suspected acute pancreatitis, do not ask the associated measure of amylase and lipase.";"For further information please visit the website of the initiative (link below";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3700;6;"Less Is More Collection - JAMA Network";"Deedwania P. JAMA Intern Med. 2015;175(12):1982-1983.";English;"Is Increased Use of Mechanical Circulatory Support Devices Justified? A Cause for Concern";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1653;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of orlistat (Xenical� or other) has shown more risks than benefits for weight-loss therapy";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2933;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015;351:h4009";English;"Many US parents have poor understanding of proper antibiotic use, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Antibiotics;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3189;6;"Less Is More Collection - JAMA Network";"Rothberg M. JAMA Intern Med. 2015;175(7):1199-1206";English;"Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3445;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The VivaScope 1500 and 3000 imaging systems are not recommended for helping decide whether to biopsy and excise skin lesions in people with suspected invasive squamous cell carcinoma, or defining margins of skin lesions in people with melanoma or invasive carcinoma.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3701;6;"Less Is More Collection - JAMA Network";"Inohara T. JAMA Intern Med. 2015;175(12):1980-1982.";English;"Use of Intra-aortic Balloon Pump in a Japanese Multicenter Percutaneous Coronary Intervention Registry";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1654;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of celecoxib (Celebrex�) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2934;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Miller M. BMJ 2015;351:h3021";English;"Chronic obstructive pulmonary disease: missed diagnosis versus misdiagnosis";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Chronic obstructive pulmonary disease";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3190;6;"Less Is More Collection - JAMA Network";"Maraka S. JAMA Intern Med. 2015;175(7):1088-1089.";English;"Subclinical Hypothyroidism During Pregnancy?Should You Expect This When You Are Expecting? A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3446;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use anti-M�llerian hormone testing to diagnose premature ovarian insufficiency.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3702;6;"Less Is More Collection - JAMA Network";"Gonzales R. JAMA Intern Med. 2015;175(12):1921-1922.";English;"Changing Clinician Behavior When Less Is More";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1655;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of etoricoxib (Arcoxia�) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2935;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;351:h3806";English;"Elective surgery for ulcerative colitis is associated with lower mortality than drug treatment in older patients.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Ulcerative Colitis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3191;6;"Less Is More Collection - JAMA Network";"Chatterjee S. JAMA Intern Med. 2015;175(7):1104-1109.";English;"Safety and Procedural Success of Left Atrial Appendage Exclusion With the Lariat Device. A Systematic Review of Published Reports and Analytic Review of the FDA MAUDE Database";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3447;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not diagnose premature ovarian insufficiency on the basis of a single blood test.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3703;6;"Less Is More Collection - JAMA Network";"Sussman J. JAMA Intern Med. 2015;175(12):1942-1949.";English;"Rates of Deintensification of Blood Pressure and Glycemic Medication Treatment Based on Levels of Control and Life Expectancy in Older Patients With Diabetes Mellitus";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1656;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of parecoxib (Dynastat�) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2936;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;351:h3934";English;"No strong association is found between pioglitazone and bladder cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Pioglitazone, Bladder Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3192;6;"Less Is More Collection - JAMA Network";"McDonald E. JAMA Intern Med. 2015;175(7):1232-1234";English;"Reduction of Central Venous Catheter Use in Medical Inpatients Through Regular Physician Audits Using an Online Tool [This study showed an overuse of central venous catheter in a Canadian hospital]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3448;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3704;6;"Less Is More Collection - JAMA Network";"Hochman M. JAMA Intern Med. 2015;175(12):1895-1896.";English;"Reconsidering Guidelines on the Use of Pneumococcal Vaccines in Adults 65 Years or Older";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5752;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Interactive telemedicine is recommended to improve quality of life in patients with heart failure, and in the control of glucose, blood pressure and LDL cholesterol in patients with diabetes";"The COVID-19 pandemic is placing a strain on healthcare systems and has resulted in widespread social distancing measures. This makes traditional face-to-face medical care more difficult and existing research on telemedicine may provide information to help with this. In this Cochrane systematic review, the authors searched for randomised trials comparing interactive telemedicine delivered in addition to, or as an alternative to, usual care versus usual care alone. They did not restrict their search by date or language of publication and did the search in June 2013. They included 93 randomised trials (total: 22,047 participants), and also identified 15 ongoing studies and a further 63 studies that are awaiting assessment. Telemedicine did not affect clinical outcomes in patients requiring mental health services when compared to usual care. Telemedicine did not affect clinical outcomes in patients requiring a specialist consultation for a dermatological condition when compared to usual care. Telemedicine did not appear to have any direct impact on health resource utilization when compared to usual care. The effect of telemedicine on hospital admissions is uncertain. ";2015;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1657;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of floctafenine (Idarac�) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2937;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Jackson T. BMJ 2015;351:h3995";English;"Confronting medicine?s flaws.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3193;6;"Less Is More Collection - JAMA Network";"Haas J. JAMA Intern Med. Published online July 06, 2015";English;"Further imaging after a normal mammogram is not recommended for low risk women with dense breast. Other risk factors should be considered before further investigation.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3449;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a serum follicle-stimulating hormone (FSH) test to diagnose menopause in women using combined oestrogen and progestogen contraception or high-dose progestogen.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5753;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Uncertainty exists about the beneficial effect of interactive telemedicine on mental health, dermatological conditions and hospital admissions";"The COVID-19 pandemic is placing a strain on healthcare systems and has resulted in widespread social distancing measures. This makes traditional face-to-face medical care more difficult and existing research on telemedicine may provide information to help with this. In this Cochrane systematic review, the authors searched for randomised trials comparing interactive telemedicine delivered in addition to, or as an alternative to, usual care versus usual care alone. They did not restrict their search by date or language of publication and did the search in June 2013. They included 93 randomised trials (total: 22,047 participants), and also identified 15 ongoing studies and a further 63 studies that are awaiting assessment. Telemedicine was associated with a slight improvement in disease-specific quality of life in patients with heart failure but mortality was similar between those receiving telemedicine and those receiving usual care only. Interactive telemedicine may improve glucose control and decrease blood pressure and LDL cholesterol in patients with diabetes compared to usual care.";2015;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1658;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of ketoprofen (Ketum� gel or other) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3194;6;"Less Is More Collection - JAMA Network";"Harding C. JAMA Intern Med. Published online July 06, 2015";English;"There is a potential risk of overdiagnosis with mammography screening.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3450;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the following laboratory and imaging tests to diagnose perimenopause or menopause in women aged over 45 years: anti-M�llerian hormone, inhibin A, inhibin B, oestradiol, antral follicle count, ovarian volume.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1659;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of piroxicam (Feldene� or other) has shown more risks than benefits as Nonsteroidal anti-inflammatory drug";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2939;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Conducting a diagnostic imaging in the first six weeks in patients with nonspecific low back pain is an intervention that should be avoided in the context of General Internal Medicine (Evidence level: Meta-analysis of randomized controlled trials)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the Smart Medicine website (in English) /Enlace a la recomendaci�n de Smart Medicine (versi�n en Ingl�s)

Link to the Smart Medicine website / Enlace a la p�gina web de Smart Medicine

" 3195;6;"Less Is More Collection - JAMA Network";"Mehta H. JAMA Intern Med. Published online July 13, 2015";English;"Hidden Risks of Blood Transfusions. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3451;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer cryoprecipitate transfusions to correct the fibrinogen level in patients who are not bleeding and are not having invasive procedures or surgery with a risk of clinically significant bleeding.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1660;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of denosumab (Prolia�) has shown more risks than benefits in patients with osteoporosis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2940;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Don?t do a magnetic resonance imaging (MRI) scan of the spine or brain for patients with only peripheral neuropathy (without signs or symptoms suggesting a brain or spine disorder).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Resonance Imaging, Peripheral Neuropathy";"Link to the recommendation in the Choosing Wisely website" 3196;6;"Less Is More Collection - JAMA Network";"Worsham C. JAMA Intern Med. Published online July 20, 2015.";English;"Prompt Extubation After Intensive Care Unit Procedures. A Teachable Moment";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3452;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Only consider fresh frozen plasma transfusion for patients with clinically significant bleeding but without major haemorrhage if they have abnormal coagulation test results (for example, prothrombin time ratio or activated partial thromboplastin time rati";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1661;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of ranelato de estroncio (Protelos�) has shown more risks than benefits in in preventing vertebral fracture recurrence.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2941;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Don?t do nerve conduction studies without also doing a needle EMG for testing for radiculopathy, a pinched nerve in the neck or back.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"EMG, Pinched Nerve";"Link to the recommendation in the Choosing Wisely website" 3197;6;"Less Is More Collection - JAMA Network";"Cai J. JAMA Intern Med. Published online July 20, 2015";English;"The use of esophagogastroduodenoscopy without an appropriate evidence based indication is not recommended.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3453;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer prophylactic platelet transfusions to patients having procedures with a low risk of bleeding, such as adults having central venous cannulation or any patients having bone marrow aspiration and trephine biopsy.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1662;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of diacerein (Art 50� or other) has shown more risks than benefits in patients with osteoarthritis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2942;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Don?t do a four limb needle EMG/nerve conduction study (NCS) testing for neck and back pain after trauma.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"EMG, Nerve Conduction";"Link to the recommendation in the Choosing Wisely website" 3198;6;"Less Is More Collection - JAMA Network";"Brennan-Taylor. JAMA Intern Med. Published online July 27, 2015";English;"?Mom, You Have to Trust Me?. [article about drug therapy]";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3454;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer prophylactic platelet transfusions to patients with any of the following: chronic bone marrow failure, autoimmune thrombocytopenia, heparin-induced thrombocytopenia, thrombotic thrombocytopenic purpura.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1663;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Glucosamine (Voltaflex� or other) may produce more risks than benefits in patients with osteoarthritis";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2943;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Don?t perform dermatomal somatosensory evoked potentials (SEPs) for a pinched nerve in the neck or back, as they are an unproven diagnostic procedure.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Somatosensory Evoked Potentials, Pinched Nerve";"Link to the recommendation in the Choosing Wisely website" 3199;6;"Less Is More Collection - JAMA Network";"Harris R. JAMA Intern Med. Published online July 27, 2015.";English;"The Psychological Effects of Lung Cancer Screening on Heavy Smokers. Another Reason for Concern";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 3455;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer erythropoietin to reduce the need for blood transfusion in patients having surgery, unless the patient has anaemia and meets the criteria for blood transfusion, but declines it because of religious beliefs or other reasons or the appropriate ";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1664;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of methocarbamol (Lumirelax�) has shown more risks than benefits in patients with muscle pain.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2944;2;"Choosing Wisely�";"American Association of Neuromuscular & Electrodiagnostic Medicine";English;"Don?t do a needle electromyography (EMG) test for isolated neck or back pain after a motor vehicle accident, as a needle EMG is unlikely to be helpful.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"EMG, Neck Pain, Back Pain";"Link to the recommendation in the Choosing Wisely website" 3200;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"AQUAS; Societat Catalana de Pediatria; Radi�legs de Catalunya";Spanish;"It is not recommended to perform chest X-Ray routinely in pediatric population for the diagnosis of asthma.";"The diagnosis of asthma in children is based on clinical findings. Medical history and physical examination are enough to make the diagnosis in most patients.

There is no scientific evidence that performing a chest X-Ray contributes to the diagnosis of bronchial asthma or to establish clinical management.";2015;;;"Low value";.;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 3456;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer fresh frozen plasma transfusions to correct abnormal coagulation in patients who are not bleeding (unless they are having invasive procedures or surgery with a risk of clinically significant bleeding) or need reversal of a vitamin K antagonis";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1665;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of tiocolchicoside (Coltramyl� or other) has shown more risks than benefits in patients with muscle pain.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3201;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"AQUAS, Societat Catalana de Cardiologia";Spanish;"After myocardial infarction it is not recommended to prescribe routinely calcium channel blockers to reduce cardiovascular risk.";"Currently, according to the latest published clinical practice guidelines -National Institute for Health and Care Excellence (NICE), American Heart Association (AHA) and European Society of Cardiology- It is not recommend to prescribe calcium channel blockers to reduce cardiovascular risk after myocardial infarction. This recommendation is based on no evidence of benefits of these drugs in cardiovascular secondary prevention. However, it is important to mention, if beta-blockers are contraindicated, verapamil or diltiazem may be considered for secondary prevention in patients without pulmonary edema and without left ventricular dysfunction.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3457;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely transfuse more than a single dose of platelets.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1666;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of quinine has shown a negative harm-benefit balance in patients with cramps";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3202;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"AQUAS, Iniciativa MAPAC";Spanish;"In women with gestational diabetes mellitus requiring drug therapy, it is not recommended to use glibenclamide as first choice, if insulin or metformin are available, due to the possibility of side effects.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3458;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not carry out fetal blood sampling if the woman is less than 34+0 weeks pregnant.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1667;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Colchimax� trademark (colchicine + opium powder + tiemonium) has shown more risks than benefits as antiinflammatory";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3203;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sipuleucel-T is not recommended within its marketing authorisation for treating adults who have asymptomatic or minimally symptomatic metastatic non-visceral hormone-relapsed prostate cancer for which chemotherapy is not yet clinically indicated";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3459;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer betamimetics for tocolysis.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1668;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The association of dexamethasone-salicylamide-hydroxyethyl salicylate (Percutalgine�) has shown more risks than benefits as painkiller in sprain or tendinitism";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3204;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"National Institute for Health and Clinical Excellence (NICE)";Spanish;"For women who were diagnosed with gestational diabetes and whose blood glucose levels returned to normal after the birth, do not routinely offer a 75 g 2-hour OGTT.";-;2015;;;"Low value";"oral glucose tolerance test";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3460;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use transvaginal ultrasound measurement of cervical length and fetal fibronectin testing in combination to diagnose preterm labour.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1669;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of domperidone (Motilium� or other) has shown more risks than benefits in patients with gastroesophageal reflux";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3205;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Diabetes should not be considered a contraindication to antenatal steroids for fetal lung maturation or to tocolysis.";-;2015;;;"Low value";pregnancy;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3461;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer women with P-PROM co-amoxiclav as prophylaxis for intrauterine infection.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1670;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of droperidol (Droleptan�) has shown more risks than benefits in patients with gastroesophageal reflux";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2950;2;"Choosing Wisely�";"American College of Medical Genetics and Genomics";English;"Don?t order APOE genetic testing as a predictive test for Alzheimer disease.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"APOE, Alzheimer Disease";"Link to the recommendation in the Choosing Wisely website" 3206;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Diabetic retinopathy should not be considered a contraindication to vaginal birth.";-;2015;;;"Low value";"delivery, pregnancy";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3462;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform diagnostic tests for P-PROM if labour becomes established in a woman reporting symptoms suggestive of P-PROM.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1671;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of prucalopride (Resolor�) has shown more risks than benefits in treating chronic constipation";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2951;2;"Choosing Wisely�";"American College of Medical Genetics and Genomics";English;"Don?t order MTHFR genetic testing for the risk assessment of hereditary thrombophilia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"MTHFR, Thrombophilia";"Link to the recommendation in the Choosing Wisely website" 3207;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer continuous glucose monitoring to pregnant women with diabetes.";-;2015;;;"Low value";pregnancy;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3463;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use nitrazine to diagnose P-PROM.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1672;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of tibolone (Livial�) may have more risks than benefits in the hormone replacement therapy of menopause";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2952;2;"Choosing Wisely�";"American College of Medical Genetics and Genomics";English;"Don?t order HFE genetic testing for a patient without iron overload or a family history of HFE-associated hereditary hemochromatosis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"HFE gene, Hereditary Hemochromatosis";"Link to the recommendation in the Choosing Wisely website" 3208;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use fasting plasma glucose, random blood glucose, HbA1c, glucose challenge test or urinalysis for glucose to assess risk of developing gestational diabetes.";-;2015;;;"Low value";pregnancy;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3464;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the results of the insulin-like growth factor binding protein-1 or placental alpha-microglobulin-1 test are negative and no amniotic fluid is observed: do not offer antenatal prophylactic antibiotics.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1673;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Iron dextran (Ferrisat�) has shown more risks than benefits in treating anemia";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2953;2;"Choosing Wisely�";"American College of Medical Genetics and Genomics";English;"Don?t order a duplicate genetic test for an inherited condition unless there is uncertainty about the validity of the existing test result.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Genetic test";"Link to the recommendation in the Choosing Wisely website" 3209;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer routine urinary cytology or prolonged cystoscopic follow-up after 12 months for people with low-risk non-muscle-invasive bladder cancer.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3465;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Apremilast is not recommended within its marketing authorisation for treating psoriasis, that is, for treating adults with moderate to severe chronic plaque psoriasis that has not responded to systemic therapy, or systemic therapy is contraindicated or no";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3721;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h4233";English;"Highlighting risk of diseases is most effective in changing attitudes to vaccines, US study finds";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1674;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of moxifloxacin (Izilox�) has shown more risks than benefits as antibiotic";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2954;2;"Choosing Wisely�";"American College of Medical Genetics and Genomics";English;"Don?t order exome or genome sequencing before obtaining informed consent that includes the possibility of secondary findings.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Exome Genome Sequencing";"Link to the recommendation in the Choosing Wisely website" 3210;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use urinary biomarkers or cytology in addition to cystoscopy for follow-up after treatment for low-risk bladder cancer.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3466;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer genetic screening (including measuring specific gene polymorphisms) in children and young people to predict or identify attachment difficulties.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3722;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Dyer O. BMJ 2015; 351:h4209";English;"The adaptation of autism management strategies is recommended taking into account the changes in diagnosis in the United States.";"The trend towards autism classification seemed particularly strong in older children. The authors estimated that, among 8 year olds, reclassification accounted for about 59% of the observed increase in autism over the 11 year study period. At age 15, reclassification accounted for as much as 97% of the perceived increase. The study also found considerable variation between US states in autism diagnosis rates, suggesting that local special education policies played a role.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 651;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer mifepristone as a treatment for missed or incomplete miscarriage";-;2015;;;"Low value";-;"Link to the recommendation in the NICE website" 1675;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of telitromycin (Ketek�) has shown more risks than benefits as antibiotic";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3211;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not take random biopsies of normal-looking urothelium during transurethral resection of bladder tumour (TURBT) unless there is a specific clinical indication (for example, investigation of positive cytology not otherwise explained).";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3467;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Schools and other education providers should avoid using permanent and fixed-term school exclusion as far as possible for children and young people in the care system with identified attachment difficulties.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3723;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Morgan D. BMJ 2015; 351:h4534";English;"Setting a research agenda for medical overuse";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1676;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of donepezil (Aricept� or other) may produce more risks than benefits in patients with Alzheimer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3212;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Base the number of whole-time equivalents on registered midwives, and do not include the following in the calculations";"Registered midwives undertaking a Local Supervising Authority Programme, registered midwives with supernumerary status (this may include newly qualified midwives, or midwives returning to practice), student midwives, the proportion of time specialist and consultant midwives who are part of the establishment spend delivering contracted specialist work (for example, specialist midwives in bereavement roles), the proportion of time midwives who are part of the establishment spend coordinating a service, for example the labour ward.";2015;;;"Low value";pregnanc;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3468;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not treat attachment difficulties with pharmacological interventions. For the use of pharmacological interventions for coexisting mental health problems, see for example, antisocial behaviour and conduct disorders in children and young people, attentio";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3724;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h4323";English;"Simple risk score for colon cancer identifies people likely to benefit from colonoscopy";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1677;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of galantamine (Reminyl� or other) may produce more risks than benefits in patients with Alzheimer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3213;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a patient decision aid to replace discussions with a person in a consultation about medicines.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3725;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015; 351:h4805";English;"Oncologists must exercise care as they incorporate new DNA sequencing technologies into clinical practice to maximize their benefits and minimize the potential harms.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1678;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of rivastigmine (Exelon� or other) may produce more risks than benefits in patients with Alzheimer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3214;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pomalidomide, in combination with dexamethasone, is not recommended within its marketing authorisation for treating relapsed and refractory multiple myeloma in adults who have had at least 2 previous treatments, including lenalidomide and bortezomib, and ";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3726;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015; 351:h5035";English;"Ramipril research papers are retracted over faked data";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1679;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of memantine (Ebixa� or other) may have more risks than benefits in patients with Alzheimer";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3215;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer sensory interventions (for example, Snoezelen rooms) before carrying out a functional assessment to establish the person's sensory profile for people with learning disabilities whose behaviour challenges.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3727;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5164";English;"Computer aided mammography is not recommended since yields no clear benefit, and CAD is a technology that does not seem to warrant added compensation beyond coverage of the mammographic examination.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1680;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of flunarizine (Sibelium�) has shown more risks than benefits in preventing migraine attacks";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2960;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial: Afegint valor a la pr�ctica cl�nica (Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Cat)";Spanish;"Do not routinely prescribe non-steroidal anti-inflammatory drugs (NSAIDs) for pacientes with a cardiovascular or chronic renal disease and hepatic failure, since the benefits do not make up for the risks.";-;2015;;;"Low value";"Non-steroidal anti-inflammatory drugs, NSAIDS";"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web Essencial" 3216;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Only offer antipsychotic medication in combination with psychological or other interventions in people with learning disabilities whose behaviour challenges.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3728;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5043";English;"Androgen deprivation therapy should be used with caution in some prostate cancer cases, study warns";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1681;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of oxetorone (Nocertone�) has shown more risks than benefits in preventing migraine attacks";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2961;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial: Afegint valor a la pr�ctica cl�nica (Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Cat)";Spanish;"Do not routinely perform plain X-ray tests for ankle-forefoot and knee acute trauma lesions in adult patients without a positive result when applying the Ottawa Rules.";-;2015;;;"Low value";"Acute Ankle Knee Injury , Ottawa Ankle Rules";"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web Essencial" 3217;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer medication to aid sleep (in people with learning diabilities whose behavour challanges). Unless the sleep problem persists after a behavioural intervention, and then only:";"-After consultation with a psychiatrist (or a specialist paediatrician for a child or young person) with expertise in its use in people with a learning disability -Together with non-pharmacological interventions and regular reviews (to evaluate continuing need and ensure that the benefits continue to outweigh the risks).";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3729;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Oliver D. BMJ 2015; 351:h5225";English;"David Oliver: Why I let some patients stay longer in hospital";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1682;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of tolcapone (Tasmar�) may have more risks than benefits in patients with Parkinson disease";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2962;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Essencial: Afegint valor a la pr�ctica cl�nica (Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Cat)";Spanish;"Symptoms of behavioural and/or cognitive changes of acute onset and suggesting risk of delirium should not be routinely treated with benzodiazepines in the elderly.";-;2015;;;"Low value";"Delirium, Benzodiazepines";"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web Essencial" 3218;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use any of the following to treat bronchiolitis in children: antibiotics, hypertonic saline, adrenaline (nebulised), salbutamol, montelukast, ipratropium bromide, systemic or inhaled corticosteroids, a combination of systemic corticosteroids and ne";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3730;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5349";English;"Beta blockers are associated with increased risk of cardiovascular events after surgery";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6546;1;"NICE ";NICE;English;"It is not recommended to give more than 2 courses of maternal corticosteroids for preterm birth";"For women between 22+0 and 23+6 weeks of pregnancy who are in suspected or established preterm labour, are having a planned preterm birth or have P?PROM, discuss with the woman (and her family members or carers, as appropriate) and the multidisciplinary team the use of maternal corticosteroids in the context of her individual circumstances. Consider a single repeat course of maternal corticosteroids for women less than 34+0 weeks of pregnancy who: - have already had a course of corticosteroids when this was more than 7 days ago, and - are at very high risk of giving birth in the next 48 hours. Where the woman is less than 30+0 weeks pregnant or if there is suspected growth restriction, take into account the possible impact on fetal growth of a repeat course of maternal corticosteroids. When offering or considering maternal corticosteroids, discuss the benefits and risks with the woman (and her family members or carers, as appropriate)";2015;;;"Low value";prevention;"Link to the recommendation on the website of the initiative" 1683;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"Ephedrine and other oral and nasal vasoconstrictive decongestants may have more risks than benefits in treating cold symptoms";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3219;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely perform a chest X-ray in children with bronchiolitis, because changes on X-ray may mimic pneumonia and should not be used to determine the need for antibiotics. Consider performing a chest X-ray if intensive care is being proposed for a c";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3731;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h5366";English;"Therapeutic hypothermia does not improve outcomes in traumatic brain injury, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5779;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of telemedicine applications is recommended in emergency rooms of small and rural hospitals";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research into the use of telemedicine applications in emergency rooms (ER) may provide information to help policy makers with this. In this systematic review, the authors searched for research which assessed technical quality, user perceptions and clinical outcomes of tele-emergency applications such as simultaneous audio and video transmissions to connect clinicians with ER or to link small hospital ER with remote medical specialists or emergency departments with better resources. They restricted their search to articles published before September 2013. They included 38 articles, which were on telemedicine for patients presenting to an ER (11 studies), minor treatment clinics for patients with minor illnesses (8), and the use of telemedicine to connect providers in ER to medical specialists for consultations (19). Patient and clinician satisfaction with tele-medicine applications in emergency care was high and clinical outcomes were similar to those reported for routine practice. At the time of the review, although tele-emergency applications seemed able to meet the needs of small and rural hospitals that require infrequent emergency specialist care, the effects for urban hospitals with overcrowded emergency departments were uncertain.";2015;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3220;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People with anaemia of chronic kidney disease (CKD) should not have iron levels checked earlier than 1 week after receiving intravenous iron. The length of time to monitoring of iron status is dependent on the product used and the amount of iron given.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3732;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5308";English;"Laparoscopic resection for rectal cancer is not supported by studies";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1685;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Pholcodine may have more risks than benefits in treating cough";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3221;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If people who are pre-dialysis* or receiving peritoneal dialysis have a normal full blood count there is little benefit in checking iron status.";"*There is no accepted definition of pre-dialysis. It is usually regarded to be CKD stages 4 and 5. Pre-dialysis includes people with a failing transplant and people having conservative management.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3733;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015; 351:h5389";English;"It's recommended to consider a cardiac troponin concentration [<5 ng/L] as the level of troponin needed to rule out MI in patients with chest pain.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3222;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Supplements of vitamin C, folic acid or carnitine should not be prescribed as adjuvants specifically for the treatment of anaemia of chronic kidney disease (CKD).";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3734;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015; 351:h5514";English;"Screen all adults for high blood pressure, US panel recommends";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1687;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Tixocortol (associated to chlorhexidine in Thiovalone�) may have more risks than benefits in treating sore throat";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3223;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely consider measurement of erythropoietin levels for the diagnosis or management of anaemia in people with anaemia of chronic kidney disease (CKD).";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3735;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5433";English;"Bowel cancer categorisation into four subtypes could help to guide treatment, doctors say";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1688;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of agomelatine (Valdoxan�) may have more risks than benefits as antidepressant";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3224;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not request transferrin saturation or serum ferritin measurement alone to assess iron deficiency status in people with anaemia of chronic kidney disease (CKD).";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3736;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5570";English;"Start mammography at age 45, US guideline recommends";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6552;1;"NICE ";NICE;English;"It is not recommended offering BRAF analysis of melanoma tissue samples from people with stage IA or IB primary melanoma at presentation except as part of a clinical trial.";"Melanoma is the fifth most common skin cancer in the UK. The earliest stage melanomas are stage 0 (melanoma in situ), and then range from stages I (1) through IV (4). Some stages are split further, using capital letters. Diagnostic testing to identify patients with BRAF-mutant melanoma who may benefit from vemurafenib treatment is not recommended in patients with stages IA and IB. Consider BRAF analysis of melanoma tissue samples from people with stage IIA or IIB primary melanoma. Perform BRAF analysis of melanoma tissue samples from people with stage IIC to IV primary melanoma. Local multidisciplinary skin teams should organize BRAF analysis of melanoma tissue samples and indicate the preferred tissue block for analysis. When performing a BRAF test, consider immunohistochemistry as the first test for BRAF V600E, if available. If BRAF V600E immunohistochemistry is negative or inconclusive, use a different BRAF genetic test. Offer BRAF analysis of melanoma tissue samples to people with melanoma if they are potential candidates for any ongoing clinical trials that require knowledge of genetic status. ";2015;;;"Low value";Management;"Link to the recommendation on the website of the initiative" 1689;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Duloxetine (Cymbalta�) may have more risks than benefits as antidepressant";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2457;6;"Less Is More Collection - JAMA Network";"Morgan D, et al.JAMA Intern Med. 2015;175(1):120-124";English;"Update on Medical Overuse";"Overtreatment, with both medical therapies and procedural interventions, places patients at risk of unnecessary adverse events.";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 3225;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence on the safety and efficacy of cyanoacrylate glue occlusion for varicose veins is limited in quantity and quality. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit or resear";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3737;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h5549";English;"CT screening in current moderate smokers may be justified as study finds similar lung cancer risk to heavier smokers";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6553;1;"NICE ";NICE;English;"It is recommended the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18.";"The guideline includes recommendations on diagnosis, management of type 1 and type 2 diabetes, diagnosis and management of diabetic ketoacidosis in children and young people with type 1 and type 2 diabetes and service provision. Diabetes is a long?term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed in this guideline.";2015;;;"High value";"Diagnosis ";"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 1690;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of milnacipran (Ixel� or other) may have more risks than benefits as antidepressant";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2458;6;"Less Is More Collection - JAMA Network";"Walid F, et al.JAMA Intern Med. 2015;175(1):26-34";English;"Dual Use of Department of Veterans Affairs and Medicare Benefits and Use of Test Strips in Veterans With Type 2 Diabetes Mellitus";"Veterans who receive glucose test strips through both the VA and Medicare use more strips and are more likely to potentially overuse strips. These results illustrate the profound importance of understanding dual VA and Medicare coverage and are emblematic of waste and inefficiency.";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n ""Less is More""" 3226;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence on ultrasound-enhanced, catheter-directed thrombolysis for pulmonary embolism raises no major safety concerns over those of catheter-directed thrombolysis (CDT) alone. With regard to efficacy, evidence of any enhancement of thrombolysis over ";"Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3738;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h5625";English;"Total knee replacement is linked to reduced pain but with serious side effects, trial finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5786;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of mHealth strategies by front-line health workers in low-resource settings is recommended to improve the promptness of data collection, reduce error rates, and improve data completeness, as well as to improve adherence of frontline health workers to treatment regimens";"The COVID-19 pandemic is placing a great strain on healthcare services. Existing research on mobile health (mHealth) strategies may provide evidence to ease this, especially in low-resource settings. In this systematic review, the authors searched for research from developing countries evaluating the feasibility of the use of mobile phones by frontline healthcare workers, the training required for adoption of mobile tools, and the effects of mobile-based services. They restricted their search to studies published in English between 2000 and 2013 and did the search in December 2013. They included 42 studies. The effects of using mHealth tools for patient-specific alerts and reminders, supervision by higher-level care providers and emergency referrals are uncertain. The effects on health outcomes, health system efficiencies and cost-effectiveness of service delivery of frontline healthcare workers using mHealth strategies are uncertain.";2015;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1691;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of venlafaxine (Effexor� LP or other) may have more risks than benefits as antidepressant";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 2459;6;"Less Is More Collection - JAMA Network";"Wray C. JAMA Intern Med. 2015;175(1):14-15";English;"D-Dimer and the Workup of Pulmonary Embolism: A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n ""Less is More""" 3227;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence on ultrasound-enhanced, catheter-directed thrombolysis for deep vein thrombosis raises no major safety concerns over those of catheter-directed thrombolysis (CDT) alone. With regard to efficacy, evidence of any enhancement of thrombolysis ove";"Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3739;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015; 351:h5634";English;"Many cancer drugs recently approved in US do not improve overall survival, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5787;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of medical scribes is recommended in healthcare settings";"The COVID-19 pandemic is placing a strain on healthcare services. The involvement of medical scribes to enter information into electronic health records (EHRs) during healthcare encounters may improve productivity and limit disruption to patient-physician interactions. In this systematic review the authors searched for effectiveness studies of medical scribes on healthcare productivity, quality and outcomes. They limited their search to studies published in English between 2000 and 2014. Five studies were identified; three assessed scribe use in an emergency department and two were based in an outpatient clinic setting. All of the included studies had a non-randomized design. Medical scribes may improve clinician satisfaction, productivity, time-related efficiencies, revenue, and patient-clinician interactions. The number of peer-reviewed studies is small and the quality of research is limited. Consequently, some findings were not consistent and confidence in the reliability of outcomes is significantly constrained. The financial impacts and the role of medical scribes in primary care are uncertain.";2015;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6555;1;"NICE ";NICE;English;"It is recommended the care and management for adults (aged 18 and over) with type 2 diabetes.";"This guideline covers care and management for adults (aged 18 and over) with type 2 diabetes. It focuses on patient education, dietary advice, managing cardiovascular risk, managing blood glucose levels, and identifying and managing long-term complications. It is important for the patient to adopt an individualised approach to diabetes care that is tailored to the needs and circumstances of adults with type 2 diabetes, taking into account their personal preferences, comorbidities and risks from polypharmacy, and their likelihood of benefiting from long-term interventions. Such an approach is especially important in the context of multimorbidity.";2015;;;"High value";Management;"?Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa? " 1692;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of tianeptine (Stablon�) may have more risks than benefits as antidepressant";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3228;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Everolimus is not recommended within its marketing authorisation for preventing organ rejection in people having a liver transplant.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3740;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5698";English;"Older patients with diabetes are often overtreated, say researchers";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1693;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of asenapine (Sycrest�) has shown more risks than benefits in patients with bipolar disorder";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3229;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer screening investigations (including imaging and blood tests) as part of follow-up to people who have had stages IB?IIB melanoma or stage IIC melanoma with a negative sentinel lymph node biopsy.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3741;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2015; 351:h5650";English;"Margaret McCartney: Flibanserin for low sexual desire is not feminism";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1694;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of dapoxetine (Priligy�) has shown more risks than benefits in treating premature ejaculation";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3230;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer screening investigations (including imaging and blood tests) as part of follow-up to people who have had stage IA melanoma.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3742;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h5652";English;"Urinary biomarkers are unreliable for diagnosing bladder cancer. Urine based biomarkers miss a substantial proportion of patients with bladder cancer and produce false positive results in others.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1695;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of etifoxine (Stresam�) has shown more risks than benefits in treating anxiety";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3231;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant radiotherapy to people with stage IIIA melanoma.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3743;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Melnick E. BMJ 2015; 351:h5831";English;"How to make less more: empathy can fill the gap left by reducing unnecessary care";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1696;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of bupropion (Zyban�) may have more risks than benefits in smoking cessation";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3232;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer imaging or sentinel lymph node biopsy to people who have stage IA melanoma or those who have stage IB melanoma with a Breslow thickness of 1 mm or less.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3744;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J.BMJ 2015; 351:h6125";English;"Rectal thermometer should be used for accurate temperature reading, analysis finds";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1697;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The use of Varenicline (Champix�) may have more risks than benefits in smoking cessation";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3233;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use confocal microscopy or computer-assisted diagnostic tools to assess pigmented skin lesions.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3745;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h6359";English;"Progesterone supplements do not reduce risk of recurrent miscarriage, study shows";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1698;14;"Prescrire bilan. Towards better patient care: drugs to avoid";Prescrire.org;Spanish;"The association of prednisolone + glycol slicylate (Cortisal�) has shown more risks than benefits as painkiller in sprain or tendinitism";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the website of the initiative

" 3234;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not issue repeat prescriptions for antimicrobials unless needed for a particular clinical condition or indication. Avoid issuing repeat prescriptions for longer than 6 months without review and ensure adequate monitoring for individual patients to redu";-;2015;;;"Low value";antibiotics;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3746;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2015; 351:h6384";English;"HIV pre-exposure prophylaxis could help 1.2 million in US";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3235;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use prolonged antibiotic treatment (more than 14 days) for the treatment of mild soft tissue diabetic foot infections.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3747;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h6319";English;"Breast MRI after mammography detects additional aggressive cancers, and can depict more disease than mammography in both the ipsilateral and contralateral breasts, so can result in potential changes to cancer grade and treatment.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3236;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer tigecycline to treat diabetic foot infections unless other antibiotics are not suitable.";-;2015;;;"Low value";antibiotic;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3748;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015; 351:h6430";English;"Metformin in obese teenagers does not improve glycaemic control, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3237;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer antibiotics to prevent diabetic foot infections.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3749;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015; 351:h6576";English;"Screening for early breast cancer reduces invasive cancer, study finds";"For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3238;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the Wagner classification system to assess the severity of a diabetic foot ulcer.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3239;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not change from intravenous insulin to subcutaneous insulin in a child or young person with diabetic ketoacidosis (DKA) until ketosis is resolving, they are alert, and they can take oral fluids without nausea or vomiting.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3240;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give children and young people with diabetic ketoacidosis (DKA) additional intravenous fluid to replace urinary losses.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3241;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give intravenous sodium bicarbonate to children and young people with diabetic ketoacidosis (DKA).";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5801;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the effectiveness or efficacy of alcohol for disinfection of semi-critical materials in health care";"Infection prevention and control interventions are important in healthcare settings, particularly during the COVID-19 pandemic. Existing research on the efficacy of using alcohol as a disinfectant might provide useful information for policy makers. In this systematic review, the authors searched for research evaluating the disinfection of semi-critical healthcare materials (such as respiratory and anaesthesia equipment, endoscopes, and dental drills) with 60?80% alcohol (w/v), with and without previous cleaning. They did not restrict their searches by date or language of publication and did the search in July 2013. They included 14 studies, which investigated the impact of alcohol disinfection on bacteria (13 studies) or on viruses (2). Disinfection of semi-critical healthcare items with ~70% alcohol might be insufficient to prevent exposure of patients to viruses and bacteria. Overall, 37% of field tests and 25% of laboratory tests detected microorganisms after alcohol disinfection. It is uncertain whether previous cleaning before alcohol disinfection is beneficial.";2015;;;Uncertain;Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3242;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely give an intravenous fluid bolus to a child or young person with severe diabetic ketoacidosis (DKA) [indicated by a blood pH below 7.1].";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5802;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Sodium hypochlorite disinfection is recommended to prevent infections in hospitals, although its direct effect on the transmission of hospital-acquired infections is unclear";"Infection prevention and control interventions are especially important during the COVID-19 pandemic. Sodium hypochlorite is used as a disinfectant to reduce the spread of hospital-acquired infections. In this systematic review, the authors searched for studies that compared the effects of sodium hypochlorite with those other disinfectant products or different concentrations of hypochlorite on the prevention of hospital-acquired infections. They did not restrict their search by date, type or language of publication and did their latest search in February 2014. They included 14 controlled trials. Sodium hypochlorite was effective at inhibiting microorganism growth in most studies. Some studies reported reduced infection, resistance and colonization rates of microorganisms with the use of sodium hypochlorite. Sodium hypochlorite was as effective or more effective to other products in most studies but contradictory results were noted when compared with hydrogen peroxide and chlorhexidine. The direct effect of sodium hypochlorite on the transmission of hospital-acquired infections is unclear.";2015;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3243;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give an intravenous fluid bolus to children and young people with mild or moderate diabetic ketoacidosis (DKA) [indicated by a blood pH of 7.1 or above].";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6571;1;"NICE ";NICE;English;"It is recommended the diagnosis and management of type 1 diabetes in adults.";"Education and support, monitoring of blood glucose, cardiovascular risk, and identification and management of long-term complications are recommended for the diagnosis and management of type 1 diabetes in adults.";2015;;;"High value";"diagnosis and management";https://www.nice.org.uk/guidance/ng17/chapter/Recommendations 3244;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give oral fluids to a child or young person who is receiving intravenous fluids for diabetic ketoacidosis (DKA) unless ketosis is resolving, they are alert, and they are not nauseated or vomiting.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3245;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer aspirin for the primary prevention of cardiovascular disease to adults with type 1 diabetes.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3246;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not generally use phosphate replacement in the management of diabetic ketoacidosis (DKA) in adults.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3247;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not generally use bicarbonate in the management of diabetic ketoacidosis (DKA) in adults.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3248;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not advise routine use of rapid-acting insulin analogues after meals for adults with type 1 diabetes.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2737;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Koretz R. BMJ 2015;350:g7809";English;"Widespread screening for hepatitis C should be reviewed because of evidence which support its clinical harms, however it might be a cost effective strategy for reducing the development of end stage liver disease.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Hepatitis C, Screening";"Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3249;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer real-time continuous glucose monitoring routinely to adults with type 1 diabetes.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6577;1;"NICE ";NICE;English;"Do not routinely offer self-monitoring of capillary blood glucose levels for adults with type 2 diabetes, except in special situations ";"Do not routinely offer self-monitoring of capillary blood glucose levels for adults with type 2 diabetes unless: - the person is on insulin or - there is evidence of hypoglycaemic episodes or - the person is on oral medication that may increase their risk of hypoglycaemia while driving or operating machinery or - the person is pregnant or is planning to become pregnant ";2015;;;"High value";Tratamiento;"Link to the recommendation on the website of the initiative/ Enlace a la recomendacio?n en la pa?gina web de la iniciativa" 2738;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h188";English;"Many older people may be overtreated for diabetes, US study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Diabetes, Older, Elderly, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3250;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not advise adults with type 1 diabetes to follow a low glycaemic index diet for blood glucose control.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2739;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Sawhney S. BMJ 2015;350:h19";English;"Don't rely on automated alerts for diagnosis of acute kidney injury. Caution is needed in interpreting test results.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Acute Kidney Injury";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3251;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not measure C-peptide and/or diabetes-specific autoantibody titres routinely to confirm type 1 diabetes in adults.";-;2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2740;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Iacobucci G. BMJ 2015;350:h450";English;"New campaign to raise awareness of oesophago-gastric cancer may lead to over-investigation, expert warns.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Esophag, Gastric Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3252;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Paclitaxel as albumin-bound nanoparticles in combination with gemcitabine is not recommended within its marketing authorisation for adults with previously untreated metastatic adenocarcinoma of the pancreas.";-;2015;;;"Low value";chemotherapy;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2741;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h522";English;"Clinical tests should be routinely ordered to accurately diagnose asthma and to avoid overdiagnosis, rather than simply taking a medical history.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Asthma";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3253;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Societat Catalana de Pediatria";Spanish;"Bronchitis in children should not be routinely treated with antibiotics, unless there is a confirmation or a high suspicion of an added bacterial infection.";-;2015;;;"Low value";-;"Link to the recommendation in Essencial website" 2742;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2015;350:h735";English;"Margaret McCartney: Cancer strategy should be led by evidence";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Evidence, Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3254;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t suggest ordering the most invasive test or treatment before considering other less invasive options.";"There are often diagnostic approaches and treatment options that result in the same clinical outcome but are less invasive. Examples include the use of ultrasound instead of computed tomography (CT) scanning to diagnose acute appendicitis in children, or the use of an oral antibiotic that has similar oral bioavailability as its intravenous counterpart. Taking time to consider the diagnostic sensitivity and specificity of less invasive tests or the therapeutic effectiveness of less invasive treatments can minimize unnecessary patient exposure to harmful side effects of more invasive tests or treatments.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2743;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015;350:h466";English;"Departing from guidelines in patients? best interest is defensible, says negligence expert";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Guidelines, Negligence";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3255;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t suggest a test, treatment, or procedure that will not change the patient?s clinical course.";"When ordering tests, it is important to always consider the diagnostic characteristics such as sensitivity, specificity and predictive value in light of the patient?s pre-test probability. Patients who are at very low baseline risk often do not require an additional test to rule out the diagnosis. Furthermore, evidence suggests that in such low-risk patients, diagnostic tests do not reassure patients, decrease their anxiety, or resolve their symptoms. Examples include the use of computed tomography (CT) scanning in low-risk patients to rule out pulmonary embolism, or pre-operative cardiac testing for patients prior to low risk surgery. Evaluation of baseline risk and the use of decision tools wherever possible, along with a ?how will this change my management? approach, can help to avoid unnecessary ?rule out? testing in patients.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3511;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t use (superficial or deep) heat to obtain clinically important long term outcomes in musculoskeletal conditions";"There is limited evidence for use of superficial or deep heat to obtain clinically important long term outcomes for musculoskeletal conditions. While there is some evidence of short-term pain relief for heat, the addition of heat should be supported by evidence and used to facilitate an active treatment program. A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life. There is emerging evidence that passive treatment strategies can harm patients by exacerbating fears and anxiety about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2744;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor S. BMJ 2015;350:h584";English;"One in three people would rather risk shorter life than take a daily pill, US study finds";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Treatment, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3256;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Manual anal stretch has a higher risk of fissure persistence than internal sphincterotomy and a significantly higher risk of minor incontinence than sphincterotomy.";"Anal fissure is an ulcer of the skin that lines the anus, causing pain on defecation. A number of procedures have been trialled for treatment of this condition, including manual anal stretch and sphincterotomy. Manual anal stretch has a higher risk of fissure persistence than internal sphincterotomy and a significantly higher risk of minor incontinence than sphincterotomy. This Cochrane review therefore suggests there is no evidence to support the ongoing use of this procedure.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3512;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t obtain a C. difficile toxin test to confirm ?cure? if symptoms have resolved.";"Rates of Clostridium difficile infection (CDI) have been increasing, especially among older adults who have recently been hospitalized or who reside in the PA/LTC setting. Patients residing in PA/LTC facilities are particularly at risk for CDI because of advanced age, frequent hospitalizations and frequent antibiotic exposure. However, only symptomatic patients should be tested. Furthermore, studies have shown that C. difficile tests may remain positive for as long as 30 days after symptoms have resolved. False positive ?test-of-cure? specimens may complicate clinical care and result in additional courses of inappropriate anti-C. difficile therapy. To limit the spread of C. difficile, care providers in the PA/LTC setting should concentrate on early detection of symptomatic patients and the consistent use of proper infection control practices, including hand washing with soap and water, contact precautions, and environmental cleaning with 1:10 dilution of sodium hypochlorite (bleach) prepared fresh daily.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 4536;33;"Choosing Wisely � : Things we do for no reason";"Moriates C. J.Hosp. Med. 2015 October;10(10):691-693";English;"Inhaled bronchodilators delivered by metered?dose inhalers (MDIs) instead of nebulizers are recommended in patients with obstructive pulmonary symptoms early in their hospital course, unless the patient is unable to use an inhaler due to altered mental status, dementia, or other circumstances. ";"For further information please visit the website of the initiative (link below) ";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2745;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h749";English;"Blood pressure targets for type 2 diabetes should be lower, say researchers";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Hypertension, Diabetes Mellitus";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4537;33;"Choosing Wisely � : Things we do for no reason";"Breu A. J. Hosp. Med. 2015 November;10(11):753-755";English;"Do not routinely order serum folate and RBC folate tests in patients suspected of having folate deficiency and treat with a diet containing folate or folic acid.";"For further information please visit the website of the initiative (link below) ";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2746;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hofmann B.M. BMJ 2015;350:h705";English;"Too much technology";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Technology;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4538;33;"Choosing Wisely � : Things we do for no reason";"Trost J. J. Hosp. Med. 2015 December;10(12):827-829";English;"Troponin should be measured in lieu of creatine kinase?myocardial band and serial creatine kinase testing to evaluate for myocardial injury in patients suspected of having acute coronary syndrome.";"For further information please visit the website of the initiative (link below) ";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2747;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mudur G. BMJ 2015;350:h1159";Spanish;"Doctors in India plan to launch network against corruption and unethical practices";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Ethical;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4539;33;"Choosing Wisely � : Things we do for no reason";"Trost J. J. Hosp. Med. 2015 December;10(12):827-829";English;"Creatine kinase?myocardial band tests should not be ordered routinely for patients suspected of having acute coronary syndrome. Hospitals should remove CK?MB from pathology lab catalogs or require specific permission to order it.";"For further information please visit the website of the initiative (link below) ";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2748;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Jain A. BMJ 2015;350:h1095";English;"Too much medicine is not just a problem of rich countries";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2749;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2015;350:h967";English;"Doctors? antibiotic prescriptions should be scrutinised, says NICE";"For further information please visit the website of the initiative (link below)";2015;;;"High value";Antibiotics;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2750;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2015;350:h1136";English;"True risks of paracetamol may be underestimated, say researchers";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Paracetamol, Risks";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2751;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Van den Bruel A. BMJ 2015;350:h980";English;"People?s willingness to accept overdetection in cancer screening: population survey.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3007;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Culturale Pediatri (ACP)/The Cultural Association of Pediatricians - ACP";English;"Avoid using drugs (anti H2, procynetics, protonic pump inibitors-PPI) in physiological Gastro Esophageal Reflux (GER) not interfering with growth and not associated with clinical signs or symptoms of GER Disease. Don?t prescribe drugs in ?happy spitters?.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Gastro Esophageal Reflux";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2752;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Barratt A. BMJ 2015;350:h867";English;"Don't neglect to consider that, expanding the age of women for the mammography screening has the potential risk of widespread overdiagnosis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Mammography, Screening";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3008;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Medicina Nucleare e Imaging Molecolare (AIMN)/ Italian Association of Nuclear Medicine";Spanish;"Don?t use brain SPECT (Single photon emission computed tomography) with DAT (dopamine transporter) radiopharmaceuticals in the differential diagnosis of degenerative Parkinsonisms or to convince a patient with Parkinson?s disease that he/she is really aff";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Brain SPECT, Parkinson";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 6592;1;"NICE ";NICE;English;"It is not recommended to use age or BMI alone to exclude or diagnose type 1 diabetes in adults, nor to routinely measure serum C?peptide to confirm the disease. ";"Type 1 diabetes affects over 370,000 adults in the UK. It results from destruction of the cells that normally make insulin. Loss of insulin secretion results in high blood glucose and other metabolic and haematological abnormalities, which have both short?term and long?term adverse effects on health. Over years, type 1 diabetes causes tissue damage which, if not detected and managed early, can result in disability: blindness, kidney failure, periodontitis, and foot ulceration leading to amputation, as well as premature heart disease, stroke and death. The risk of all of these complications is greatly reduced by treatment that keeps circulating glucose levels to as near normal as possible, reducing tissue damage. Disability from complications that are not avoided can often be prevented by early detection and active management.";2015;;;"Low value";"Diabetes 1, Treatment, Management, Diagnosis";"Link to the recommendation on the website of the initiative" 2753;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Carter S.M. BMJ 2015;350:h869";English;"The challenge of overdiagnosis begins with its definition.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3009;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Medicina Nucleare e Imaging Molecolare (AIMN)/ Italian Association of Nuclear Medicine";English;"Don?t treat with radioiodine low-risk differentiated thyroid carcinomas (namely ""microcarcinomas"" or carcinomas <1 cm, in the absence of unfavorable prognostic factors), after total thyroidectomy";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Carcinomas thyroid, Radioiodine";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2754;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Ansah E.K. BMJ 2015;350:h1019";English;"Rapid diagnostic malaria tests on fever management are recommended in the private retail sector used by the poorest patients. It can substantially improve targeting of drugs safely.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Malaria, Diagnosis";"Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3010;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Association of Medical Endocrinologists - AME";English;"Thyroid US screening is not recommended in patients without thyroid disease?s signs or symptoms and without thyroid carcinoma family history.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Thyroid;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2755;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Johansson M. BMJ 2015;350:h825";English;"Abdominal aortic aneurysm (AAAs) screening program with the changes in aortic diameter should be revisited.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Abdominal Aortic Aneurysm";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3011;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Association of Medical Endocrinologists - AME";English;"Avoid excess bone density testing: intervals less than two years are rarely necessary.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Bone density testing";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2756;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Apenberg P. BMJ 2015;350:h1237";English;"Myth busting in medicine";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Evidence;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3012;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Association of Medical Endocrinologists - AME";English;"Use of free testosterone testing is not recommended for hypogonadism or hyperandrogenism diagnosis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Testosterone, Hypogonadism, Hyperandrogenism";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2757;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Loder E. BMJ 2015;350:h1163";English;"Too much medicine: the challenge of finding common ground";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 3013;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Association of Medical Endocrinologists - AME";English;"FT3 testing is not necessary in most thyroid diseases patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Thyroid;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2758;2;"Choosing Wisely�";"American Academy of Otolaryngology ? Head and Neck Surgery Foundation";English;"Don?t place ear tubes in otherwise healthy children who have had a single episode of ear fluid lasting less than 3 months.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Ear tubes, Ear fluid, Children";"Link to the recommendation in the Choosing Wisely website" 3014;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Association of Medical Endocrinologists - AME";Spanish;"Thyroid nodules patients should not be treated with L-thyroxine except in selected cases.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Thyroid nodules";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2759;2;"Choosing Wisely�";"American Academy of Otolaryngology ? Head and Neck Surgery Foundation";English;"Don?t order imaging studies in patients with non-pulsatile bilateral tinnitus, symmetric hearing loss and an otherwise normal history and physical examination.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Tinnitus;"Link to the recommendation in the Choosing Wisely website" 3015;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione per un?assistenza appropriata in ostetricia e ginecologia - ANDRIA";English;"Don?t require routinely to all patients general blood tests, general coagulation tests or tests for trombophylia to prescribe oral contraceptive medications. (The Italian Association for the Promotion of appropriate care in Obstetrics, Ginecology and Peri";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Oral contraceptive medications";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2760;2;"Choosing Wisely�";"American Academy of Otolaryngology ? Head and Neck Surgery Foundation";English;"Don?t routinely use perioperative antibiotics for elective tonsillectomy in children.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Tonsillectomy;"Link to the recommendation in the Choosing Wisely website" 3272;2;"Choosing Wisely�";"Society for Healthcare Epidemiology of America";English;"Don?t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection.";"Antibiotics are often started when a patient is possibly infected. After three days, laboratory and radiology information is available and antibiotics should either be deescalated to a narrow-spectrum antibiotic based on culture results or discontinued if evidence of infection is no longer present. Lessening antibiotic use decreases risk of infections with Clostridium difficile (C. difficile) or antibiotic-resistant bacteria.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2761;2;"Choosing Wisely�";"American Academy of Otolaryngology ? Head and Neck Surgery Foundation";English;"Don?t routinely perform sinonasal imaging in patients with symptoms limited to a primary diagnosis of allergic rhinitis alone.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Rhinitis;"Link to the recommendation in the Choosing Wisely website" 3273;2;"Choosing Wisely�";"Society for Healthcare Epidemiology of America";English;"Avoid invasive devices (including central venous catheters, endotracheal tubes and urinary catheters) and, if required, use no longer than necessary. They pose a major risk for infections.";"Invasive devices are often necessary for patient support; however, they are a major risk for healthcare-associated infections (HAIs). We are learning they can often be avoided and, if used, can be quickly removed with the help of clinical reminders and protocols. They should never be used for convenience.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2762;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t place an indwelling urinary catheter to manage urinary incontinence.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Urinary catheter, Incontinence";"Link to the recommendation in the Choosing Wisely website" 3274;2;"Choosing Wisely�";"Society for Healthcare Epidemiology of America";English;"Don?t perform urinalysis, urine culture, blood culture or C. difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to over diagnosis and overtreatment.";"Although important for diagnosing disease when used in patients with appropriate signs or symptoms, these tests often are positive when an infection is not present. For example, in the absence of signs or symptoms, a positive blood culture may represent contamination, a positive urine culture could represent asymptomatic bacteriuria, and a positive test for C. difficile could reflect colonization. There are no perfect tests for these or most infections. If these tests are used in patients with low likelihood of infection, they will result in more false positive tests than true positive results, which will lead to treating patients without infection and exposing them to risks of antibiotics without benefits of treating an infection.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2763;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t recommend screening for breast, colorectal or prostate cancer if life expectancy is estimated to be less than 10 years.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Screening, Cancer";"Link to the recommendation in the Choosing Wisely website" 3275;2;"Choosing Wisely�";"Society for Healthcare Epidemiology of America";English;"Don?t use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence.";"C. difficile can be a life threatening illness and is generally caused by antibiotics killing normal bacteria in the intestine. Patients recovering from C. difficile are three times as likely to have a recurrence if they receive an antibiotic in the following month. However, unnecessary antibiotics are often used in this population ? primarily for misdiagnosed urinary tract infection or pneumonia.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2764;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t obtain a C. difficile toxin test to confirm ?cure? if symptoms have resolved.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Clostridium Difficile";"Link to the recommendation in the Choosing Wisely website" 3276;2;"Choosing Wisely�";"Society for Healthcare Epidemiology of America";English;"Don?t continue surgical prophylactic antibiotics after the patient has left the operating room.";"Prophylactic antibiotics during surgery can significantly decrease the risk of surgical site infections; however, they only have benefit if used immediately around the time of surgery. When antibiotics are used for longer than necessary, they increase the risk of infection with antibiotic-resistant bacteria and C. difficile.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2765;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t initiate antihypertensive treatment in individuals ?60 years of age for systolic blood pressure (SBP) <150 mm Hg or diastolic blood pressure (DBP) <90 mm Hg.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Hypertension;"Link to the recommendation in the Choosing Wisely website" 3021;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"In gathering information on the history of a transient loss of consciousness, a clear description of a blackout and a list of all drugs in use cannot be omitted.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Transient loss of consciousness";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3277;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis.";"The potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits. Although the short-term use of systemic corticosteroids is sometimes appropriate to provide relief of severe symptoms, long-term treatment could cause serious short- and long-term adverse effects in both children and adults. In extreme cases that have failed to respond to other appropriate treatments, the benefits of systemic corticosteroids must be weighed against these potentially serious risks.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2766;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t administer supplemental oxygen to relieve dyspnea in patients with cancer who do not have hypoxia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Cancer;"Link to the recommendation in the Choosing Wisely website" 3022;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";Spanish;"In the clinical evaluation of a patient with a previous transient loss of consciousness, measurement of laying down and standing blood pressure cannot be omitted in order to exclude orthostatic hypotension.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Previous transient loss of consciousness, Orthostatic Hypotension";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3278;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t use skin prick tests or blood tests such as the radioallergosorbent test (RAST) for the routine evaluation of eczema.";"Skin prick tests or blood tests may help identify the causes of allergic reactions, including hives or sneezing after exposure to dust or pollen. However, these tests are not useful for diagnosing dermatitis or eczema. When testing for suspected allergies is deemed necessary in patients with these rashes, it is better to conduct patch testing with ingredients of products that come in contact with the patient?s skin.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2767;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t use L-carnitine/acetyl-L-carnitine supplements to prevent or treat symptoms of peripheral neuropathy in patients receiving chemotherapy for treatment of cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";L-carnitine;"Link to the recommendation in the Choosing Wisely website" 3023;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"In the evaluation of transient loss of consciousness and a normal neurological examination, don?t perform brain imaging studies (CT or MRI).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Transient loss of consciousness";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3279;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t routinely use microbiologic testing in the evaluation and management of acne.";"Bacteria are only one of several factors that contribute to acne. Microbiologic testing, used to determine the type of bacteria present in an acne lesion, is generally unnecessary because it does not affect the management of typical acne patients. Microbiologic testing should be considered only when acne has failed to respond to conventional treatments, particularly in patients who have already been treated with oral antibiotics.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2768;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t use mixed medication mouthwash, commonly termed ?magic mouthwash,? to prevent or manage cancer treatment-induced oral mucositis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Mucositis;"Link to the recommendation in the Choosing Wisely website" 3024;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The International Society of Doctors for the Environment ? ISDE Italian section";English;"Air: don?t consume energy derived from fossil fuels (coal, petrol, petrol, gas). When possible, use renewable energy sources (those which can be provided by solar energy, photovoltaic systems, wind power, geothermic sources and buildings constructed usin";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Renewable Energy";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3280;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection.";"Research has suggested that bilateral lower leg cellulitis is very rare. Patients with swelling and redness of both legs most likely have another condition, such as dermatitis resulting from leg swelling, varicose veins or contact allergies. To ensure appropriate treatment, doctors must consider the likelihood of diagnoses other than cellulitis when evaluating swelling and redness of the lower legs. Misdiagnosis of bilateral cellulitis can lead to overuse of antibiotics and subject patients to potentially unnecessary hospital stays.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2769;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t use aloe vera on skin to prevent or treat radiodermatitis.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Alove vera, Radiodermatitis";"Link to the recommendation in the Choosing Wisely website" 3025;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The International Society of Doctors for the Environment ? ISDE Italian section";English;"Water: don?t drink bottled water choosing, where possible, water from the tap which often has better organoleptic characteristics and is subject to rigorous quality control.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Water;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3281;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t routinely prescribe antibiotics for inflamed epidermal cysts.";"The overwhelming majority of red and swollen epidermal cysts (ECs) are inflamed but not infected. It is important to confirm infection before treating these cysts with antibiotics. Appropriate treatments for inflamed ECs include incision and drainage or an injection of corticosteroid directly into the cyst.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2770;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t neglect to advise patients with cancer to get physical activity and exercise during and after treatment to manage fatigue and other symptoms.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Exercise, Cancer";"Link to the recommendation in the Choosing Wisely website" 3026;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The International Society of Doctors for the Environment ? ISDE Italian section";English;"Biodiversity: use antibiotics only when absolutely necessary and only under medical supervision.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Biodiversity, Antibiotics";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3282;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Perinatal Pediatrics";English;"Avoid routine use of anti-reflux medications for treatment of symptomatic gastroesophageal reflux disease (GERD) or for treatment of apnea and desaturation in preterm infants.";"Gastroesophageal reflux is normal in infants. There is minimal evidence that reflux causes apnea and desaturation. Similarly, there is little scientific support for the use of H2 antagonists, proton-pump inhibitors, and motility agents for the treatment of symptomatic reflux. Importantly, several studies show that their use may have adverse physiologic effects as well as an association with necrotizing enterocolitis, infection and, possibly, intraventricular hemorrhage and mortality.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2771;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t use phenytoin or fosphenytoin to treat seizures caused by drug toxicity or drug withdrawal.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Phenytoin, Seizures";"Link to the recommendation in the Choosing Wisely website" 3027;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The International Society of Doctors for the Environment ? ISDE Italian section";English;"Ionized Radiation: X-rays should not be carried out unless there is a specific clinical indication.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Ionized Radiation";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3283;2;"Choosing Wisely�";http://www.choosingwisely.org/clinician-lists/american-academy-pediatrics-section-perinatal-pediatri;English;"Avoid routine continuation of antibiotic therapy beyond 48 hours for initially asymptomatic infants without evidence of bacterial infection.";"There is insufficient evidence to support antibiotic treatment for more than 48 hours to rule out bacterial infection in asymptomatic term and preterm infants. Current blood culturing systems identify the great majority of pathologic organisms prior to 48 hours. Prolonged antibiotic use may be associated with necrotizing enterocolitis and death in extremely low birthweight infants.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2772;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t recommend ?detoxification? through colon cleansing or promoting sweating for disease treatment or prevention.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Colon;"Link to the recommendation in the Choosing Wisely website" 3028;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The International Society of Doctors for the Environment ? ISDE Italian section";English;"Nutrition: don?t purchase or consume foods which are mass produced by industry or come from a distant geographical location preferring instead fresh foods (fruit, vegetables, whole wheat cereals and milk) from your local area.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Nutrition;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3284;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Perinatal Pediatrics";English;"Avoid routine use of pneumograms for pre-discharge assessment of ongoing and/or prolonged apnea of prematurity.";"Cardio-respiratory events are common in both term and preterm infants. Although there may be a role for pneumograms in selected cases where the etiology of the events is in doubt, they have not been shown to reduce acute life-threatening events or mortality from their routine use.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2773;2;"Choosing Wisely�";"American Academy of Otolaryngology ? Head and Neck Surgery Foundation";English;"Don?t order more than one computerized tomography (CT) scan of the paranasal sinuses within 90 days to evaluate uncomplicated chronic rhinosinusitis patients when the paranasal sinus CT obtained is of adequate quality and resolution";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Rhinosinusitis;"Link to the recommendation in the Choosing Wisely website" 3029;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Palliative Care - SICP";English;"Don?t exclude nor defer the oral or parenteral administration of opioids for the palliative treatment of dyspnoea in patients affected by chronic incurable illness with a limited life expectancy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Opioids, Dyspnoea";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3285;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Perinatal Pediatrics";English;"Avoid routine daily chest radiographs without an indication for intubated infants.";"Although intermittent chest radiographs may identify unexpected findings, there is no evidence documenting the effectiveness of daily chest X-rays to reduce adverse outcomes. Further, this practice is associated with increased radiation exposure.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2774;2;"Choosing Wisely�";"AMDA ? The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t recommend aggressive or hospital-level care for a frail elder without a clear understanding of the individual?s goals of care and the possible benefits and burdens.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Goals of care";"Link to the recommendation in the Choosing Wisely website" 3030;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Palliative Care - SICP";English;"Don?t initiate or prolong artificial nutrition (enteral or parenteral) in late stage cancer patients with a life expectancy of less than a few weeks and a Performance Status <50.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Artificial Nutrition, Late Stage Cancer";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3286;2;"Choosing Wisely�";"American Academy of Pediatrics ? Section on Perinatal Pediatrics";English;"Avoid routine screening term-equivalent or discharge brain MRIs in preterm infants.";"Findings on term-equivalent magnetic resonance imaging (MRI) correlate with neurodevelopmental outcomes at discharge and at 2 and 5 years of age. There is, however, insufficient evidence that the routine use of term-equivalent or discharge screening brain MRIs in preterm infants improves long-term outcome.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2775;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t order tests to evaluate for or diagnose ?idiopathic environmental intolerances,? ?electromagnetic hypersensitivity? or ?mold toxicosis.?";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Hypersensitivity, Intolerance";"Link to the recommendation in the Choosing Wisely website" 3031;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Palliative Care - SICP";English;"Don?t combine drugs for which there is no documented evidence of compatibility and chemical and physical stability in devices for the continuous subcutaneous or intravenous infusion of medications (e.g. Elastomers).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Continuous infusion";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3287;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t miss the opportunity to initiate conversations with patients about whether a test, treatment or procedure is necessary.";"Patient requests sometimes drive overuse. For example, a parent might request antibiotics for his or her child who likely has viral sinusitis, or a patient might request magnetic resonance imaging (MRI) for low-back pain. Often patients are unaware of the benefits, side-effects and risks of tests and treatments. Taking time to explore a patient?s concerns, and counseling them about the relative benefits and risks of tests or treatments represents a patient-centered approach to ensuring the appropriate use of resources.";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2776;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t perform hair or nail testing for ?metal poisoning? screening in patients with nonspecific symptoms.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Metal Poisoning";"Link to the recommendation in the Choosing Wisely website" 3032;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Palliative Care - SICP";English;"When organizing a local palliative care network, don?t omit the activation of II� level home care involving medical staff (doctors and nurses) with specialised training palliative care and team management.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Palliative Care Network";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3288;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t hesitate to ask for clarification on tests, treatments, or procedures that you believe are unnecessary.";"Unfortunately, in some learning environments, a hierarchy exists between supervisors and students that makes it difficult for students to feel comfortable speaking up. As a result, students might observe unnecessary care, but avoid saying anything for fear of potential consequences. Supervisors need to encourage students to feel free to question whether tests or treatments are truly necessary without fear of repercussion. The clinical training environment should be one where students feel safe to ask questions.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2777;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t perform fasciotomy in patients with snake envenomation absent direct measurement of elevated intracompartmental pressures.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Fasciotomy;"Link to the recommendation in the Choosing Wisely website" 3033;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Palliative Care - SICP";English;"Don?t implement programs/pathways aimed at improving the quality of end of life care that are neither proven to be effective or included in specific research programs, unless they are supported and monitored by medical staff belonging to a specialised pal";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Quality Palliative Care";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3289;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t suggest ordering tests or performing procedures for the sole purpose of gaining personal clinical experience.";"The clinical training years in medical school represent an important opportunity for students to translate what was learned in the classroom to the bedside. This can be a challenging time of great uncertainty for students. Students may order tests excessively due to a lack of clinical experience, or recommend investigations in order to build upon their personal experience.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2778;2;"Choosing Wisely�";"American College of Preventive Medicine";English;"Don?t take a multi-vitamin, vitamin E or beta carotene to prevent cardiovascular disease or cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Multi-Vitamin, Beta Carotene";"Link to the recommendation in the Choosing Wisely website" 3034;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Genetica Umana (SIGU)";English;"Don?t perform screening tests of polymorphisms of factor V (Leiden) and Factor II (G20210A) in unselected patients, like all patients with only one episodes of venous thrombosis, in healthy subjects or in pregnant women with no specific anamnestic signs o";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Polymorphisms Factor V Leiden Factor II G20210A";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3290;19;"Choosing Wisely Canada";"Medical Students and Trainees";English;"Don?t suggest ordering tests or treatments pre-emptively for the sole purpose of anticipating what your supervisor would want.";"A ?hidden curriculum? pervasive in the academic environment encourages medical students to search for zebras through extensive (and often unnecessary) diagnostic workups. Because restraint is often discouraged, students adopt the belief that faculty expect an exhaustive diagnostic approach, and feel that they need to demonstrate their knowledge, thoroughness and curiosity through test ordering. Students can overcome this practice by articulating why they chose not to order a specific test. This, combined with a shift towards ?celebrating restraint? by faculty can help to combat this pervasive practice in medical training.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2779;2;"Choosing Wisely�";"American College of Preventive Medicine";English;"Don?t routinely perform PSA-based screening for prostate cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"PSA, Prostate Cancer";"Link to the recommendation in the Choosing Wisely website" 3035;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society for Medical Education - SIPeM";English;"Don't use non-interactive lectures as the main teaching method. Privilege the use of interactive methods instead.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medical Education";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3291;19;"Choosing Wisely Canada";Anesthesiology;English;"Don?t order baseline laboratory studies (complete blood count, coagulation testing, or serum biochemistry) for asymptomatic patients undergoing low-risk non-cardiac surgery.";"Conducting baseline laboratory investigations before low-risk non-cardiac surgery contributes little value to perioperative care. A focused clinical history and physical examination may reliably identify relevant abnormalities sought by routine laboratory testing before low-risk surgery. In addition, evidence suggests that abnormal results in this setting only rarely influence management and do not improve clinical outcomes. Preoperative testing may add value in the setting of a symptomatic patient or higher-risk surgery, but should not be performed routinely before low-risk surgery on asymptomatic patients.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2780;2;"Choosing Wisely�";"American College of Preventive Medicine";English;"Don?t use whole-body scans for early tumor detection in asymptomatic patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Cancer, Tumor";"Link to the recommendation in the Choosing Wisely website" 3036;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society for Medical Education - SIPeM";English;"Don't address topics about clinical or organization choices without considering their ethical, social and inter-professional aspects, patient's expectations and values, and the most appropriate teaching setting (hospital, primary care).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medical Education";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3292;19;"Choosing Wisely Canada";Anesthesiology;English;"Don?t order a baseline electrocardiogram for asymptomatic patients undergoing low-risk non-cardiac surgery.";"Electrocardiograms (ECGs) performed before elective, non-cardiac, surgeries are frequently abnormal. This is especially true when this test is done in older patients. Despite the frequency of these abnormalities, ECGs do little to improve risk prediction beyond simply asking patients about their health. Serious cardiac events like heart attack are rare following low-risk surgeries; there is little that physicians can do to further lower this risk. A preoperative ECG will therefore not improve outcome but may lead to more testing or treatment that is of little benefit. ECGs used to identify the cause of symptoms (palpitations, chest pain, dyspnea, etc.) remain useful diagnostic tools regardless of whether the patient is having surgery.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2781;2;"Choosing Wisely�";"American College of Preventive Medicine";English;"Don?t use expensive medications when an equally effective and lower-cost medication is available.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medication, Cost";"Link to the recommendation in the Choosing Wisely website" 3037;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society for Medical Education - SIPeM";English;"Avoid non-structured oral exams, and don't use only cognitive tools of technical knowledge in the assessment of practical skills.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medical Education";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3293;19;"Choosing Wisely Canada";Anesthesiology;English;"Don?t order a baseline chest X-ray in asymptomatic patients, except as part of surgical or oncological evaluation.";"While chest X-rays (CXRs) remain an important part of surgeon?s evaluation before cancer or thoracic surgeries, it is better if these staging examinations are complete before committing a patient to surgery. CXRs are not indicated in the routine pre?anesthetic assessment. In the absence of symptoms, CXRs yield few diagnoses and many false positives. CXRs do not improve risk prediction or stratification. CXR in the pre-anesthetic evaluation should be reserved for patients with symptoms consistent with acute cardiopulmonary illness (dyspnea, wheeze, productive sputum, etc.).";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2782;2;"Choosing Wisely�";"American College of Preventive Medicine";English;"Don?t perform screening for cervical cancer in low-risk women aged 65 years or older and in women who have had a total hysterectomy for benign disease.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Cervical Cancer";"Link to the recommendation in the Choosing Wisely website" 3038;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society for Medical Education - SIPeM";English;"Don't let learners perform procedures directly on patients, without having practiced them in an appropriate simulated model, and without proper tutorial supervision.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medical Education";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3294;19;"Choosing Wisely Canada";Anesthesiology;English;"Don?t perform resting echocardiography as part of preoperative assessment for asymptomatic patients undergoing low to intermediate-risk non-cardiac surgery.";"Resting echocardiography has a clear role for resolving diagnostic questions in surgical patients, such as identifying the basis for suspicious systolic murmurs or new dyspnea on exertion. Outside these indications, resting echocardiography does not contribute significant additional prognostic information to usual clinical evaluation. It is not useful as a screening tool to identify surgical patients at risk for cardiac complications.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2783;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t order an erythrocyte sedimentation rate (ESR) to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein (CRP) to detect acute phase inflammation.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"ESR, Inflammation, CRP";"Link to the recommendation in the Choosing Wisely website" 3039;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society for Medical Education - SIPeM";English;"Don't use only cognitive tests with a prevalent biological focus in the selection of candidates for the access to undergraduate and postgraduate medical and health sciences schools.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Medical Education";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 3295;19;"Choosing Wisely Canada";Anesthesiology;English;"Don?t perform cardiac stress testing for asymptomatic patients undergoing low to intermediate risk non-cardiac surgery.";"Stress testing can help resolve diagnostic uncertainty in surgical patients, such as determining whether individuals with chest discomfort and vascular risk factors have undiagnosed coronary artery disease. It can also help identify patients at elevated risk for cardiac complications after major vascular surgery. Nonetheless, asymptomatic individuals with good functional capacity have a very low risk of cardiac complications after low-to-intermediate non-cardiac surgery. Stress testing in such individuals is not useful for delineating expected perioperative risk and guiding clinical care.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2784;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t test vitamin K levels unless the patient has an abnormal international normalized ratio (INR) and does not respond to vitamin K therapy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Vitamin K";"Link to the recommendation in the Choosing Wisely website" 3040;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend growth monitoring at all appropriate* primary care visits using the 2014 WHO Growth Charts for Canada. (Strong recommendation; very low quality evidence). The growth monitoring recommendations apply to all children and youth 0?17 years of age";"*Appropriate primary care visits include scheduled health supervision visits, visits for immunizations or medication renewal, episodic care or acute illness, and other visits where the primary care practitioner deems it appropriate. Primary care visits are completed at primary health care settings, including those outside of a physician?s office (e.g. public health nurses carrying out a well-child visit at a community setting).

For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3296;19;"Choosing Wisely Canada";Headache;English;"Don?t order neuroimaging or sinus imaging in patients who have a normal clinical examination, who meet diagnostic criteria for migraine, and have no ?red flags? for a secondary headache disorder.";"Red flags for a secondary headache include thunderclap onset, fever and meningismus, papilloedema, unexplained focal neurological signs, unusual headache attack precipitants, and headache onset after age 50. The yield of neuroimaging in patients with typical recurrent migraine attacks is very low. Any imaging study, particularly MRI, can identify incidental findings of no clinical significance which may lead to patient anxiety and further unnecessary investigation. For patients with typical migraine and a normal clinical examination who desire reassurance, careful explanation of the diagnosis and patient education may be more advisable.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5344;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"There is no certainty to recommend pressure?controlled versus volume?controlled ventilation for acute respiratory failure due to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS)";"We could not be sure whether the proportions of patients who died in hospital were very different between those treated with PCV and with VCV. For every 1000 persons treated with VCV, 636 deaths were reported. On the basis of our results, we could expect to see between 210 fewer deaths and 13 more deaths with PCV. We found that effects on mortality in the ICU and on mortality at 28 days were similarly uncertain. Our results include the possibility that VCV or PCV could be better for reducing the duration of ventilation or the development of traumatic lung damage caused by ventilation (barotrauma). None of the studies provided reliable information regarding to what extent failure of other organs would be impacted by the type of ventilation, nor did they provide information on differences in infection risk or quality of life following discharge from intensive care.";2015;;;Uncertain;Treatment-Covid;"Link to the recommendation on the website of the initiative/ " 2785;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Testosterone;"Link to the recommendation in the Choosing Wisely website" 3041;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend that primary care practitioners not routinely offer structured interventions* aimed at preventing overweight and obesity in healthy weight children and youth**. (Weak recommendation; very low quality evidence)";"*Structured interventions are behavioural modification programs that involve several sessions that take place over weeks to months, follow a comprehensive-approach delivered by a specialized inter-disciplinary team, involve group sessions, and incorporate family and parent involvement. Behaviourally-based interventions may focus on diet, increasing exercise, making lifestyle changes, or any combination of these. These can be delivered by a primary health care team in the office or through a referral to a formal program within or outside of primary care, such as hospital-based, school-based or community programs.

**The prevention recommendations apply to all children and youth 0?17 years of age who have a healthy weight. They do not apply to children and youth with eating disorders, or who are underweight, overweight, or obese.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3297;19;"Choosing Wisely Canada";Headache;English;"Don?t prescribe opioid analgesics or combination analgesics containing opioids or barbiturates as first line therapy for the treatment of migraine.";"Non-steroidal anti-inflammatory drugs and triptans are recommended first line treatments for acute migraine therapy. Opioids may produce increased sensitivity to pain and increase the risk that intermittent headache attacks will become more frequent and escalate to a chronic daily headache syndrome (medication overuse headache), particularly when opioids are used on 10 days a month or more. Opioids may impair alertness and produce dependence or addiction syndromes.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5345;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";Spanish;"No studies were found evaluating the effects of wearing gloves, gowns, or masks for contact with hospitalized MRSA patients, or with their immediate environment, on the transmission of MRSA to patients, hospital staff, caregivers, or patients' visitors.";"- No studies eligible for this review were identified, either completed or ongoing. - This lack of evidence should not be interpreted as evidence of any effect of these interventions. The effects of gloves, gowns, and masks in these circumstances have yet to be determined by rigorous experimental studies such as group randomized trials involving multiple wards or hospitals, or discontinued time series studies.";2015;;;Uncertain;Prevention-Covid19;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2786;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t test for myoglobin or CK-MB in the diagnosis of acute myocardial infarction (AMI). Instead, use troponin I or T.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Myoglobina, CK-MB, Acute Myocardial Infarction, Troponin";"Link to the recommendation in the Choosing Wisely website" 3042;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For children and youth aged 2 to 17 years who are overweight or obese, we recommend that primary care practitioners offer or refer to structured behavioural interventions* aimed at healthy weight management.** (Weak recommendation; moderate quality eviden";"*Structured interventions are behavioural modification programs that involve several sessions that take place over weeks to months, follow a comprehensive-approach delivered by a specialized inter-disciplinary team, involve group sessions, and incorporate family and parent involvement. Behaviourally-based interventions may focus on diet, increasing exercise, making lifestyle changes, or any combination of these. These can be delivered by a primary health care team in the office or through a referral to a formal program within or outside of primary care, such as hospital-based, school-based or community programs.

**The management recommendations apply to children and youth 2?17 years of age who are overweight or obese. Children and youth with health conditions where weight management is inappropriate are excluded.

For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3298;19;"Choosing Wisely Canada";Headache;English;"Don?t prescribe acute medications or recommend an over-the-counter analgesic for patients with frequent migraine attacks without monitoring frequency of acute medication use with a headache diary.";"All acute medications used for migraine attacks, when used too frequently, increase the risk of medication overuse headache with progression to a chronic daily headache syndrome. Use of opioids, triptans, ergotamines, or combination analgesics of any kind on 10 days a month or more, and use of NSAIDs or acetaminophen on 15 days a month or more places patients at risk for medication overuse headache. Patients with migraine should be educated with regard to these risks.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2787;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t order multiple tests in the initial evaluation of a patient with suspected thyroid disease. Order thyroid-stimulating hormone (TSH), and if abnormal, follow up with additional evaluation or treatment depending on the findings.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Thyroid disease, TSH";"Link to the recommendation in the Choosing Wisely website" 3043;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For children and youth aged 2 to 11 years who are overweight or obese, we recommend that primary care practitioners not offer Orlistat aimed at healthy weight management.*(Strong recommendation; very low quality evidence)";"*The management recommendations apply to children and youth 2?17 years of age who are overweight or obese. Children and youth with health conditions where weight management is inappropriate are excluded.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3299;19;"Choosing Wisely Canada";Headache;English;"Don?t forget to consider the behavioural components of migraine treatment, including lifestyle issues like regular and adequate meals and sleep, and management of specific triggers including stress.";"Lifestyle issues and specific trigger management can contribute considerably to successful migraine control. Patient education regarding these factors may reduce the need for expensive medications and reduce indirect costs related to disability. Training in relaxation and other stress management techniques should be considered. Training in other skills like pacing activities to help patients manage their schedules and stress levels well, and how to take acute medications appropriately are also important.";2015;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2788;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t obtain a karyotype as part of the initial evaluation for amenorrhea.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Karyotype, Amenorrhea";"Link to the recommendation in the Choosing Wisely website" 3044;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For children and youth aged 12 to 17 years who are overweight or obese, we recommend that primary care practitioners not routinely offer Orlistat aimed at healthy weight management*. (Weak recommendation; moderate quality evidence)";"*The management recommendations apply to children and youth 2?17 years of age who are overweight or obese. Children and youth with health conditions where weight management is inappropriate are excluded.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3300;19;"Choosing Wisely Canada";"Medical Microbiology and Infectious Disease";English;"Don?t routinely prescribe intravenous forms of highly bioavailable antimicrobial agents for patients who can reliably take and absorb oral medications.";"Antimicrobials such as fluoroquinolones, trimethoprim-sulfamethoxazole, clindamycin, linezolid, metronidazole and fluconazole have excellent bioavailability and only rarely need to be administered intravenously. Use of oral formulations of these medications reduces the need for placement and maintenance of venous access devices and their associated complications.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5348;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento de la hipoxemia)";Spanish;"Prone respiratory support did not appear to have any beneficial effects in all participants requiring respiratory support, although in participants with more severe lung damage it appeared to have a reduction in mortality as well as in participants who received early and prolonged treatment.";"- The most frequent complications were compression ulcers and blockage or obstruction of the tracheal tube. Low blood pressure and abnormal heart rhythms were also observed. - Applying the prone position to all intensive care patients with low oxygen levels is not warranted, but some particular groups of patients, for example, those with especially low oxygen levels, would benefit from the prone position.";2015;;;Uncertain;Treatment-Covid19;"Link to the recommendation on the website of the initiative/Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2789;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t prescribe testosterone or testosterone products to men contemplating/attempting to initiate pregnancy.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Testosterone;"Link to the recommendation in the Choosing Wisely website" 3045;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For children and youth aged 2 to 17 years who are overweight or obese, we recommend that primary care practitioners not routinely refer for surgical interventions.* (Strong recommendation; very low quality evidence)";"*The management recommendations apply to children and youth 2?17 years of age who are overweight or obese. Children and youth with health conditions where weight management is inappropriate are excluded.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"http://canadiantaskforce.ca/ctfphc-guidelines/2015-obesity-children/#fn-ii" 3301;19;"Choosing Wisely Canada";"Medical Microbiology and Infectious Disease";English;"Don?t prescribe alternate second-line antimicrobials to patients reporting non-severe reactions to penicillin when beta-lactams are the recommended first-line therapy.";"Reported penicillin reactions frequently result in the use of alternate second-line agents that may be clinically inferior or may pose increased risks to patients resulting in longer lengths of stay and increased costs of care. Alternate broad-spectrum agents may also result in increased rates of adverse events and selection for antimicrobial resistance. Therefore, it is important to obtain a detailed history of a patient?s reported prior reaction to penicillin to determine whether beta-lactam therapy can be safely administered.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2790;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform endometrial biopsy in the routine evaluation of infertility.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Endometrial Biopsy, Infertility";"Link to the recommendation in the Choosing Wisely website" 3046;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend measuring height, weight and calculating BMI* at appropriate** primary care visits. (Strong recommendation; very low quality evidence)";"These recommendations apply to apparently healthy adults ? 18 years of age who present to primary care. These recommendations do not apply to people with eating disorders, or who are pregnant.

*BMI [weight (kg) � height (m�)] categories are underweight = BMI < 18.5; normal weight = BMI 18.5?24.9; overweight = BMI 25.0?29.9; obese = BMI ? 30.

**Appropriate visits include: wellness visits, visits for medication renewal and other visits where the primary care practitioner deems it appropriate.

For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3302;19;"Choosing Wisely Canada";"Medical Microbiology and Infectious Disease";English;"Don?t routinely repeat CD4 measurements in patients with HIV infection with HIV-1 RNA suppression for >2 years and CD4 counts >500/�L, unless virologic failure occurs or intercurrent opportunistic infection develops.";"The 2014 recommendations of the International Antiviral Society ? US Panel state that measurement of CD4 count is optional among patients with suppressed viral loads for >2 years and CD4 counts >500/�L. CD4 measurement in these patients is of low-value and may create unnecessary patient concern in response to normal variation of CD4 counts. In prospective studies of patients who have responded to antiretroviral therapy with HIV-1 RNA suppression and rises in CD4 cell count >200 cells/?L, there was little clinical benefit from continued routine measurement of CD4 counts.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2791;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t obtain follicle-stimulating hormone (FSH) levels in women in their 40s to identify the menopausal transition as a cause of irregular or abnormal menstrual bleeding.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"FSH, Menopause";"Link to the recommendation in the Choosing Wisely website" 3047;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend that practitioners not offer formal, structured interventions* aimed at preventing weight gain in normal weight adults. (Weak recommendation; very low quality evidence)";"These recommendations do not apply to people with eating disorders, or who are underweight, pregnant, overweight or obese (Body Mass Index [BMI] ? 25).

*Formal structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined for prevention of weight gain included behaviourally-based prevention interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally-based interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. Lifestyle interventions generally included counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet.

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3303;19;"Choosing Wisely Canada";"Medical Microbiology and Infectious Disease";English;"Don?t routinely repeat radiologic imaging in patients with osteomyelitis demonstrating clinical improvement following adequate antimicrobial therapy.";"There is poor correlation between clinical response and resolution of findings on magnetic resonance imaging (MRI), computed tomography (CT), and nuclear studies in patients with osteomyelitis. Because radiologic resolution may lag behind clinical improvement, repeat imaging may lead to unnecessary prolongation of antimicrobial therapy. Repeat imaging is indicated in cases where there is a lack of clinical response, progression of clinical findings, or the presence of an undrained abscess on the initial scan.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2792;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform prolactin testing as part of the routine infertility evaluation in women with regular menses.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Prolactin, Infertility";"Link to the recommendation in the Choosing Wisely website" 3048;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults who are obese (30 ? BMI < 40) and are at high risk of diabetes*, we recommend that practitioners offer or refer to structured behavioural interventions** aimed at weight loss.(Strong recommendation; moderate quality evidence)";"These recommendations apply to adults ? 18 years of age who are overweight or obese (25 ? BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ? 40, who may benefit from specialized bariatric programs.

*High risk status is defined by 10 year risk of diabetes of ? 33%, which can be assessed using the CANRISK or FINDRISC risk assessment tool.

**Formal structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined for prevention of weight gain included behaviourally-based prevention interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally-based interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. Lifestyle interventions generally included counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet.

For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3304;19;"Choosing Wisely Canada";"Medical Microbiology and Infectious Disease";English;"Don?t prescribe aminoglycosides for synergy to patients with bacteremia or native valve infective endocarditis caused by Staphylococcus aureus.";"The addition of an aminoglycoside such as gentamicin to beta-lactam therapy or vancomycin for treatment of bacteremia or native valve infective endocarditis caused by Staphylococcus aureus has not been demonstrated to improve clinical outcomes. This practice may result in adverse effects including acute kidney injury and ototoxicity. The addition of gentamicin is still recommended in cases of prosthetic valve endocarditis caused by Staphylococcus aureus.";2015;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2793;2;"Choosing Wisely�";"American Urogynecologic Society";English;"Don?t exclude pessaries as a treatment option for pelvic organ prolapse.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Prolapse;"Link to the recommendation in the Choosing Wisely website" 3049;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults who are overweight or obese, we recommend that practitioners offer or refer to structured behavioural interventions* aimed at weight loss.(Weak recommendation; moderate quality evidence)";"These recommendations apply to adults ? 18 years of age who are overweight or obese (25 ? BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ? 40, who may benefit from specialized bariatric programs.

*Formal structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined for prevention of weight gain included behaviourally-based prevention interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally-based interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. Lifestyle interventions generally included counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet.

For further information please visit the website of the initiative (link below)";2015;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 2794;2;"Choosing Wisely�";"American Urogynecologic Society";English;"Don?t perform cystoscopy, urodynamics or diagnostic renal and bladder ultrasound in the initial work-up of an uncomplicated overactive bladder (OAB) patient.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Overactive Bladder";"Link to the recommendation in the Choosing Wisely website" 3050;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss*.(Weak recommendation; moderate quality evidence)";"These recommendations apply to adults ? 18 years of age who are overweight or obese (25 ? BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ? 40, who may benefit from specialized bariatric programs.

*The CTFPHC examined the use of metformin and orlistat for weight loss only and not for the treatment of other conditions, such as diabetes

For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 2795;2;"Choosing Wisely�";"American Urogynecologic Society";English;"Avoid removing ovaries at hysterectomy in pre-menopausal women with normal cancer risk.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Ovarian Cancer, Oophorectomy";"Link to the recommendation in the Choosing Wisely website" 2796;2;"Choosing Wisely�";"American Urogynecologic Society";English;"Avoid using a fluoroquinolone antibiotic for the first-line treatment of uncomplicated urinary tract infections (UTIs) in women.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Urinary Tract Infections, Fluoroquinolone";"Link to the recommendation in the Choosing Wisely website" 2797;2;"Choosing Wisely�";"American Urogynecologic Society";English;"Avoid using synthetic or biologic grafts in primary rectocele repairs.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Rectocele;"Link to the recommendation in the Choosing Wisely website" 1262;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Metoclopramide should not be used in children under one year with a physiological gastroesophageal reflux";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la p�gina web de la iniciativa

" 2542;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"The routine prescription of fibrates is not recommended for primary prevention of cardiovascular disease";"-Cardiovascular disease is the leading cause of death in Catalonia. -Cardiovascular disease can be prevented or delayed with good control of risk factors. Primary prevention aims to people with no risk factors initiate a more severe disease such as hypertriglyceridemia or acute myocardial infarction. -It is not recommended routinely provide drug therapy with fibrates in primary prevention of cardiovascular disease because there is insufficient evidence about its benefits, except in cases of isolated hypertriglyceridemia, or hypertriglyceridemia with atherosclerotic disease or intolerance to all statins";2015;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina de Essencial" 2798;2;"Choosing Wisely�";"Infectious Diseases Society of America";English;"Don?t treat asymptomatic bacteruria with antibiotics.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Bacteriuria;"Link to the recommendation in the Choosing Wisely website" 2543;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"A plain abdominal radiography does not add value to the management of patient with acute abdominal pain, except in certain circumstances *";"*Suspicion of intestinal obstruction, perforation of hollow viscera, renal colic by radiopaque stones or foreign bodies.

-The Acute abdominal pain is one of the most frequent reasons for consulting hospital emergency and requires early and accurate assessment.
-A routinely plain abdominal radiography should not be performed in acute abdominal pain because it does not provide relevant information for patient management.
-The Effective dose of ionizing radiation of plain abdominal radiography is 35 times higher than that of a chest radiograph.";2015;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2799;2;"Choosing Wisely�";"Infectious Diseases Society of America";English;"Avoid prescribing antibiotics for upper respiratory infections.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Upper Respiratory Infection";"Link to the recommendation in the Choosing Wisely website" 2544;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM";Spanish;"Do not carry out imaging studies (CT/MRI) on patients whose presentation suggests idiopathic primary headaches";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2800;2;"Choosing Wisely�";"Infectious Diseases Society of America";English;"Don?t use antibiotic therapy for stasis dermatitis of lower extremities.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Dermatitis;"Link to the recommendation in the Choosing Wisely website" 2545;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take simple radiographies on intracranial injury, except when non-accidental cause is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2801;2;"Choosing Wisely�";"Infectious Diseases Society of America";English;"Avoid testing for a Clostridium difficile infection in the absence of diarrhea.";"For further information please visit the website of the initiative (link below)";2015;;;"High value";"Clostridium Difficile";"Link to the recommendation in the Choosing Wisely website" 2546;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform imaging studies on uncomplicated low-back pain with no red flags";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2802;2;"Choosing Wisely�";"Infectious Diseases Society of America";English;"Avoid prophylactic antibiotics for the treatment of mitral valve prolapse.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Mitral Prolapse";"Link to the recommendation in the Choosing Wisely website" 2547;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform imaging studies on uncomplicated neck pain with no red flags";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2803;2;"Choosing Wisely�";"American Urological Association";English;"Don?t diagnose microhematuria solely on the results of a urine dipstick (macroscopic urinalysis).";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Microhematuria;"Link to the recommendation in the Choosing Wisely website" 2548;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform a barium enema to assess colon diseases";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2804;2;"Choosing Wisely�";"American Urological Association";English;"Don?t obtain computed tomography scan of the pelvis for asymptomatic men with low-risk clinically localized prostate cancer.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Protate Cancer";"Link to the recommendation in the Choosing Wisely website" 2549;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out barium studies on inflammatory bowel disease (IBD)";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2805;2;"Choosing Wisely�";"American Urological Association";English;"Offer PSA screening for detecting prostate cancer only after engaging in shared decision making.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Prostate Cancer, PSA";"Link to the recommendation in the Choosing Wisely website" 2550;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not systematically take preoperative chest radiographies";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2806;2;"Choosing Wisely�";"American Urological Association";English;"Don?t prescribe antimicrobials to patients using indwelling or intermittent catheterization of the bladder unless there are signs and symptoms of urinary tract infection.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Catheterization Bladder, Antibiotics";"Link to the recommendation in the Choosing Wisely website" 2551;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not use imaging techniques in monitoring solid benign lung nodules";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2807;2;"Choosing Wisely�";"American Urological Association";English;"Don?t remove synthetic vaginal mesh in asymptomatic patients.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Vaginal Mesh";"Link to the recommendation in the Choosing Wisely website" 2552;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not perform abdominal CT scans on paediatric patients when acute appendicitis is suspected";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2808;2;"Choosing Wisely�";"Society for Vascular Surgery";English;"Avoid routine venous ultrasound tests for patients with asymptomatic telangiectasia.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";Telangiectasia;"Link to the recommendation in the Choosing Wisely website" 2553;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not administer intravenous contrast without a previous safety check";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2809;2;"Choosing Wisely�";"Society for Vascular Surgery";English;"Avoid routine ultrasound and fistulogram evaluations of well-functioning dialysis accesses.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Fistulogram, Dialysis";"Link to the recommendation in the Choosing Wisely website" 2554;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not take daily chest radiographies on patients admitted to Intensive Care Unit";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2810;2;"Choosing Wisely�";"Society for Vascular Surgery";English;"Don?t use IVC filters as primary prevention of pulmonary emboli in the absence of an extremity clot or prior pulmonary embolus.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Inferior Vena Cava Filter";"Link to the recommendation in the Choosing Wisely website" 2555;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not systematically perform chest radiographies after a thoracocentesis";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2811;2;"Choosing Wisely�";"Society for Vascular Surgery";English;"Don?t use interventions (including surgical bypass, angiogram, angioplasty or stent) as a first line of treatment for most patients with intermittent claudication.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Intermittent Claudication";"Link to the recommendation in the Choosing Wisely website" 3067;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Performing the Prostate Specific Antigen (PSA) test to screen for prostate cancer without a discussion of the risks and benefits (Evidence level: Randomized controlled trials)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the Smart Medicine website (in German) / Enlace a la p�gina web de Smart Medicine (En alem�n)

Link to the recommendation on the Smart Medicine website (in English) / Enlace a la recomendaci�n de Smart Medicine (versi�n en Ingl�s)
" 2556;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out imaging studies to detect metastasis on patients with breast cancer and no symptoms";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2812;2;"Choosing Wisely�";"Society for Vascular Surgery";English;"Avoid use of ultrasound for routine surveillance of carotid arteries in the asymptomatic healthy population at any time.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Ultrasound, Carotid Stenosis";"Link to the recommendation in the Choosing Wisely website" 3068;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Prescribing antibiotics for uncomplicated upper respiratory tract nfections (Evidence level: Multiple randomized controlled trials)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the Smart Medicine website (in German) / Enlace a la p�gina web de Smart Medicine (En alem�n)

Link to the recommendation on the Smart Medicine website (in English) / Enlace a la recomendaci�n de Smart Medicine (versi�n en Ingl�s)
" 2557;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not conduct imaging studies to rule out metastasis on patients who underwent breast cancer surgery with curative intent and have no symptoms";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2813;2;"Choosing Wisely�";"American Society for Metabolic and Bariatric Surgery";English;"Avoid an open approach for primary bariatric surgical procedures.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Bariatric Surgery";"Link to the recommendation in the Choosing Wisely website" 3069;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Obtaining preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology (Evidence level: Multiple retrospective cohort studies)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the Smart Medicine website (in German) / Enlace a la p�gina web de Smart Medicine (En alem�n)

Link to the recommendation on the Smart Medicine website (in English) / Enlace a la recomendaci�n de Smart Medicine (versi�n en Ingl�s)
" 2558;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not do breast surgery in suspicious nodules without previously trying a percutaneous biopsy";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2814;2;"Choosing Wisely�";"American Society for Metabolic and Bariatric Surgery";English;"Don?t routinely use the intensive care unit for postoperative monitoring.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Intensive Care, Bariatric Surgery";"Link to the recommendation in the Choosing Wisely website" 3070;31;"Smarter medicine";"Swiss Society of General Internal Medicine/Acad�mie Suisse des Sciences M�dicales";English;"Continuing long-term treatment of gastrointestinal symptoms with proton pump inhibitors without titrating to the lowest effective dose needed (Evidence level: Randomized controlled trials and prospective cohort studies)";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";-;"

Link to the recommendation on the Smart Medicine website (in German) / Enlace a la p�gina web de Smart Medicine (En alem�n)

Link to the recommendation on the Smart Medicine website (in English) / Enlace a la recomendaci�n de Smart Medicine (versi�n en Ingl�s)
" 2559;25;"Recomendaciones de NO HACER. SERAM [SERAM Do Not Do recommendations]";"Sociedad Espa�ola de Radiolog�a M�dica (SERAM)";Spanish;"Do not carry out early detection breast RMI studies on patients with no risk factors";-;2015;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a la recomendaci�n en la p�gina web de la SERAM" 2815;2;"Choosing Wisely�";"American Society for Metabolic and Bariatric Surgery";English;"Avoid routine use of invasive monitoring.";"For further information please visit the website of the initiative (link below)";2015;;;"Low value";"Central Catheter";"Link to the recommendation in the Choosing Wisely website" 3071;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Grupo de Trabajo de la semFYC para el proyecto Recomendaciones �No hacer�";Spanish;"No realizar tratamiento intensivo de la glucemia en ancianos diab�ticos, los objetivos de control deben ser m�s moderados en esta poblaci�n.";-;2015;;;"Low value";"Diabetes, Older people";"Link to the recommendation in the semFYC website" 2304;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Intensiva Cr�tica y Unidades Coronarias - Ministerio de Sanidad";Spanish;"Do not perform blood tests routinely without specific clinical indications.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2305;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Intensiva Cr�tica y Unidades Coronarias - Ministerio de Sanidad";Spanish;"No not do chest X-Rays daily routinely to patients in the intensive care unit.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2306;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"The routine prescription of long half-life benzodiazepines for treating chronic insomnia as first choice in elderly is not recommended.";"-The Use of benzodiazepines in the elderly is very common.
-The Benzodiazepines increase the risk of cognitive impairment, delirium, falls and fractures in elderly, especially if they are used concomitantly with other drugs and as a result of the using health and social resources.
-Nonpharmacologic measures are the treatment of choice. However, if benzodiazepines or sleep aids are needed, it is preferable to use short half-life benzodiazepines, and their use should not exceed four weeks , due to the risk of adverse events.";2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la p�gina web de Essencial" 2307;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Intensiva Cr�tica y Unidades Coronarias - Ministerio de Sanidad";Spanish;"Do not maintain the isolation measures established in patients who have had a confirmed communicable disease throughout their stay in the ICU. Maintain them during colonization or infectious disease";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2308;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Intensiva Cr�tica y Unidades Coronarias - Ministerio de Sanidad";Spanish;"Do not transfuse packed red blood cells in non-bleeding critically ill patients, hemodynamically stable, without cardiac/central nervous system involvement and with a concentration of Hb> 7g/dl.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2309;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not offer antiEGFR antibodies and antiangiogenic antibodies simultaneously in patients with wild-type KRAS metastatic colorectal cancer.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2310;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"In breast cancer: do not offer adjuvant chemotherapy and adjuvant endocrine therapy simultaneously.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2311;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not start neoadjuvant therapy (primary systemic therapy) for breast cancer without a complete histology (including hormone and HER2 receptors) and a tumor markers study.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2312;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"It is not recommended to use bisphosphonates for the prevention of bone metastases in patients with prostate cancer.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2313;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not use adjuvant therapy in patients with non-small cell lung cancer stage IA (T1a-bN0M0) if margins are negative.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2314;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do PET-FDG for mass screening of prostate cancer.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2826;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Testing for unlikely conditions to reassure patients has been considered to be an inappropriate practice.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2315;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not substitute isotopic techniques for sentinel lymph node biopsy for non-isotopic techniques, until they do not reach the same diagnostic accuracy and scientific evidence of isotope techniques.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2827;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Testing to rule out unlikely conditions without thoughtful deliberation (e.g. Wilson disease) has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2316;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do parathyroid scintigraphy with SPECT-CT for localization of adenomas in patients without biochemical diagnosis of hyperparathyroidism and patients without surgical criteria.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2828;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Transfusing red blood cells when hemoglobin level is higher than 7g/dL has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al articulo de la serie ?Less is More?" 2317;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do skull X-Ray routinely in patients with traumatic brain injury (TBI), except TBI confirmed or suspected of non-accidental cause.";-;2014;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a las recomendaciones en la p�gina de la SERAM" 2829;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Providing testosterone replacement therapy routinely has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the publication on the website of JAMA Internal Medicine / Enlace a la publicaci�n en la revista JAMA Internal Medicine" 2318;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do an abdominal X-Ray routinely in children or adolescents with acute abdominal pain, unless intestinal obstruction or perforation are suspected.";-;2014;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a las recomendaciones en la p�gina de la SERAM" 2830;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Prescribing antibiotics or proton pump inhibitor medications routinely and without a clear indication has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the publication in the JAMA Internal Medicine Journal." 3086;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"Do not request serum tumor markers for population-based screening (unless belonging in the risk groups defined for each type of tumor).";-;2014;;;"Low value";"Tumoral Markers, Screening";"Link to the recommendation in the MSSI website" 2319;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do a pelvic X-Ray in trauma patients if a full body CT is planned.";-;2014;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a las recomendaciones en la p�gina de la SERAM" 2831;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Performing surgery when it is not clear if benefits clearly outweigh surgical risks has been considered an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in JAMA Internal Medicine / Enlace a la publicaci�n en la revista JAMA Internal Medicine" 3087;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"Do not run HbA1c tests more than twice a year in patients with good clinical-metabolic control. Should the test need to be run more frequently, do not do so within a time period of less than three months.";-;2014;;;"Low value";"Diabetes, HbA1C";"Link to the recommendation in the MSSI website" 2320;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do a CT or MRI in children with simple febrile seizure.";-;2014;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a las recomendaciones en la p�gina de la SERAM" 2832;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Closing patent foramen ovale after stroke and performing an echocardiography with a bubble study or peripheral venous doppler ultrasound routinely have been considered to be an inappropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in JAMA Internal Medicine / Enlace a la publicaci�n en la revista JAMA Internal Medicine" 3088;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"Do not perform screening tests for thyroid function in inpatients; only run TSH tests, with the option of measuring FT4 and other elements as well, in outpatients if appropriate.";-;2014;;;"Low value";Thyroid;"Link to the recommendation in the MSSI website" 2321;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do a screening breast MRI in asymptomatic women without risk factors.";-;2014;;;"Low value";-;"Link to the recommendation on the website of SERAM / Enlace a las recomendaciones en la p�gina de la SERAM" 2833;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Prescribing physical therapy before arthroscopic meniscectomy for a meniscal tear has been considered an appropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Link to the article in JAMA Internal Medicine / Enlace a la publicaci�n en la revista JAMA Internal Medicine" 3089;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"Do not reestimate antinuclear antibodies within a time period of less than 3 months.";-;2014;;;"Low value";"Antinuclear Antibody";"Link to the recommendation in the MSSI website" 2322;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not do a myocardial perfusion scintigraphy for the diagnosis of ischemic heart disease in certain situations*";"*1. Asymptomatic low risk patients. 2. Patients with low pretest probability with a previous interpretable ECG and exercise capacity. 3. Preoperative assessment of low-risk surgery.";2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2834;28;"Morgan, et al. Article Update on Medical Overuse [Actualizaci�n en sobreutilizaci�n en Medicina]";"JAMA Intern Med. 2015;175(1):120-124.";English;"Understanding and communicate the risks of overdiagnosis and overtreatment with patients who are being screened for cancer has been considered an appropriate practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 3090;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Asociaci�n Espa�ola de Biopatolog�a M�dica";Spanish;"Do not test for CK or CK-MB in the diagnosis of AMI.";-;2014;;;"Low value";"CK, CK-MB, Myocardial Infarction";"Link to the recommendation in the MSSI website" 2323;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not perform breast cancer surgery or melanoma surgery using sentinel node criteria and radioactive tracers without the minimum warranties*.";"*The technique is not available, or if the medical and surgical team does not have enough experience in this technique.";2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2325;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t recommend routine or multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia";"Once target control is achieved and the results of self-monitoring become quite predictable, there is little gained in most individuals from repeatedly confirming this state. There are many exceptions, such as acute illness, when new medications are added, when weight fluctuates significantly, when A1c targets drift off course and in individuals who need monitoring to maintain targets. Self-monitoring is beneficial as long as one is learning and adjusting therapy based on the result of the monitoring.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2326;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests unless there is a palpable abnormality of the thyroid gland.";"Thyroid ultrasound is used to identify and characterize thyroid nodules, and is not part of the routine evaluation of abnormal thyroid function tests (over- or underactive thyroid function) unless the patient also has a large goiter or a lumpy thyroid. Incidentally discovered thyroid nodules are common. Overzealous use of ultrasound will frequently identify nodules, which are unrelated to the abnormal thyroid function, and may divert the clinical evaluation to assess the nodules, rather than the thyroid dysfunction. Imaging may be needed in thyrotoxic patients; when needed, a thyroid scan, not an ultrasound, is used to assess the etiology of the thyrotoxicosis and the possibility of focal autonomy in a thyroid nodule.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 23;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the clinical suspicion of prostate cancer is high, do not offer prostate biopsy for histological confirmation, unless this is required as part of a clinical trial.";"If the clinical suspicion of prostate cancer is high, because of a high prostate-specific antigen (PSA) value and evidence of bone metastases (identified by a positive isotope bone scan or sclerotic metastases on plain radiographs), prostate biopsy for histological confirmation should not be performed, unless this is required as part of a clinical trial.";2014;;;"Low value";"PSA, prostate, cancer, biopsy";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2327;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t use Free T4 or T3 to screen for hypothyroidism or to monitor and adjust levothyroxine (T4) dose in patients with known primary hypothyroidism.";"T4 is converted into T3 at the cellular level in virtually all organs. Intracellular T3 levels regulate pituitary secretion and blood levels of TSH, as well as the effects of thyroid hormone in multiple organs. Therefore, in most people a normal TSH indicates either normal endogenous thyroid function or an adequate T4 replacement dose. TSH only becomes unreliable in patients with suspected or known pituitary or hypothalamic disease when TSH cannot respond physiologically to altered levels of T4 or T3.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2328;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency";"Many of the symptoms attributed to male hypogonadism are commonly seen in normal male aging or in the presence of comorbid conditions. Testosterone therapy has the potential for serious side effects and represents a significant expense. It is therefore important to confirm the clinical suspicion of hypogonadism with biochemical testing. Current guidelines recommend the use of a total testosterone level obtained in the morning. A low level should be confirmed on a different day, again measuring the total testosterone. In some situations, a free or bioavailable testosterone may be of additional value.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2329;19;"Choosing Wisely Canada";"Canadian Society of Endocrinology and Metabolism";English;"Don?t routinely test for Anti-Thyroid Peroxidase Antibodies (anti ? TPO)";"Positive anti-TPO titres are not unusual in the ?normal? population. Their presence in the context of thyroid disease only assists in indicating that the pathogenesis is probably autoimmune. As thyroid autoimmunity is a chronic condition, once diagnosed there is rarely a need to re-measure anti-TPO titres. In euthyroid pregnant patients deemed at high risk of developing thyroid disease, anti-TPO antibodies may influence the frequency of surveillance for hypothyroidism during the pregnancy. It is uncommon that measurement of anti-TPO antibodies influences patient management.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2077;6;"Less Is More Collection - JAMA Network";"Caverly T, et al. JAMA Intern Med. 2014;174(1):8-9";English;"Too Much Medicine Happens Too Often: The Teachable Moment and a Call for Manuscripts From Clinical Trainees";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2078;6;"Less Is More Collection - JAMA Network";"Niess M, et al. JAMA Intern Med. 2014;174(1):12.";English;"Don't routinely order chest x-ray as a preoperative assessment in asymptomatic patients undergo non-cardiac surgery unless there is a clinical indication.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 4894;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For 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 not been made and it is not clear whether antibiotics should be prescribed. Use the results of the C?reactive protein test to guide antibiotic prescribing in people without a clinical diagnosis of pneumo";"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.";2014;;;"High value";Infections;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2079;6;"Less Is More Collection - JAMA Network";"Visconti A, et al. JAMA Intern Med. 2014;174(2):184.";English;"Avoid ordering obfuscating follow up imaging for patients with osteomyelitis who have received appropriate treatment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2335;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t routinely measure Vitamin D in low risk adults";"Because Canada is located above the 35� North latitude, the average Canadian?s exposure to sunlight is insufficient to maintain adequate Vitamin D levels, especially during the winter. Therefore, measuring serum 25-hydroxyvitamin D levels is not necessary because routine supplementation with Vitamin D is appropriate for the general population. An exception is made for measuring Vitamin D levels in patients with significant renal or metabolic disease.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2080;6;"Less Is More Collection - JAMA Network";"Lynn L, et al. JAMA Intern Med. 2014;174(2):183";English;"Avoid ordering unnecessary tests without a clinical indication..";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2336;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t do screening mammography for low risk women aged 40-49. ";"If, after this careful assessment and discussion, a woman?s breast cancer risk is not high, current evidence indicates that the benefit of screening mammography is small. Furthermore, for this age group there is a greater risk of false-positive screening results and consequently of undergoing unnecessary or harmful follow-up procedures. As always, clinicians need to be aware of changes in the balance of evidence on risk and benefit and support women in understanding this evidence. High quality materials to assist these discussions are available through the Canadian Task Force on Preventive Health Care.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2081;6;"Less Is More Collection - JAMA Network";"Liu P, et al. JAMA Intern Med. 2014;174(2):182.";English;"Diuretics and Diarrhea: A Dangerous Combination: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2337;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t do annual physical exams on asymptomatic adults with no significant risk factors";"A periodic physical examination has tremendous benefits; it allows physicians to check on their healthy patients while they remain healthy. However, the benefits of this check-up being done on an annual basis are questionable since many chronic illnesses that benefit from early detection take longer than a year to develop. Preventive health checks should instead be done at time intervals recommended by guidelines, such as those noted by the Canadian Task Force on the Periodic Health Examination.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2082;6;"Less Is More Collection - JAMA Network";"Tseng C, et al. JAMA Intern Med. 2014;174(2):259-268";English;"Assessing Potential Glycemic Overtreatment in Persons at Hypoglycemic Risk";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2338;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t order DEXA (Dual-Energy X-ray Absorptiometry) screening for osteoporosis on low risk patients";"While all patients aged 50 years and older should be evaluated for risk factors for osteoporosis using tools such as the osteoporosis self-assessment screening tool (OST), bone mineral density screening via DEXA is not warranted on women under 65 or men under 70 at low risk.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2083;6;"Less Is More Collection - JAMA Network";"Harris R, et al. JAMA Intern Med. 2014;174(2):281-286.";English;"The Harms of Screening: A Proposed Taxonomy and Application to Lung Cancer Screening";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2339;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits";"While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2084;6;"Less Is More Collection - JAMA Network";"Tajouri T, et al. JAMA Intern Med. 2014;174(2):185";English;"Care at the end of the life: ""The Elephant in the Room?Your Patient Is Dying: A Teachable Moment""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2340;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada";English;"Don?t order thyroid function tests in asymptomatic patients";"The primary rationale for screening asymptomatic patients is that the resulting treatment results in improved health outcomes when compared with patients who are not screened. There is insufficient evidence available indicating that screening for thyroid diseases will have these results.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2085;6;"Less Is More Collection - JAMA Network";"Badani S, et al. JAMA Intern Med. 2014;174(3):319.";English;"Use of preoperative C-reactive protein (CRP level) criterion in asymptomatic patients undergo elective orthopedic surgery and in the absence of other systemic indicators or comorbidities is not necessary unless clinically indicated.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2341;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto";English;"Don?t maintain long term Proton Pump Inhibitor (PPI) therapy for gastrointestinal symptoms without an attempt to stop/reduce PPI at least once per year in most patients";"PPIs are effective drugs for the treatment of gastro-esophageal reflux disease (GERD). Patients should always be prescribed the lowest dose of drug that manages their symptoms. Even though GERD is often a chronic condition, over time the disease may not require acid suppression and it is important that patients do not take drugs that are no longer necessary. For this reason patients should try stopping their acid suppressive therapy at least once per year. Patients with Barrett?s esophagus, Los Angeles Grade D esophagitis, and gastrointestinal bleeding would be exempt from this.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2086;6;"Less Is More Collection - JAMA Network";"Pujols A, et al. JAMA Intern Med. 2014;174(3):323.";English;"Overtreatment and overdiagnosis situations: ""Taking Care of My Parents""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2342;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto";English;"Avoid using an upper GI series to investigate dyspepsia";"Upper GI series are often requested for the investigation of upper gastrointestinal symptoms. This investigation has a significant proportion of false positive and false negative results compared with endoscopy, and studies have consistently found that this is not a cost-effective approach compared to other strategies of managing dyspepsia.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3110;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;349:g7466";English;"Cons outweigh pros of preventive aspirin in women, study finds [article about Low dose aspirin to prevent cancer and cardiovascular disease in women]";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 2087;6;"Less Is More Collection - JAMA Network";"Yu Y, et al.JAMA Intern Med. 2014;174(3):320";English;"Do I Need a Stent? Choosing Medical Care Wisely";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2343;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto";English;"Avoid performing an endoscopy for dyspepsia without alarm symptoms for patients under the age of 55 years";"Endoscopy is an accurate test for diagnosing dyspepsia, but organic pathology that does not respond to acid suppression or Helicobacter pylori eradication therapy is rare under the age of 55. Most guidelines therefore recommend as the first line approach for managing dyspepsia either empirical proton pump inhibitor therapy or a non-invasive test for Helicobacter pylori and then offering therapy if the patient is positive. If the patient has alarm features such as progressive dysphagia, anemia or weight loss, endoscopy may be appropriate.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2088;6;"Less Is More Collection - JAMA Network";"Kox M, et al. JAMA Intern Med. 2014;174(3):477-478";English;"Management of Critically Ill Patients?Reply";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2344;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto";English;"Avoid performing a colonoscopy for constipation in those under the age of 50 years without family history of colon cancer or alarm features";"Constipation is a common problem and systematic review data suggests this is not an accurate symptom in diagnosing organic disease. If the patient is also under the age of 50 and does not have a family history of colon cancer and there are no alarm features such as anemia or weight loss, then the risk of colorectal cancer is very low and the risks of colonoscopy usually outweigh the benefits in these patients.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3112;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Treasure T. BMJ 2014;348:g2085";Spanish;"Operating to remove recurrent colorectal cancer: have we got it right?";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2089;6;"Less Is More Collection - JAMA Network";"Schuur J, et al. JAMA Intern Med. 2014;174(4):509-515";English;"A Top-Five List for Emergency Medicine: 1. Do not order computed tomography (CT) of the cervical spine for patients after trauma who do not meet some criteria*";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Neck pain, cervicalgia";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2345;19;"Choosing Wisely Canada";"Canadian Association of Gastroenterology - Canadian Medical Association - University of Toronto";English;"Don?t routinely use long term steroid therapy in inflammatory bowel disease";"The risks of long term steroid therapy (therapy for more than 4 months and/or more than two courses in a year) outweigh any benefits in inflammatory bowel disease and should not be given to patients. Instead, they should be offered more effective maintenance therapy such as immunosuppression or biologic therapy that are safer and have more evidence for efficacy.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3113;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kamphuis E. BMJ 2014;348:g252";English;"Are we overusing IVF? (in vitro fertilisation)";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo en la p�gina web de TheBMJ" 2090;6;"Less Is More Collection - JAMA Network";"Geller A, et al. JAMA Intern Med. 2014;174(5):678-686.";English;"National Estimates of Insulin-Related Hypoglycemia and Errors Leading to Emergency Department Visits and Hospitalizations";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2346;19;"Choosing Wisely Canada";"Canadian Hematology Society - Canadian Medical Association - University of Toronto";English;"Don?t give IVIG as first line treatment for patients with asymptomatic immune thrombocytopenia (ITP)";"Treatment for ITP is recommended for a platelet count less than 30�109/L. Corticosteroids are considered first-line treatment, with the addition of IVIgG reserved for severe ITP and bleeding, when a rapid rise in platelets is required, or when corticosteroids are contraindicated. There is no evidence of benefit of IVIgG in combination with corticosteroids for first-line treatment of asymptomatic ITP. Unnecessary IVIgG infusions can result in multiple adverse effects, including acute hemolytic or anaphylactic reactions, infections, thromboembolic events, and aseptic meningitis.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2091;6;"Less Is More Collection - JAMA Network";"Redmond R, et al. JAMA Intern Med. 2014;174(5):667.";English;"It is not recommended to start the evaluation of clinical symptoms with complex complementary tests.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2347;19;"Choosing Wisely Canada";"Canadian Hematology Society - Canadian Medical Association - University of Toronto";English;"During interruption of warfarin anticoagulation for procedures, don?t ?bridge? with full-dose low molecular weight heparin (LMWH) or unfractionated heparin (UFH) unless the risk of thrombosis is high";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2092;6;"Less Is More Collection - JAMA Network";"Sheu L, et al. JAMA Intern Med. 2014;174(5):665-666.";English;"Don't perform colonoscopy for the initial investigation of chronic diarrhea and scant hematochezia, unless the findings are inconclusive or if IBD is suspected.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2348;19;"Choosing Wisely Canada";"Canadian Hematology Society - Canadian Medical Association - University of Toronto";English;"Don?t order thrombophilia testing in women with early pregnancy loss";"Early pregnancy losses are common amongst healthy women. Current guidelines do not support the routine screening of women with pregnancy loss for inherited thrombophilias. Moreover, there are recommendations against instituting thromboprophylaxis in women with inherited thrombophilias wishing to achieve a successful term pregnancy. By performing testing for inherited thrombophilias, patients may be unnecessarily exposed to the harms of thromboprophylaxis, inappropriately labeled with a disease-state, and may unnecessarily modify future plans for travel, pregnancy or surgery based on detection of an ?asymptomatic? thrombophilia. Further, patients with negative testing may receive false reassurance.";2014;;;"Low value";-;"Link to the recommnedation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2093;6;"Less Is More Collection - JAMA Network";"James A, et al. JAMA Intern Med. 2014;174(6):853-854.";English;"Don't perform echocardiogram as a preoperative assessment in patients undergo non-cardiac low risk surgery unless clinically indicated.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2349;19;"Choosing Wisely Canada";"Canadian Hematology Society - Canadian Medical Association - University of Toronto";English;"Don?t request a fine-needle aspirate (FNA) for the evaluation of suspected lymphoma";"The diagnosis of lymphoma requires specimens with intact cellular architecture for accurate histopathologic and immunophenotypic classification. FNA is associated with a low sensitivity and potentially results in delays in lymphoma diagnosis. Although excisional biopsy is the gold standard for lymphoma diagnosis, depending on the lymph node location, excisional biopsy may be associated with complications and the need for general anesthesia. At a minimum, an imaging-guided core biopsy should be obtained to improve the accuracy and timeliness of lymphoma diagnosis.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2094;6;"Less Is More Collection - JAMA Network";"Barry M, et al. JAMA Intern Med. 2014;174(6):851-852.";English;"It is not recommended ordering imaging tests or procedures on incidental findings if they are not related to the clinical symptoms or signs of the patients.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2350;19;"Choosing Wisely Canada";"Canadian Hematology Society - Canadian Medical Association - University of Toronto";English;"Don?t transfuse patients based solely on an arbitrary hemoglobin threshold";"Decisions to transfuse should be based on assessment of an individual patient including their underlying cause of anemia. There is high quality evidence that demonstrates a lack of benefit and, in some cases, harm to patients transfused to achieve an arbitrary transfusion threshold. If necessary, transfuse only the minimum number of units required instead of a liberal transfusion strategy. Risks of red blood cell transfusions include allergy, fever, infections, volume overload and hemolysis.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2095;6;"Less Is More Collection - JAMA Network";"Bernstein R, et al. JAMA Intern Med. 2014;174(6):858.";English;"Obertreatment situations: ""More Can Be Life Threatening""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2351;19;"Choosing Wisely Canada";"Canadian Society of Nephrology - Canadian Medical Association - University of Toronto";English;"Don?t initiate erythropoiesis-stimulating agents (ESAs) in chronic kidney disease (CKD) patients with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia";"Administering ESAs to CKD patients with the goal of normalizing hemoglobin levels has not demonstrated survival or cardiovascular disease benefit, and may be harmful in comparison to a treatment regimen that delays ESA administration or sets relatively conservative targets (90?110 g/L).";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2096;6;"Less Is More Collection - JAMA Network";"Carnovale C, et al. JAMA Intern Med. 2014;174(7):1031-1032.";English;"Allopurinol Overuse in Asymptomatic Hyperuricemia: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2352;19;"Choosing Wisely Canada";"Canadian Society of Nephrology - Canadian Medical Association - University of Toronto";English;"Don?t prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes";"The use of NSAIDS, including cyclo-oxygenase type 2 (COX-2) inhibitors, for the pharmacological treatment of musculoskeletal pain can elevate blood pressure, make antihypertensive drugs less effective, cause fluid retention and worsen kidney function in these individuals. Other medication prescribed by a healthcare professional may be safer than and as effective as NSAIDs.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2097;6;"Less Is More Collection - JAMA Network";"Schwartz A, et al. JAMA Intern Med. 2014;174(7):1067-1076";English;"Measuring Low-Value Care in Medicare";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2353;19;"Choosing Wisely Canada";"Canadian Society of Nephrology - Canadian Medical Association - University of Toronto";English;"Don?t prescribe angiotensin converting enzyme (ACE) inhibitors in combination with angiotensin II receptor blockers (ARBs) for the treatment of hypertension, diabetic nephropathy and heart failure";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2098;6;"Less Is More Collection - JAMA Network";"Rohrhoff N, et al. JAMA Intern Med. 2014;174(7):1035-1036.";English;"An Adverse Reaction to a Medication Given to Treat an Adverse Reaction: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2354;19;"Choosing Wisely Canada";"Canadian Society of Nephrology - Canadian Medical Association - University of Toronto";English;"Don?t initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team";"The decision to initiate chronic dialysis should be part of an individualized, shared decision-making process between patients, their families, and their nephrology health care team. This process includes eliciting individual patient goals and preferences and providing information on prognosis and expected benefits and harms of dialysis within the context of these goals and preferences. Limited observational data suggest that survival may not differ substantially for older adults with a high burden of comorbidity who initiate chronic dialysis versus those managed conservatively.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2099;6;"Less Is More Collection - JAMA Network";"Strewler A, et al. JAMA Intern Med. 2014;174(7):1033-1034.";English;"Approach to Overuse of Herbal and Dietary Supplements: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2355;19;"Choosing Wisely Canada";"Canadian Society of Nephrology - Canadian Medical Association - University of Toronto";English;"Don?t initiate dialysis in outpatients with Stage 5 CKD in the absence of clinical indications";"Initiating chronic dialysis before the appearance of uremic symptoms or other clinical indication is associated with significant burden and inconvenience for the patient without any clinical benefit. Recent guidelines from the Canadian Society of Nephrology recommend that patients with an estimated glomerular filtration rate (eGFR) less than 15 mls/min should be closely followed by their nephrologist and dialysis deferred until symptoms of uremia, volume overload, hyperkalemia or acidosis become an issue or the eGFR drops below 6 mls/min.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3123;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use tetrastarch for fluid resuscitation.";-;2014;;;"Low value";Fluidtherapy;"Link to the NICE website" 2100;6;"Less Is More Collection - JAMA Network";"Matulevicius S, et al. JAMA Intern Med. 2014;174(7):1196-1197.";English;"Before looking for the clinical state of the patients ppropriate echocardiogram is not recommended.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2356;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada - Canadian Medical Association - University of Toronto";English;"Don?t endorse clinically unnecessary absence from work";"There is substantial evidence to support the positive link between work and health (physical, mental and social health). Both employment and income are separate determinants of health and are used as health status indicators. Absence from work contributes to declining health, slower recovery times, and longer duration of disability. Maintaining and restoring working capacity is an important function of health services which improves function and can also impact upon recovery and prognosis. Supporting unnecessary restrictions or total disability (absence from work) creates disability which in turn negatively impacts upon health. When asked to provide an opinion on functional abilities to employers or insurers, the focus should be on abilities; restrictions should be objective, specific, and listed only when absolutely medically indicated.";2014;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3124;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use office-based serological tests for H pylori because of their inadequate performance.";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 2101;6;"Less Is More Collection - JAMA Network";"Jackson B, et al. JAMA Intern Med. Published online July 14, 2014.";English;"Overtreatment situations: ""Rescuing My Grandmothers""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2357;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada - Canadian Medical Association - University of Toronto";English;"Don?t prescribe opiates for the treatment of acute or chronic non-cancer pain without first assessing side effects, work status, and capacity to drive a motor vehicle";"Increases in opioid prescribing have been accompanied by simultaneous increases in abuse, serious injuries, and deaths from overdose. Compared to those on no, or lower opiate doses, those prescribed higher opiate doses have increased disability risk and duration. The use of opiates can result in effects such as euphoria, drowsiness or inability to concentrate. Cognitive and psychomotor ability are essential functions for driving a motor vehicle and other complex work tasks. Those who prescribe opiates may be obligated to report a patient?s inability to drive safely.";2014;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3125;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use bioimpedance as a substitute for BMI as a measure of general adiposity.";-;2014;;;"Low value";-;"Link to the NICE website" 2102;6;"Less Is More Collection - JAMA Network";"Bascom P, et al. JAMA Intern Med. Published online July 28, 2014.";English;"Overtreatment situations: ""The Many Stories of My Mother?s Death""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2358;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada - Canadian Medical Association - University of Toronto";English;"Don?t order X-rays for acute low back pain in the absence of red flags";"Acute low back pain is a common health problem affecting between 50-90% of people over the course of a lifetime with less than 2% of cases representing potentially serious conditions requiring surgical or medical intervention. Red flags suggesting additional testing include such things as a history of significant trauma, cauda equina syndrome, symptoms suggestive of tumour or infection (fever, weight loss, history of cancer), steroid use, etc. However, the majority of acute low back pain episodes are benign, self-limited cases that do not warrant any imaging studies. Unnecessary imaging can be harmful due to the potential adverse health effects associated with radiation exposure and due to attribution of symptoms to unrelated incidental findings leading to prolonged disability.";2014;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 3126;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful.";-;2014;;;"Low value";-;"Link to the NICE website" 1591;2;"Choosing Wisely�";"American Academy of Orthopaedic Surgeons";English;"Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2103;6;"Less Is More Collection - JAMA Network";"Letourneau L, et al. JAMA Intern Med. Published online July 28, 2014.";English;"Overdiagnosis and overtreatment situations: ""Next Time I?ll Ask""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2359;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada - Canadian Medical Association - University of Toronto";English;"Don?t order blood mercury levels unless in specific circumstances*";"*Dietary history suggests risk; the patient is pregnant or planning to become pregnant; and/or the patient is occupationally exposed to organomercury compounds.

For further information please visit the website of the initiative (link below) For adults, Health Canada?s guidance value for total blood mercury concentrations is 8 �g/L (40 nmol/L) for childbearing women and 20 �g/L (100 nmol/L) for females ? 50 years and males > 18 years. Although clinically significant exposures may still occur in Canada, less than 1% of Canadian adults have total blood mercury concentrations above Health Canada?s guidance value. As such, the large majority of individuals who present with concerns of metal toxicity do not actually have toxicity, and testing results in false positives (values above the reference range but not in the range of toxicity). Occupationally exposed workers and childbearing women are susceptible subgroups therefore testing in these populations is warranted in cases where a careful occupational and/or environmental history suggests a significant exposure. In the absence of clinical presentation and history indicating toxicity risk, testing should be avoided because it may lead to misinterpretation and unnecessary concern or interventions (dietary restriction, chelation) that may cause harm.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2615;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria semFYC";Spanish;"Is not recommended to prescribe antibiotics in acute sinusitis, unless purulent rhinorrhea and maxillofacial or dental pain are present longer than 7d, or if symptoms get worst.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3127;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give orlistat to children for obesity unless prescribed by a multidisciplinary team with expertise in: - drug monitoring - psychological support - behavioural interventions - interventions to increase physical activity - interventions to improve di";-;2014;;;"Low value";-;"Link to the recommendation on the website of NICE/ Enlace a la p�gina web de la NICE" 1592;2;"Choosing Wisely�";"American Academy of Orthopaedic Surgeons";English;"Don?t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina wbe de la iniciativa" 2104;6;"Less Is More Collection - JAMA Network";"MacKenzie A, et al. JAMA Intern Med. 2014;174(8):1221-1222.";English;"Balancing the Benefits and Risks of Empirical Antibiotics for Sinusitis: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2360;19;"Choosing Wisely Canada";"Occupational Medicine Specialists of Canada - Canadian Medical Association - University of Toronto";English;"Don?t repeat chest X-rays when screening exposed workers for asbestosis unless clinical indications are present";"Asbestosis generally becomes manifest clinically 15-20 years after the onset of exposure. High resolution CT (HRCT) is more sensitive than both chest radiography and conventional CT for detecting parenchymal fibrosis (asbestosis) but a normal HRCT scan cannot completely exclude asbestosis. Given the long latency between asbestos exposure and asbestosis and given that no effective treatment is available to improve the outcome, screening and early detection of asbestosis is unlikely to allow any remedial action to be taken in the workplace or to confer any health advantage on asbestos-exposed individuals. Repeated imaging exposes the patient to radiation, which is not without risk. Therefore, while it is appropriate to obtain a baseline X-ray at the time of first assessment, for screening purposes, radiation risk outweighs the benefit of frequent chest X-rays. Radiation exposure would also be a concern for repeated CT scans.";2014;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 2616;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to prescribe antibiotics for pharyngitis, unless a high suspicion of having streptococcal infection and / or a positive Strep A test are present.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3128;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not diagnose MS on the basis of MRI findings alone. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1593;2;"Choosing Wisely�";"American Academy of Orthopaedic Surgeons";English;"Don?t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2105;6;"Less Is More Collection - JAMA Network";"Davidson J, et al. JAMA Intern Med. 2014;174(8):1225-1226.";English;"Overtreatment situations: ""Waiting for Words""";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2361;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t order test to detect recurrent cancer in asymptomatic patients if there is not a realistic expectation that early detection of recurrence can improve survival or quality of life. ";"In some specific situations, the early detection of cancer recurrence (local and/or distant) may increase the likelihood of successful subsequent curative treatment. However, in many circumstances, earlier knowledge of recurrence does not improve outcome. As such, it is important to balance the information that can come from advanced testing with what is best for the individual patient. Specifically, the need for patient reassurance should be balanced against the anxiety and uncertainty provoked by extensive follow-up testing when there is not a realistic expectation that the early identification of recurrence may improve survival or quality of life.";2014;;;"Low value";-;"Link to the recommendatio on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2617;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria semFYC";Spanish;"It is not recommended to prescribe antibiotics for lower respiratory tract infections in healthy people in whom no pneumonia is suspected.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3129;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use vitamin B12 injections to treat fatigue in people with MS. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la p�gina web de la NICE" 1594;2;"Choosing Wisely�";"American Academy of Orthopaedic Surgeons";English;"Don?t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n de la p�gina web de la iniciativa" 2106;6;"Less Is More Collection - JAMA Network";"Sullivan T, et al. JAMA Intern Med. 2014;174(8):1219-1220";English;"Antibiotic Overuse and Clostridium difficile A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2362;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease";"Screening for cancer can be lifesaving in otherwise healthy at-risk patients. While screening tests lead to a mortality benefit which emerges years after the test is performed, they expose patients to immediate potential harms. In general, patients with metastatic cancer have competing mortality risks that would outweigh the mortality benefits of screening as demonstrated in healthy patients. In fact, patients with metastatic disease may be more likely to experience harm since patients with limited life expectancy are more likely to be frail and more susceptible to complications of testing and treatments. Therefore, the balance of potential benefits and harms does not favor recommending screening for a new asymptomatic primary malignancy in most patients with metastatic disease. Screening may be considered in a very small subgroup of patients where metastatic disease is relatively indolent, or its treatment is expected to result in prolonged survival.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2618;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to prescribe antibiotics in certain groups of people with asymptomatic bacteriuria *";"Nonpregnant premenopausal women, diabetics, elderly, institutionalized elderly, patients with spinal cord injury, and patients with urinary catheters.";2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3130;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use fampridine to treat lack of mobility in people with MS because it is not a cost effective. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la p�gina web de la NICE" 1595;2;"Choosing Wisely�";"American Academy of Orthopaedic Surgeons";English;"Don?t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2107;6;"Less Is More Collection - JAMA Network";"Onuoha O, et al. JAMA Intern Med. 2014;174(8):1391-1395.";English;"Choosing Wisely in Anesthesiology: The Gap Between Evidence and Practice";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2363;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Avoid chemotherapy and instead focus on symptom relief and palliative care in patients with advanced cancer unlikely to benefit from chemotherapy (e.g., performance status 3 or 4)";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2619;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to prescribe Hormone therapy (estrogen alone or with progestin) to prevent certain health problems* in postmenopausal women.";"* Cardiovascular disease, dementia or declining cognitive functioning.";2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3131;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely diagnose a relapse of MS if symptoms are present for more than 3 months. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 5691;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"It is recommended telephone counseling to reduce depressive symptoms and meet the important needs of caregivers of patients with dementia.";"This result should be confirmed in future studies evaluating efficacy through consistent randomized controlled studies and aspects of experience using qualitative studies with abundant data.";2014;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative" 1596;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t put asymptomatic children in weak reading glasses.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2108;6;"Less Is More Collection - JAMA Network";"Kavanagh K, et al. JAMA Intern Med. Published online August 04, 2014.";English;"How I Was Prescribed an Unnecessary Antibiotic While Traveling to a Conference on Antibiotic Resistance";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2364;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t perform routine colonoscopic surveillance every year in patients following their colon cancer surgery*";"*frequency should be based on the findings of the prior colonoscopy and corresponding guidelines.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2620;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to prescribe NSAIDs in patients with certain health problems*. If necessary, it should be prescribed with caution.";"*Cardiovascular disease, chronic kidney disease, hypertension, heart failure or liver cirrhosis.";2014;;;"Low value";"Nonsteroidal anti-inflammatory drug";"Link to the recommendation in the semFYC website" 3132;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer Sativex to treat spasticity in people with MS because it is not a cost effective treatment. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1597;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Annual comprehensive eye exams are unnecessary for children who pass routine vision screening assessments.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2109;6;"Less Is More Collection - JAMA Network";"Hung K, et al. JAMA Intern Med. Published online August 04, 2014.";English;"Dual Therapy Difficulties in Angiotensin Blockade for Proteinuria: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2365;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t delay or avoid palliative care for a patient with metastatic cancer because they are pursuing disease-directed treatment";"Numerous studies?including randomized trials?show that palliative care improves pain and symptom control, improves family satisfaction with care, and reduces costs. Palliative care does not accelerate death, and may prolong life in selected populations. The benefits of disease-directed treatment (e.g., chemotherapy or radiation) can be enhanced by early consideration of palliative care.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2621;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to prescribe benzodiazepines or non-benzodiazepine hypnotics for long periods of time in patients with insomnia.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3133;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not prescribe steroids at lower doses than methylprednisolone 0.5 g daily for 5 days to treat an acute relapse of MS. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1598;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t recommend vision therapy for patients with dyslexia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2110;6;"Less Is More Collection - JAMA Network";"Mason M, et al. JAMA Intern Med. Published online August 11, 2014";English;"Looking for Trouble?Patient Preference Misdiagnosis and Overtesting: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2366;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis";"Randomized trials have established that single-fraction radiation to a previously unirradiated, uncomplicated peripheral bone or vertebral metastasis provides comparable pain relief and morbidity compared to multiple-fraction regimens, while optimizing patient and caregiver convenience. Although it results in a higher incidence of retreatment at a later date (20% vs. 8 % for multi-fraction regimens), the decreased patient burden usually outweighs any considerations of long-term effectiveness for those with a limited life expectancy.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2622;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to routinely prescribe pharmacological treatment of hypercholesterolemia in elderly (75 years or more) for the primary prevention of cardiovascular events.";-;2014;;;"Low value";Statins;"Link to the recommendation in the semFYC website" 3134;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give people with MS a supply of steroids to self-administer at home for future relapses. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1599;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t routinely order imaging for all patients with double vision.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2111;6;"Less Is More Collection - JAMA Network";"LeBude B, et al. JAMA Intern Med. Published online August 11, 2014.";English;"Don't routinely order blood culture in febrile inpatients unless consider the pretest probability of bacteremia, in addition to the likelihood that the results will influence management.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2367;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t initiate management in patients with low-risk prostate cancer (T1/T2, PSA < 10 ng/ml, and Gleason score < 7) without first discussing active surveillance";"Patients with localized prostate cancer have a number of reasonable management options. These include surgery, radiation, as well as conservative monitoring without therapy in appropriate patients. Shared decision-making between the patient and the physician can lead to better alignment of patient goals with treatment and more efficient care delivery. The use of patient-directed written decision aids concerning prostate cancer can give patients confidence about their choices, and improve compliance with therapy. Discussion regarding active surveillance should include both the elements and timing of such surveillance, and emphasize the need for compliance.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2623;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to routinely prescribe proton pump inhibitors for gastric protection in NSAID users without an increased risk of bleeding.";-;2014;;;"Low value";"Omeprazole, Lansoprazole, Pantoprazole";"Link to the recommendation in the semFYC website" 3135;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer vitamin D solely for the purpose of treating MS. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1600;2;"Choosing Wisely�";"American Association for Pediatric Ophthalmology and Strabismus";English;"Don?t order retinal imaging tests for children without symptoms or signs of eye disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2112;6;"Less Is More Collection - JAMA Network";"McMillan J, et al. JAMA Intern Med. Published online August 18, 2014";English;"Implementing a Graduate Medical Education Campaign to Reduce or Eliminate Potentially Wasteful Tests or Procedures";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2368;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t initiate whole breast radiotherapy in 25 fractions as a part of breast conservation therapy in women age ?50 with early stage invasive breast cancer*";"*without considering shorter treatment schedules. For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2624;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to continue dual antiplatelet therapy * for more than 12 months after coronary angioplasty and stenting.";"* Aspirin and cloplidogrel or other P2Y12 receptor inhibitor (clopidogrel, prasugrel, ticagrelor, ticlopidine)";2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3136;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer omega-3 or omega-6 fatty acid compounds to treat MS. Explain that there is no evidence that they affect relapse frequency or progression of MS. (MS: multiple sclerosis)";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1601;2;"Choosing Wisely�";"American College of Chest Physicians and American Thoracic Society";English;"Don?t perform CT surveillance for evaluation of indeterminate pulmonary nodules at more frequent intervals or for a longer period of time than recommended by established guidelines.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2113;6;"Less Is More Collection - JAMA Network";"Kalra R, et al. JAMA Intern Med. Published online August 18, 2014.";English;"Urinary Catheterization?When Good Intentions Go Awry: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2369;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t deliver care (e.g., follow-up) in a high-cost setting (e.g., inpatient, cancer center) that could be delivered just as effectively in a lower-cost setting (e.g., primary care)";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2625;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommend to indicate glucose self-analysis in patients with type 2 diabetes who are not receiving insulinin, it should be reserved for certain circumstances *";"*Patients with unstable blood glucose levels, those prone to hypoglycemia or having changes in the treatment";2014;;;"Low value";diabetic;"Link to the recommendation in the semFYC website" 3137;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pulmonary artery catheterisation to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1602;2;"Choosing Wisely�";"American College of Chest Physicians and American Thoracic Society";English;"Don?t routinely offer pharmacologic treatment with advanced vasoactive agents* to patients with pulmonary hypertension resulting from left heart disease or hypoxemic lung diseases**";"*Approved only for the management of pulmonary arterial hypertension **(Groups II or III pulmonary hypertension).";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2114;6;"Less Is More Collection - JAMA Network";"Wolfe A, et al. JAMA Intern Med. Published online August 25, 2014.";English;"Patent Foramen Ovale and Stroke Prevention?To Close or Not to Close: A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2370;19;"Choosing Wisely Canada";"Canadian Association of Medical/Radiation/Surgical Oncology and Can. Partnership Against Cancer";English;"Don?t routinely use extensive locoregional therapy in most cancer situations where there is metastatic disease and minimal symptoms attributable to the primary tumour (e.g., colorectal cancer)";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2626;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to do prostate cancer screening with PSA in asymptomatic people.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3138;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer opiates to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1603;2;"Choosing Wisely�";"American College of Chest Physicians and American Thoracic Society";English;"For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don?t renew the prescription without assessing the patient for ongoing hypoxemia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2115;6;"Less Is More Collection - JAMA Network";"Chiolero A, et al. JAMA Intern Med. Published online August 25, 2014";English;"Don't perform organized mammography screening in women at appropriate age before giving information about harms and benefits of screening.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2371;19;"Choosing Wisely Canada";"Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto";English;"Don?t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment";"Palliative care provides an added layer of support to patients with life-limiting disease and their families. Symptomatic patients can benefit regardless of their diagnosis, prognosis or disease treatment regimen. Studies show that integrating palliative care with disease-modifying therapies improves pain and symptom control, as well as patient quality of life and family satisfaction. Early access to palliative care has been shown to reduce aggressive therapies at the end of life, prolong life in certain patient populations, and significantly reduce hospital costs.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2627;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended systematically order a bone densitometry in postmenopausal women to assess the risk of fracture, without assessing the risk factors that may justify it.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3139;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer nitrates to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1604;2;"Choosing Wisely�";"American College of Chest Physicians and American Thoracic Society";English;"Don?t perform chest CT (CT angiography) to evaluate for possible pulmonary embolism in patients with a low clinical probability and negative results of a highly sensitive D-dimer assay.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2116;16;"ACR Appropriateness Criteria�";"American College of Radiology";English;"To see the ACR Appropriateness Criteria� please visit their website http://www.acr.org/Quality-Safety/Appropriateness-Criteria";-;2014;;;"Low value";-;"Website of ACR Appropriateness Criteria� / P�gina web ACR Appropriateness Criteria� " 2372;19;"Choosing Wisely Canada";"Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto";English;"Don?t delay advance care planning conversations";"Advance care planning is a process, which includes choosing a surrogate or alternate decision-maker and communicating values or wishes for medical care. This helps prepare a person for in-the-moment medical decision-making, as well as guiding their surrogate or alternate decision-maker should the person lose capacity for decision-making. Advance care planning is appropriate for healthy adults and patients with their family and healthcare providers, early, recurrently, and as circumstances change. Evidence shows that advance care planning conversations improve patient and family satisfaction with care and concordance between patients? and families? wishes, increase the completion of advance care planning documents, reduce the likelihood of patients receiving hospital care and the number of days spent in hospital, and increase the likelihood of receiving hospice care.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2628;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to carry out imaging as diagnostic test for venous thromboembolism or pulmonary embolism in patients with a low pretest probability.";-;2014;;;"Low value";-;"Link to the recommendation in the semFYC website" 3140;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer sodium nitroprusside to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1605;2;"Choosing Wisely�";"American College of Chest Physicians and American Thoracic Society";English;"Don?t perform CT screening for lung cancer among patients at low risk for lung cancer.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2117;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients with bronchiolitis it is not recommended to do a chest x-ray routinely.";"-Bronchiolitis is defined as the first episode of inflammation of the lower respiratory tract, it is commonly caused by viruses in infants (<24 months). -The diagnosis is clinical and is not recommended to routinely perform a chest X-ray in patients with typical acute bronchiolitis. -Chest radiography is not useful in distinguishing a bacterial infection from a viral infection, and it can increase the unnecessary prescription of antibiotics. -It is recommended to do a X-ray in cases where there is doubt in the diagnosis due to atypical clinical, serious conditions or unsatisfactory evolution.";2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2373;19;"Choosing Wisely Canada";"Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto";English;"Don?t use oxygen therapy to treat non-hypoxic dyspnea";"Oxygen is frequently used to relieve shortness of breath in patients with advanced illness; however, supplemental oxygen does not benefit patients who are breathless but not hypoxic. Supplemental flow of air has been found equally effective to oxygen in this context.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2629;27;"Recomendaciones ""No hacer"". SemFYC [SemFYC Do not Do recommendations]";"Sociedad Espa�ola de Medicina de Familia y Comunitaria (semFYC)";Spanish;"It is not recommended to carry out imaging in patients with low back pain before 6 weeks in the absence of red flags.";-;2014;;;"Low value";LBP;"Link to the recommendation in the semFYC website" 3141;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer inotropes or vasopressors to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1606;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t use homeopathic medications, non-vitamin dietary supplements or herbal supplements as treatments for disease or preventive health measures.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2118;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients with anemia due to chronic kidney disease (stages III-V not on dialysis) and hemoglobin levels ?11 g / dl, Erythropoiesis-Stimulating Agents (ESA) should not be use routinely.";"Anemia associated with chronic renal disease is a common complication. Treatment with Erythropoiesis-Stimulating Agents (ESA) improve anemia symptoms and some related clinical outcomes. However, high levels of hemoglobin in patients with chronic kidney disease treated with ESA are associated with increased morbidity and mortality to comparing to low levels of hemoglobin. Treatment of anemia with ESA requires an individual assessment for each patient, taking into account the benefits and potential risks and comorbidities.";2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2374;19;"Choosing Wisely Canada";"Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto";English;"Don?t use stool softeners alone to prevent opioid induced constipation";"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 cramping, and incomplete stool passage.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3142;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer ultrafiltration to people with acute heart failure.";-;2014;;;"Low value";-;"Link to the NICE website" 1607;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t administer a chelating agent prior to testing urine for metals, a practice referred to as ?provoked? urine testing.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2119;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not recommend to order imaging in children with persistent sinusitis, unless severe clinical manifestations, complications or a surgical indication are present.";"Sinusitis is a common disease in primary care, and in most cases does not require routine imaging for diagnosis. Imaging tests in children may lead to misleading diagnosis and, at the same time, an increased exposure of children to unnecessary radiation.";2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2375;19;"Choosing Wisely Canada";"Canadian Society of Palliative Care Physicians - Canadian Medical Association -University of Toronto";English;"Don?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";"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 circulatory overload, and sepsis.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3143;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use blood testing for serum specific immunoglobulin E (IgE) to diagnose drug allergy in a non-specialist setting.";-;2014;;;"Low value";-;"Enlace a la p�gina web de la NICE" 1608;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t order heavy metal screening tests to assess non-specific symptoms in the absence of excessive exposure to metals.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2376;19;"Choosing Wisely Canada";"Canadian Association of Pathologists - Canadian Medical Association - University of Toronto";English;"Don?t perform population based screening for 25-OH-Vitamin D deficiency";"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).";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n" 3144;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use questionnaires in primary care to identify bipolar disorder in adults.";-;2014;;;"Low value";-;"Link to the NICE website" 1609;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t recommend chelation except for documented metal intoxication which has been diagnosed using validated tests in appropriate biological samples.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2377;19;"Choosing Wisely Canada";"Canadian Association of Pathologists - Canadian Medical Association - University of Toronto";English;"Don?t screen women with Pap smears if under 21 years of age or over 69 years of age";"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.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1610;2;"Choosing Wisely�";"American College of Medical Toxicology and The American Academy of Clinical Toxicology";English;"Don?t remove mercury-containing dental amalgams.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2378;19;"Choosing Wisely Canada";"Canadian Association of Pathologists - Canadian Medical Association - University of Toronto";English;"Avoid routine preoperative laboratory testing for low risk surgeries without a clinical indication";"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 symptomatic patients and those with risks factors for which diagnostic testing can provide clarification of patient surgical risk.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n" 3146;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not start lithium to treat bipolar disorder in primary care for people who have not taken lithium before, except under shared-care arrangements.";-;2014;;;"Low value";-;"Link to the NICE website" 1611;2;"Choosing Wisely�";"American Geriatrics Society";English;"Avoid physical restraints to manage behavioral symptoms of hospitalized older adults with delirium.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2379;19;"Choosing Wisely Canada";"Canadian Association of Pathologists - Canadian Medical Association - University of Toronto";English;"Avoid standing orders for repeat complete blood count (CBC) on inpatients who are clinically/laboratorily stable";"Standing orders for inpatients for CBC testing should be avoided as this can lead to over-testing in relatively stable patients. Particularly in patients with longer term hospital stays, there is some evidence that repeated blood testing can have a negative effect on patients including some increase in anemia. Trauma patients often have blood draws repeated frequently even in the absence of indications of hematologic instability on admission.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n" 3147;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not start valproate in primary care to treat bipolar disorder.";-;2014;;;"Low value";-;"Link to the NICE website" 1612;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t prescribe a medication without conducting a drug regimen review.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2380;19;"Choosing Wisely Canada";"Canadian Association of Pathologists - Canadian Medical Association - University of Toronto";English;"Don?t send urine specimens for culture on asymptomatic patients including the elderly, diabetics, or as a follow up to confirm effective treatment";"There is no evidence that antibiotic treatment is indicated in any of these patients. Thus sending urine specimens in asymptomatic patients will only result in inappropriate antibiotic use and increased risk of resistance. The only exceptions are screening of pregnant women early in pregnancy for whom there are clear guidelines for screening/management; and screening for asymptomatic bacteriuria before urologic procedures for which mucosal bleeding is anticipated.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n" 5708;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";Spanish;"Electronic prescribing in outpatient care is recommended to reduce prescription errors, increase efficiency in the prescription and dispensing process, improve patient outcomes, decrease patient visits, and reduce costs";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research on strategies such as electronic prescribing in the ambulatory setting may provide information to help policy makers with this. In this systematic review, the authors searched for research exploring the benefits of, and barriers to electronic prescribing in ambulatory care. They restricted their search to studies done in the USA and published in English between 2005 and 2013. They included 47 articles of various study types and designs.";2014;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1613;2;"Choosing Wisely�";"American Headache Society";English;"Don?t perform computed tomography (CT) imaging for headache when magnetic resonance imaging (MRI) is available, except in emergency settings.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2381;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto";English;"Don?t transfuse blood if other non-transfusion therapies or observation would be just as effective";"Blood transfusion should not be given if other safer non-transfusion alternatives are available. For example, patients with iron deficiency without hemodynamic instability should be given iron therapy.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1614;2;"Choosing Wisely�";"American Headache Society";English;"Don?t perform neuroimaging studies in patients with stable headaches that meet criteria for migraine.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2382;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto";English;"Don?t transfuse more than one Red cell unit at a time when transfusion is required in stable, non-bleeding patients";"Indications for red blood transfusion depend on clinical assessment and the cause of the anemia. In a stable, non-bleeding patient, often a single unit of blood is adequate to relieve patient symptoms or to raise the hemoglobin to an acceptable level. Transfusions are associated with increased morbidity and mortality in high-risk hospitalized inpatients. Transfusion decisions should be influenced by symptoms and hemoglobin concentration. Single unit red cell transfusions should be the standard for non-bleeding, hospitalized patients. Additional units should only be prescribed after re-assessment of the patient and their hemoglobin value.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1615;2;"Choosing Wisely�";"American College of Rheumatology ? Pediatric Rheumatology";English;"Don?t order autoantibody panels unless positive antinuclear antibodies (ANA) and evidence of rheumatic disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2383;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto";English;"Don?t transfuse plasma to correct a mildly elevated (<1.8) international normalized ratio (INR) or activated partial thromboplastin time (aPTT) before a procedure";"A mildly elevated INR is not predictive of an increased risk of bleeding. Furthermore, transfusion of plasma has not been demonstrated to significantly change the INR value when the INR was only minimally elevated (<1.8).";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5711;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";Spanish;"The overall impact of extended roles of allied health professionals on patient outcomes, cost effectiveness, training requirements, niche identification and sustainability are uncertain";"The COVID-19 pandemic is placing a great strain on healthcare workers. Existing research on the effects of extended roles for allied health professionals might provide information to can help policy makers to help with this. In this systematic review, the authors searched for studies examining the extension of the scope roles of allied health professionals in physiotherapy, occupational therapy and speech pathology. They restricted their search to studies published in English from 2005 to 2013. They included 21 studies, including cohort studies, surveys, focus groups and semi-structured interviews. Extending the scope of practice for allied health professionals may be cost-effective and may improve patient outcomes. Legislative barriers that exist in healthcare may be challenging for allied health professionals to enable them to extend their professional scope.";2014;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1616;2;"Choosing Wisely�";"American College of Rheumatology ? Pediatric Rheumatology";English;"Don?t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2384;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto";English;"Don?t routinely transfuse platelets for patients with chemotherapy-induced thrombocytopenia if the platelet count is greater than 10 X 109/L in the absence of bleeding";"A platelet count of 10 X 109/L or greater usually provides adequate hemostasis. Platelet transfusions are associated with adverse events and risks. Considerations in the decision to transfuse platelets include the cause of the thrombocytopenia, comorbid conditions, symptoms of bleeding, risk factors for bleeding, and the need to perform an invasive procedure.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1617;2;"Choosing Wisely�";"American College of Rheumatology ? Pediatric Rheumatology";English;"Don?t routinely perform surveillance joint radiographs to monitor juvenile idiopathic arthritis (JIA) disease activity.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2385;19;"Choosing Wisely Canada";"Canadian Society for Transfusion Medicine - Canadian Medical Association - University of Toronto";English;"Don?t routinely use plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists";"Patients requiring non-emergent reversal of warfarin can often be treated with vitamin K or by discontinuing the warfarin therapy. Prothrombin complex concentrates should only be used for patients with serious bleeding or for those who need urgent surgery. Plasma should only be used in this setting if prothrombin complex concentrates are not available or are contraindicated.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1618;2;"Choosing Wisely�";"American College of Rheumatology ? Pediatric Rheumatology";English;"Don?t perform methotrexate toxicity labs more often than every 12 weeks on stable doses.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2386;19;"Choosing Wisely Canada";"Canadian Urological Association - Canadian Medical Association - University of Toronto";English;"Don?t order a routine bone scan and CT scan of the pelvis in men with low-risk prostate cancer";"Low-risk patients (defined by D?Amico criteria and National Comprehensive Cancer Network guidelines) are unlikely to have metastatic disease. Accordingly, imaging is generally unnecessary in patients with newly diagnosed prostate cancer who have a PSA <20.0 ng/mL and a Gleason score 6 or less unless the patient?s history or clinical examination suggests distant disease. Metastases are much more likely in high-grade disease that is characterized by fast and aggressive growth into surrounding areas such as bones or lymph nodes.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1619;2;"Choosing Wisely�";"American College of Rheumatology ? Pediatric Rheumatology";English;"Don?t repeat a confirmed positive ANA in patients with established juvenile idiopathic arthritis or systemic lupus erythematosus (SLE).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2387;19;"Choosing Wisely Canada";"Canadian Urological Association - Canadian Medical Association - University of Toronto";English;"Don?t order serum testosterone in men without symptoms of hypogonadism";"In the evaluation of men with erectile dysfunction, testosterone should only be ordered if there are signs and/or symptoms of hypogonadism.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1620;2;"Choosing Wisely�";"American College of Surgeons";English;"Don?t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2388;19;"Choosing Wisely Canada";"Canadian Urological Association - Canadian Medical Association - University of Toronto";English;"Don?t prescribe testosterone to men with erectile dysfunction who have normal testosterone levels";"While testosterone treatment may increase sexual interest, there appears to be no significant influence on erectile function in men with normal testosterone levels.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1621;2;"Choosing Wisely�";"American College of Surgeons";English;"Avoid the routine use of ?whole-body? diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n de la p�gina web de la iniciativa" 2389;19;"Choosing Wisely Canada";"Canadian Urological Association - Canadian Medical Association - University of Toronto";English;"Don?t use antimicrobials to treat asymptomatic bacteriuria in the elderly";"Studies suggest that asymptomatic bacteriuria in the elderly does not carry significant risk of morbidity if left untreated. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show increased adverse antimicrobial effects. Consensus criteria has been developed to characterize the specific clinical symptoms that, when associated with bacteriuria, define urinary tract infection. Screening for and treatment of asymptomatic bacteriuria is recommended before urologic procedures for which mucosal bleeding is anticipated.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5717;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Home visits were not found to be effective in preventing deterioration and death in older adults ";"La pandemia COVID-19 est� ejerciendo una presi�n sobre los servicios de salud y atenci�n social. Las investigaciones existentes sobre visitas domiciliarias a adultos mayores pueden proporcionar informaci�n pertinente a los responsables pol�ticos en esta esfera. En esta revisi�n sistem�tica de Campbell, los autores buscaron ensayos aleatorizados de visitas domiciliarias para prevenir el deterioro, la institucionalizaci�n y la muerte en adultos mayores. No se limitaron por idioma de publicaci�n e hicieron la b�squeda en diciembre de 2012. Incluyeron 64 estudios con una serie de criterios de elegibilidad (28.642 participantes). Las visitas domiciliarias involucraron a las enfermeras solamente (27 estudios); otros profesionales, incluidos los visitantes de la salud, fisioterapeutas, trabajadores sociales, m�dicos, (20); o una combinaci�n de profesionales de la salud, generalmente una enfermera en combinaci�n con otro profesional (17). Overall, home visits were not found to be effective in maintaining the health and autonomy of community?dwelling older adults. Preventive home visits did not reduce overall mortality and did not have a significant effect on the number of people who were institutionalised.";2014;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1622;2;"Choosing Wisely�";"American College of Surgeons";English;"Avoid 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.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recommendaci�n en la p�gina web de la iniciativa" 2390;19;"Choosing Wisely Canada";"Canadian Urological Association - Canadian Medical Association - University of Toronto";English;"Don?t perform ultrasound on boys with cryptorchidism";"Ultrasound is of minimal value in localizing the position or existence of testes that cannot be felt through physical examination. Studies have shown that there remained a significant chance that testes were present even after a negative ultrasound result. The likelihood of locating testes is low when using ultrasound.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1623;2;"Choosing Wisely�";"American College of Surgeons";English;"Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2391;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antigen-specific active immunotherapy for ovarian cancer";"""NICE summary of review conclusions

Antigen-specific active immunotherapy for ovarian cancer is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project. Reducing or stopping antigen-specific active immunotherapy for ovarian cancer is likely to improve the quality of patient care by reducing exposure to unproven therapies and result in productivity savings.

The Implications for practice section of the Cochrane review stated: immunological responses have been observed for most strategies evaluated, these do not coincide with clinical benefits for ovarian cancer patients. Furthermore, there are currently no immunological surrogate markers that At this point in time, there is no evidence of effective immunotherapy for ovarian cancer. Although promising correlate with clinical outcomes. Until evidence of true clinical effectiveness is available, immunotherapy should therefore not be offered as an alternative to standard therapy for primary or recurrent ovarian cancer.""";2014;;;"Low value";-;"Link to the recommendation in the NICE website" 2392;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Bed rest and posture for preventing post-dural puncture headache";"""Post-dural puncture headaches are a recognised complication of any procedure where the dura is punctured. The dural puncture may be intentional, with the use of a spinal needle, or unintentional, as a complication of epidural injections or catheterisations. It is thought that cerebrospinal fluid (CSF) leakage through the puncture hole is a key determinant of whether a headache develops, so it was thought that bed rest would reduce fluid leakage by reducing the hydrostatic pressure at the puncture site or fluid supplementation would increase CSF production to compensate for any leak. There are no clear benefits associated with either bed rest or fluid supplementation. It is not current practice for patients to be kept in hospital strictly for bed rest and so this review would not result in the freeing up of beds but there may be cash savings from the reduced use of intravenous fluids.""";2014;;;"Low value";-;"Link to the recommendation in the Choosing Wisely website" 1625;2;"Choosing Wisely�";"American Headache Society";English;"Don?t prescribe opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2393;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Early epoetin for preventing red blood cell transfusion in premature infants";"""Use of epoetin (also known as EPO) may reduce the use of blood transfusions but not sufficiently to reduce donor exposure. Use of epoetin appears to lead to an increase in the incidence of retinopathy of prematurity (ROP). As such the Cochrane review determined that the use of epoetin is not recommended.""";2014;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la NICE" 1626;2;"Choosing Wisely�";"American Psychiatric Association";English;"Don?t prescribe antipsychotic medications to patients for any indication without appropriate initial evaluation and appropriate ongoing monitoring.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2394;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine abdominal drainage for uncomplicated open cholecystectomy";"""There is no benefit to patients in placing open or closed drains for uncomplicated open cholecystectomy. The placement of a drain is associated with increased risk to patients in terms of wound and chest infections.""";2014;;;"Low value";-;"Link to the recommendation in the NICE website" 2650;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Office-based serological tests for H. pylori cannot be recommended because of their inadequate performance.";-;2014;;;"Low value";"Helycobacter, Serology";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1627;2;"Choosing Wisely�";"American Headache Society";English;"Don?t recommend surgical deactivation of migraine trigger points outside of a clinical trial.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2395;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Robotic surgery for benign gynaecological disease";"""Robotic surgery (also known as computer-assisted surgery or robotically-assisted surgery) has become increasingly popular as it has the potential to offer increased surgical precision. Use of robotic surgery as opposed to standard laparoscopic surgery for benign (non-malignant) gynaecological disease however is not currently supported by sufficient good quality evidence. It was not found to offer any significant advantages over laparoscopic surgery and furthermore the evidence suggests that robotic surgery resulted in more postoperative complications, longer operating time with more than twice the associated cost.

Reducing or stopping the use of robotic surgery for benign gynaecological disease and performing standard laparoscopic surgery instead is therefore likely to have an impact on both quality of patient care and productivity.""";2014;;;"Low value";-;"Link to the recommendation in the NICE website" 2651;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use very-low-calorie diets (800 kcal/day or less) to manage obesity (defined as BMI over 30).";-;2014;;;"Low value";"Diet, Obesity";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1628;2;"Choosing Wisely�";"American Psychiatric Association";English;"Don?t routinely prescribe two or more antipsychotic medications concurrently.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recommendaci�n en la p�gina web de la iniciativa
" 2652;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely diagnose a relapse of Multiple Sclerosis if symptoms are present for more than 3 months.";-;2014;;;"Low value";"Multiple, Sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5468;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Using weaning protocols reduces the average total time spent on mechanical ventilation, the duration of weaning and length of stay in the intensive care unit , without causing any additional harms.";"Some patients with COVID-19 will become critically ill and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). Clinicians use a variety of methods to bring people off MV as they recover, including formal weaning protocols. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials of the effects of weaning protocols on reducing the time that critically ill patients spend on MV. They did not restrict by language of publication and conducted their searches in January 2014. They identified 13 studies in which clinicians used weaning protocols to guide them when reducing MV support and four in which MV was reduced automatically by computers programmed to follow a protocol. Using weaning protocols reduces the average total time spent on MV, the duration of weaning and length of stay in the ICU, without causing any additional harms. Protocols were not found to be beneficial in neurosurgical patients. A wide variety of types of weaning protocol were studied and it is uncertain which protocols work best for which patients.";2014;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1629;2;"Choosing Wisely�";"American Headache Society";English;"Don?t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2653;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer gauze dressings to treat a pressure ulcer in adults, neonates, infants, children and young people.";-;2014;;;"Low value";ulcer;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1630;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2654;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use iodine dressings to treat a pressure ulcer in neonates.";-;2014;;;"Low value";Ulcer;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6750;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"It is not recomendedto provide annual medication reviews for people taking statins";"Provide annual medication reviews for people taking statins. Use these reviews to discuss medication adherence and lifestyle modification and address CVD risk factors. Consider an annual nonfasting blood test for non-HDL cholesterol to inform the discussion. Talk to people who are stable on a low- or medium-intensity statin about the likely benefits and potential risks of switching to a high-intensity statin when they have a medication review, and agree with the person if a change is needed. ";2014;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 1631;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t recommend screening for breast or colorectal cancer, nor prostate cancer (with the PSA test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"PSA, screening";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1632;2;"Choosing Wisely�";"American Geriatrics Society";English;"Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults*";"*Instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6752;36;"Choosing Wisely UK";"Royal College of General Practitioners";English;"It is recommended that decision aids be used to support this process for clinicians and patients when considering risk-modifying treatment in primary prevention.";"When considering risk modifying treatment in primary prevention, for example treatment for blood pressure, cholesterol or bone density, share the option to have treatment or not before prescribing. Decision aids exist to support this process for doctors and patients.�";2014;;;"High value";Treatment;"Link to the recommendation on the website of the initiative" 2145;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada (PHAC)";English;"For men aged less than 55 years, we recommend not screening for prostate cancer with the prostate-specific antigen test (PSA).";"(Strong recommendation; low quality evidence)

For further information please visit the website of the initiative (link below)";2014;;;"Low value";screening;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2146;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada (PHAC)";English;"For men aged 55?69 years, we recommend not screening for prostate cancer with the prostate-specific antigen test (PSA).";"(Weak recommendation; moderate quality evidence)

For further information please visit the website of the initiative (link below)";2014;;;"Low value";screening;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2147;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada (PHAC)";English;"For men 70 years of age and older, we recommend not screening for prostate cancer with the prostate-specific antigen test (PSA).";"(Strong recommendation; low quality evidence)

For further information please visit the website of the initiative (link below)";2014;;;"Low value";screening;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2148;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use neuromuscular adhesive bandages routinely or as first-line treatment to reduce pain and improve function in neuromuscular disorders.";-;2014;;;"Low value";patch;"Link to the recommendations in the website of the Spanish Ministry of Health
" 6757;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"Electronic monitoring of the baby's heart is not recommended routinely during labor unless the mother is at higher than normal risk of complications for the healthcare professionals.";"The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Advise continuous monitoring with CTG if: - doubts arise about fetal heart rate with intermittent auscultation and continue, or. - maternal or fetal risk factors appear intrapartum.";2014;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative" 5479;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid ";Spanish;"Some patients with COVID-19 will develop pneumonia, which can become a serious and life-threatening illness";"Nine of the included trials compared different antibiotics and, hence, we could not combine the results of the individual trials to present our overall conclusion. There were some notable adverse events in seven studies: 1) erythromycin demonstrated significant gastrointestinal side effects compared to clarithromycin in two studies; 2) nemonoxacin demonstrated higher gastrointestinal (nausea, diarrhoea) and nervous system (dizziness, headache) adverse events compared to levofloxacin; 3) cethromycin demonstrated more side effects, especially a distortion of the sense of taste, than clarithromycin; 4) gastritis and diarrhoea were more common in the high?dose amoxicillin group (1 g three times a day) compared to the other three antibiotic groups (clarithromycin, azithromycin and levofloxacin).";2014;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1642;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Vitamin D in the elderly is not recommended to reduce the risk of falls, except in people with vitamin D deficiency.";"Sun exposure and food intake are the main sources that ensure a healthy amount of vitamin D.
-Vitamin D needs are changing throughout life: they are greater in old age.
-The vitamin D is involved in many human physiological processes, including the mineralization of the skeleton and muscles health. However, the results of treatment with vitamin D on muscle strength are controversial.
-The recommended doses exhibit (gastrointestinal, mostly) mild side effects, which may affect adherence to treatment. The routinary use of vitamin D in older people without a proven deficit of vitamin D has not been shown to be effective in preventing falls.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1390;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1391;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1392;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t treat uncomplicated, non-melanoma skin cancer less than one centimeter in size on the trunk and extremities with Mohs micrographic surgery.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2160;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Radiologia Medica (SIRM)";Spanish;"I do not have magnetic resonance imaging (MRI) of the lumbosacral spine within the first six weeks of low-back pain, in the absence of red flag signs/symptoms.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1393;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1394;2;"Choosing Wisely�";"American Academy of Dermatology";English;"Don?t routinely use topical antibiotics on a surgical wound.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1395;2;"Choosing Wisely�";"American College of Occupational and Environmental Medicine";English;"Don?t prescribe opioids for treatment of chronic or acute pain for workers who perform safety-sensitive jobs such as operating motor vehicles, forklifts, cranes or other heavy equipment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1396;2;"Choosing Wisely�";"American College of Occupational and Environmental Medicine";English;"Don?t initially obtain X-rays for injured workers with acute non-specific low back pain.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"low back pain, x-ray, radiography, imaging, images, lumbar";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1397;2;"Choosing Wisely�";"American College of Occupational and Environmental Medicine";English;"Don?t order low back X-rays as part of a routine preplacement medical examination.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"low back, x-ray, radiography, imaging, images, lumbar, occupational";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1398;2;"Choosing Wisely�";"American College of Occupational and Environmental Medicine";English;"Don?t routinely order X-ray for diagnosis of plantar fasciitis/heel pain in employees who stand or walk at work.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1399;2;"Choosing Wisely�";"American College of Occupational and Environmental Medicine";English;"Don?t routinely order sleep studies (polysomnogram) to screen for/diagnose sleep disorders in workers suffering from chronic fatigue/insomnia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1400;2;"Choosing Wisely�";"American Society of Anesthesiologists ? Pain Medicine";English;"Don?t prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1401;2;"Choosing Wisely�";"American Society of Anesthesiologists ? Pain Medicine";English;"Don?t prescribe opioid analgesics as long-term therapy to treat chronic non-cancer pain until the risks are considered and discussed with the patient.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1402;2;"Choosing Wisely�";"American Society of Anesthesiologists ? Pain Medicine";English;"Avoid imaging studies (MRI, CT or X-rays) for acute low back pain without specific indications.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"low back pain, x-ray, radiography, imaging, images, lumbar";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2938;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is not recommended to use glibenclamide (glyburide) for the treatment of women with gestational diabetes who need drug treatment if insulin or metformin are available.";-;2014;;;"Low value";-;"Link to the recommendation" 1403;2;"Choosing Wisely�";"American Society of Anesthesiologists ? Pain Medicine";English;"Don?t use intravenous sedation for diagnostic and therapeutic nerve blocks, or joint injections as a default practice.*";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1404;2;"Choosing Wisely�";"American Society of Anesthesiologists ? Pain Medicine";English;"Avoid irreversible interventions for non-cancer pain that carry significant costs and/or risks.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1406;2;"Choosing Wisely�";"North American Spine Society";English;"Don?t perform elective spinal injections without imaging guidance, unless contraindicated.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1407;2;"Choosing Wisely�";"North American Spine Society";English;"Don?t use Bone Morphogenetic Protein (rhBMP) for routine anterior cervical spine fusion surgery.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1408;2;"Choosing Wisely�";"North American Spine Society";English;"Don?t use electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of axial lumbar, thoracic or cervical spine pain.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1409;2;"Choosing Wisely�";"North American Spine Society";English;"Don?t recommend bed rest for more than 48 hours when treating low back pain.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2945;2;"Choosing Wisely�";"American Association of Neurological Surgeons and Congress of Neurological Surgeons";English;"Don?t administer steroids after severe traumatic brain injury.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Steroids, Traumatic Brain Injury";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2946;2;"Choosing Wisely�";"American Association of Neurological Surgeons and Congress of Neurological Surgeons";Spanish;"Don?t obtain imaging (plain radiographs, magnetic resonance imaging, computed tomography [CT], or other advanced imaging) of the spine in patients with non-specific acute low back pain and without red flags.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Low Back Pain, Imaging";"Link to the recommendation in the Choosing Wisely website" 1923;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Don?t perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy.";"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 planning to receive whole breast radiation and stage appropriate systemic therapy, axillary node dissection should not be performed.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2947;2;"Choosing Wisely�";"American Association of Neurological Surgeons and Congress of Neurological Surgeons";English;"Don?t routinely obtain CT scanning of children with mild head injuries.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"CT scanning, Head Injury, Children";"Link to the recommendation in the Choosing Wisely website" 1924;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto";English;"Avoid the routine use of ?whole-body? diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.";"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.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2948;2;"Choosing Wisely�";"American Association of Neurological Surgeons and Congress of Neurological Surgeons";English;"Don?t routinely screen for brain aneurysms in asymptomatic patients without a family or personal history of brain aneurysms, subarachnoid hemorrhage (SAH) or genetic disorders that may predispose to aneurysm formation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Brain Aneurysms, Subarachnoid Hemorrhage";"Link to the recommendation in the Choosing Wisely website" 1925;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto";English;"Avoid 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.";"Screening for colorectal cancer has been shown to reduce the mortality associated with this common disease; colonoscopy provides the opportunity to detect and remove adenomatous polyps, the precursor lesion to many cancers, thereby reducing the incidence of the disease later in life. However, 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.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2949;2;"Choosing Wisely�";"American Association of Neurological Surgeons and Congress of Neurological Surgeons";English;"Don?t routinely use seizure prophylaxis in patients following ischemic stroke.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Seizure, Ischemic Stroke";"Link to the recommendation in the Choosing Wisely website" 5765;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The collaboration of pharmaceutical services is recommended in general practice as it is associated with improvements in the quality and suitability of prescriptions";"The COVID-19 pandemic is placing a strain on healthcare services. Existing research on the effects of collaborative practices between pharmacists and general practitioners might provide useful information for policy makers, for example for the control of risk factors for complications and poor outcomes of COVID-19, such as heart disease, diabetes and obesity, and for improving patient outcomes. In this systematic review, the authors searched for randomized trials of the impact of co-locating pharmacists in general practitioner practices and collaborative working with practice staff. They restricted their search to studies published in English between 1966 and 2013. They included 38 studies. The studies included specific patient populations (for example, patients with cardiovascular disease) (29 studies) or wider patient populations (9). The reviewers did not formally assess the certainty (quality) of the evidence, but they did a risk of bias assessment for each trial. Providing pharmacist services in general practice was associated with improvements in blood pressure, blood glucose control, cholesterol levels, and cardiovascular risk-scores, compared to usual care, apart from improve the quality and appropriateness of prescribing. No impact was reported on symptoms, quality of life, patient satisfaction and medical costs. The cost-effectiveness, long-term health impacts, and feasibility of co-locating pharmacist services in general practice are uncertain.";2014;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1926;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto";English;"Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.";"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.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2694;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kamphuis E. BMJ 2014;348:g252";English;"Are we overusing in vitro fertilisation (IVF)?";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"In Vitro Fertilisation";"Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4742;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Do not perform axillary lymph node dissection for clinical stages I and II breast cancer with clinically negative lymph nodes without attempting sentinel node biopsy. ";"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. It is not recommended to perform axilary node dissection when: - The sentinel lymph nodes are negative for cancer; - One or two sentinel nodes are involved with cancer that is not extensive in the node, the patient received breast conserving surgery and is planning to receive whole breast radiation and stage appropriate systemic therapy.";2014;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative " 1927;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.";"Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is the preferred initial consideration for imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent in experienced hands. Recognizing that expertise may vary, strategies including improving diagnostic expertise in community based ultrasound and the development of evidence-based clinical decision rules are realistic goals in improving diagnosis without the use of CT scan.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2695;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Yuan S. BMJ 2014;348:g1262";English;"China should reduce the overuse of intravenous infusion";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Intravenous Infusion, Overuse";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1928;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons - Canadian Medical Association - University of Toronto";English;"Avoid repair of minimally symptomatic inguinal hernias where appropriate by offering an option of watchful waiting for up to two years.";"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.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2696;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ�2014;348:g1205";English;"In the presence of an incidental adrenal tumor, it is potentially recommended to follow up hormonal changes and monitor cardiometabolic risks.";"For further information please visit the website of the initiative (link below)";2014;;;"High value";"Adrenal, Monitoring";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1929;19;"Choosing Wisely Canada";"Canadian Association of Radiologists - Canadian Medical Association - University of Toronto";English;"Don?t do imaging for lower-back pain unless red fl ags are present.";"Red flags include suspected epidural abscess or hematoma presenting with acute pain, but no neurological symptoms (urgent imaging is required); suspected cancer; suspected infection; cauda equina syndrome; severe or progressive neurologic deficit; and suspected compression fracture. In patients with suspected uncomplicated herniated disc or spinal stenosis, imaging is only indicated after at least a six-week trial of conservative management and if symptoms are severe enough that surgery is being considered.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2697;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Sunkara S. BMJ 2014;348:g1583";English;"Overuse of in vitro fertilisation should be restricted specially due to Increase in older women presenting as unexplained subfertility.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Subfertility, In Vitro Fertilisation";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4745;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Avoid the routine use of ?whole-body? diagnostic computed tomography (CT) scanning in patients with minor or single system trauma.";"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.";2014;;;"Low value";-;"

Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative

" 1930;19;"Choosing Wisely Canada";"Canadian Association of Radiologists - Canadian Medical Association - University of Toronto";English;"Don?t do imaging for minor head trauma unless red flags are present.";"Red flags include Glasgow Coma Scale (GCS) less than 13; GCS less than 15 at 2 hours post-injury; a patient aged 65 years or older; obvious open skull fracture; suspected open or depressed skull fracture; any sign of basilar skull fracture (e.g., hemotympanum, raccoon eyes, Battle?s Sign, CSF otorhinorrhea); retrograde amnesia to the event lasting 30 minutes or longer after the event; ?dangerous? mechanism (e.g., pedestrian struck by motor vehicle, occupant ejected from motor vehicle, or fall from higher than 3 feet or down more than 5 stairs); and coumadin-use or bleeding disorder.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2698;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kamerow D. BMJ 2014;348:g182";English;"Don't rely on market and screening tests like Preposterous for the measurement of Testosterone leading to overdiagnosis.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Testosteron;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1931;19;"Choosing Wisely Canada";"Canadian Association of Radiologists - Canadian Medical Association - University of Toronto";English;"Don?t do imaging for uncomplicated headache unless red flags are present.";"Red flags include recent onset, rapidly increasing frequency and severity of headache; headache causing the patient to wake from sleep; associated dizziness, lack of coordination, tingling or numbness, new neurologic deficit; and new onset of a headache in a patient with a history of cancer or immunodeficiency.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2699;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2014;348:g1743";English;"US thyroid cancer rates are epidemic of diagnosis not disease,so, avoid overdiagnosis in thyroid cancer.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Thyroid, Cancer, Overdiagnosis";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4747;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Avoid 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.";"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.";2014;;;"Low value";-;"

Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative

" 1932;19;"Choosing Wisely Canada";"Canadian Association of Radiologists - Canadian Medical Association - University of Toronto";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.";"Although CT is accurate in the evaluation of suspected appendicitis in the pediatric population, ultrasound is nearly as good in experienced hands. Since ultrasound will reduce radiation exposure, ultrasound is the preferred initial imaging examination in children. If the results of the ultrasound exam are equivocal, it may be followed by CT. This approach is cost-effective, reduces potential radiation risks and has excellent accuracy, with reported sensitivity and specificity of 94 percent.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2700;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Cundy T. BMJ 2014;348:g1567";English;"Don't forget that new criteria on the diagnosis of Gestational diabetes may triple the prevalence but effect on outcomes is unclear.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Diabetes, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1933;19;"Choosing Wisely Canada";"Canadian Association of Radiologists - Canadian Medical Association - University of Toronto";English;"Don?t do an ankle X-ray series in adults for minor injuries.";"X-rays are only indicated if there is pain in the malleolar zone, bone tenderness at the posterior edge or tip of either malleolus, or inability to bear weight for four steps immediately after the trauma and in the emergency department.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2701;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Brunet M. BMJ 2014;348:g2224";English;"The diagnosis of dementia must belong only to the patient. Don't administer other targets (like market,and,..) on the setting of diagnosis.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Dementia, Overdiagnostic";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1934;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society - Canadian Medical Association - University of Toronto";English;"Don?t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.";"Asymptomatic, low-risk patients account for up to 45 percent of unnecessary ?screening?. Testing should be performed only when the following findings are present: diabetes in patients older than 40-years-old; peripheral arterial disease; or greater than 2 percent yearly risk for coronary heart disease events.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2702;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kermode-Scott B. BMJ 2014;348:g2673";English;"Nine Canadian medical bodies launch campaign to reduce unnecessary medical tests and treatments.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1935;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society - Canadian Medical Association - University of Toronto";English;"Don?t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.";"Performing stress cardiac imaging or advanced non-invasive imaging in patients without symptoms on a serial or scheduled pattern (e.g., every one to two years or at a heart procedure anniversary) rarely results in any meaningful change in patient management. This practice may, in fact, lead to unnecessary invasive procedures and excess radiation exposure without any proven impact on patients? outcomes. An exception to this rule would be for patients more than five years after a bypass operation.";2014;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de Choosing Wisely Canada
" 2703;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Jackson T. BMJ 2014;348:g2098";English;"Doctors on the record.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Doctor;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1936;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society - Canadian Medical Association - University of Toronto";English;"Don?t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.";"Non-invasive testing is not useful for patients undergoing low-risk non-cardiac surgery (e.g., cataract removal). These types of tests do not change the patient?s clinical management or outcomes.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2704;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2014;348:g1788";English;"Geriatrician questions prescribing for stroke prevention in people over 80.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Stroke;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 6544;1;"NICE ";NICE;English;"It is recommended to interpret the body mass index with caution to measure and classify overweight, obesity and central adiposity in certain subgroups.";"Use BMI as a practical measure of overweight and obesity. Interpret it with caution because it is not a direct measure of central adiposity. In adults with BMI below 35 kg/m2, measure and use their waist-to-height ratio, as well as their BMI, as a practical estimate of central adiposity and use these measurements to help to assess and predict health risks (for example, type 2 diabetes, hypertension or cardiovascular disease). Use clinical judgement when interpreting the healthy weight category because a person in this category may nevertheless have central adiposity. Interpret BMI with caution in adults with high muscle mass because it may be a less accurate measure of central adiposity in this group. Use clinical judgement when interpreting BMI below the 91st centile, especially the healthy weight category in BMI charts because a child or young person in this category may nevertheless have central adiposity. When talking to a child, young person, and their families and carers, explain that they should try and keep their waist to half their height (so a waist-to-height-ratio of under 0.5). Offer a higher level of intervention to children with weight-related comorbidities. Adjust the approach depending on the child's clinical needs. Interpret BMI with caution in people aged 65 and over, taking into account comorbidities, conditions that may affect functional capacity and the possible protective effect of having a slightly higher BMI when older. The health risks associated with higher levels of central adiposity include type 2 diabetes, hypertension and cardiovascular disease. When talking to a person about their waist-to-height ratio, explain that they should try and keep their waist to half their height (so a waist-to-height ratio of under 0.5). Ask the person's permission before talking about the degree of overweight, obesity and central adiposity, and discuss it in a sensitive manner. Give adults information about the severity of their overweight or obesity and central adiposity and the impact this has on their risk of developing other long-term conditions (such as type 2 diabetes, cardiovascular disease, hypertension, dyslipidaemia, certain cancers and respiratory, musculoskeletal and other metabolic conditions such as non-alcoholic fatty liver disease). Consider using waist-to-height ratio in children and young people aged 5 and over to assess and predict health risks associated with central adiposity (such as type 2 diabetes, hypertension or cardiovascular disease). ";2014;;;"High value";management;"Link to the recommendation on the website of the initiative" 1937;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society - Canadian Medical Association - University of Toronto";English;"Don?t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.";"Patients with native valve disease usually have years without symptoms before the onset of deterioration. An echocardiogram is not recommended yearly unless there is a change in clinical status.";2014;;;"Low value";-;"Link to the recommendation on the website of the iniciative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2705;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Torjesen I. BMJ 2014;349:g4335";English;"Treating type 2 diabetes in elderly people may do more harm than good, study finds.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Diabetes, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 4753;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Avoid admission or preoperative chest X-rays for ambulatory patients with unremarkable history and physical exam.";"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.";2014;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to therecommendation on the website of the initiative" 1938;19;"Choosing Wisely Canada";"Canadian Cardiovascular Society - Canadian Medical Association - University of Toronto";English;"Don?t order annual electrocardiograms (ECGs) for low-risk patients without symptoms.";"Don?t obtain screening electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease. In asymptomatic individuals at low risk for coronary heart disease (10-year risk <10%), screening for coronary heart disease with electrocardiography does not improve patient outcomes.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2706;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;348:g3791";English;"A third of adults in England have ?prediabetes,? study says.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Diabetes, Prediabetes, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1939;19;"Choosing Wisely Canada";"Canadian Geriatrics Society -Canadian Medical Association - University of Toronto";English;"Don?t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.";"Cohort studies have found no adverse outcomes for older men or women associated with asymptomatic bacteriuria. Antimicrobial treatment studies for asymptomatic bacteriuria in older adults demonstrate no benefits and show increased adverse antimicrobial effects. Consensus criteria has been developed to characterize the specific clinical symptoms that, when associated with bacteriuria, define urinary tract infection. Screening for and treatment of asymptomatic bacteriuria is recommended before urologic procedures for which mucosal bleeding is anticipated.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2451;6;"Less Is More Collection - JAMA Network";"Schuur J, et al. JAMA Intern Med. 2014;174(4):509-515";English;"A Top-Five List for Emergency Medicine: 2. Do not order CT to diagnose pulmonary embolism without first risk stratifying for pulmonary embolism*";"*(pretest probability and D-dimer tests if low probability).

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""" 2707;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2014;349:g4342";English;"Pelvic exam screening should not be routinely performed on healthy,asymptomatic women in appropriate age who are not pregnant.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Pelvic exam";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2963;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione italiana di dietetica e nutrizione clinica ? onlus";English;"Don?t use the so-called ""food intolerance tests"" as a tool for the dietary treatment of obesity or for diagnosing suspected food intolerances.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Food Intolerance";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1940;19;"Choosing Wisely Canada";"Canadian Geriatrics Society -Canadian Medical Association - University of Toronto";English;"Don?t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.";"Large scale studies consistently show that the risk of motor vehicle accidents, falls and hip fractures leading to hospitalization and death can more than double in older adults taking benzodiazepines and other sedative-hypnotics. The number needed to treat with a sedative-hypnotic for improved sleep is 13, whereas the number needed to harm is only 6. Older patients, their caregivers and their health care providers should recognize these potential harms when considering treatment strategies for insomnia, agitation or delirium. Use of benzodiazepines should be reserved for alcohol withdrawal symptoms/delirium tremens or severe generalized anxiety disorder unresponsive to other therapies. Prescribing or discontinuing sedative-hypnotics in hospital can have substantial impact on long-term use. Cognitive behavioural therapy, brief behavioural interventions and benzodiazepine-tapering protocols have proven benefit in sedative-hypnotic discontinuation. These non-pharmacologic interventions are also beneficial in improving sleep.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2452;6;"Less Is More Collection - JAMA Network";"Schuur J, et al. JAMA Intern Med. 2014;174(4):509-515";English;"A Top-Five List for Emergency Medicine: 3. Do not order magnetic resonance imaging of the lumbar spine for patients with lower back pain without high-risk features.";"Partners Healthcare is an integrated delivery system in eastern Massachusetts that includes 2 academic and 4 community hospital emergency departments. The initiative have created a ?top-five? list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians.";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""" 2708;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2014;348:g4218";English;"Overprescribing antidepressants: where?s the evidence?";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Depresion, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2964;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione italiana di dietetica e nutrizione clinica ? onlus";English;"Avoid treating obesity and eating disorders with pre-printed diets and in the absence of a multidimensional approach.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Obesity, Eating Disorders";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1941;19;"Choosing Wisely Canada";"Canadian Geriatrics Society -Canadian Medical Association - University of Toronto";English;"Don?t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral feeding.";"Careful hand-feeding for patients with severe dementia is at least as good as tube-feeding for the outcomes of death, aspiration pneumonia, functional status and patient comfort. Food is the preferred nutrient. Use of oral nutritional supplements may be beneficial. Tube-feeding is associated with agitation, increased use of physical and chemical restraints and worsening pressure ulcers.";2014;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inicaitiva
" 2453;6;"Less Is More Collection - JAMA Network";"Schuur J, et al. JAMA Intern Med. 2014;174(4):509-515";English;"A Top-Five List for Emergency Medicine: 4. Do not order CT of the head for patients with mild traumatic head injury who do not meet New Orleans Criteria or Canadian CT Head Rule.";"Partners Healthcare is an integrated delivery system in eastern Massachusetts that includes 2 academic and 4 community hospital emergency departments. The initiative have created a ?top-five? list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians.";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""" 2709;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;348:g3607";English;"GPs in England prescribed 2.7 million extra antidepressants during 2012 recession.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Depresion, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2965;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione italiana di dietetica e nutrizione clinica ? onlus";English;"Don?t encourage an extensive and indiscriminate use of dietary supplements as preventive measures in cancer and cardiovascular disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Dietary Supplements";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 6037;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t treat with an anticoagulant for more than three months in a patient with a first venous thromboembolism (VTE) occurring in the setting of a major transient risk factor.";"Anticoagulation is potentially harmful and costly. Patients with a first VTE triggered by a major, transient risk factor such as surgery, trauma or an intravascular catheter are at low risk for recurrence once the risk factor has resolved and an adequate treatment regimen with anticoagulation has been completed. Evidence-based and consensus guidelines recommend three months of anticoagulation over shorter or longer periods of anticoagulation in patients with VTE in the setting of a reversible provoking factor. By ensuring a patient receives an appropriate regimen of anticoagulation, clinicians may avoid unnecessary harm, reduce health care expenses and improve quality of life. This Choosing Wisely� recommendation is not intended to apply to VTE associated with non-major risk factors (e.g., hormonal therapy, pregnancy, travel-associated immobility, etc.), as the risk of recurrent VTE in these groups is either intermediate or poorly defined.";2014;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1942;19;"Choosing Wisely Canada";"Canadian Geriatrics Society -Canadian Medical Association - University of Toronto";English;"Don't use antipsychotics as first choice to treat behavioural and psychological symptoms of dementia.";"People with dementia often exhibit aggression, resistance to care and other challenging or disruptive behaviours. In such instances, antipsychotic medicines are often prescribed, but they provide limited benefit and can cause serious harm, including premature death. Use of these drugs should be limited to cases where non-pharmacologic measures have failed and patients pose an imminent threat to themselves or others. Identifying and addressing causes of behaviour change can make drug treatment unnecessary.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2454;6;"Less Is More Collection - JAMA Network";"Schuur J, et al. JAMA Intern Med. 2014;174(4):509-515";English;"A Top-Five List for Emergency Medicine: 5. ""Do not order coagulation studies for patients without hemorrhage or suspected coagulopathy (eg, with anticoagulation therapy, clinical coagulopathy).";"Partners Healthcare is an integrated delivery system in eastern Massachusetts that includes 2 academic and 4 community hospital emergency departments. The initiative have created a ?top-five? list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians.";2014;;;"Low value";-;"Link to the article in the collectio ""Less is More"" / Enlace al art�culo de la serie ""Less is More""" 2710;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2014;349:g4443";English;"Campaign is launched to make patients the focus of evidence based medicine";"For further information please visit the website of the initiative (link below)";2014;;;"High value";"Evidence Based Medicine";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2966;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione italiana di dietetica e nutrizione clinica ? onlus";English;"Avoid restrictive approaches not proven to be effective and not involving the family in overweight problems and obesity in children.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Overweight, Obesity";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1943;19;"Choosing Wisely Canada";"Canadian Geriatrics Society -Canadian Medical Association - University of Toronto";English;"Avoid using medications known to cause hypoglycemia to achieve hemoglobin A1c <7.5% in many adults age 65 and older; moderate control is generally better.";"There is no evidence that using medications to achieve intense glycemic control in older adults with type 2 diabetes is beneficial (A1c under 7.0%). Among non-older adults, except for long-term reductions in myocardial infarction and mortality with metformin, using medications to achieve glycated haemoglobin levels less than 6 % is associated with harms, including higher mortality rates. Intense control has been consistently shown to produce higher rates of hypoglycemia in older adults. Given the long timeframe (approximately 8 years) to achieve theorized benefits of intense control, glycemic targets should reflect patient goals, health status, and life expectancy. Reasonable glycemic targets would be 7.0 ? 7.5% in healthy older adults with long life expectancy, 7.5 ? 8.0% in those with moderate comorbidity and a life expectancy < 10 years, and 8.0 ? 8.5% in those with multiple morbidities and shorter life expectancy.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2711;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Yudkin J. BMJ 2014;349:g4485";English;"The epidemic of pre-diabetes: the medicine and the politics";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Prediabetes, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2967;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione italiana di dietetica e nutrizione clinica ? onlus";English;"Avoid Artificial Nutrition (AN) in clinical situations in which an evidence-based approach has not proven its efficacy, i.e. in patients with advanced dementia or cancer at the terminal stage.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Artifitial Nutrition";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1944;19;"Choosing Wisely Canada";"Canadian Orthopaedic Association -Canadian Medical Association - University of Toronto";English;"Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.";"Since ultrasound is not effective at diagnosing unsuspected deep vein thrombosis (DVT) and appropriate alternative screening tests do not exist, if there is no change in the patient?s clinical status, routine post-operative screening for DVT after hip or knee arthroplasty does not change outcomes or clinical management.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2712;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2014;349:g4911";English;"Organized diagnosis programs of dementia should be revisited since it has a potential risk of widespread overdiagnosis..";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Dementia, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1945;19;"Choosing Wisely Canada";"Canadian Orthopaedic Association -Canadian Medical Association - University of Toronto";English;"Don?t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.";"The use of needle lavage in patients with symptomatic osteoarthritis of the knee does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness or swelling.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2713;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2014;349:g4424";English;"Opioid prescribing rates in US vary widely between states, CDC reports";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Opioids;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1946;19;"Choosing Wisely Canada";"Canadian Orthopaedic Association -Canadian Medical Association - University of Toronto";English;"Don?t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.";"Both glucosamine and chondroitin sulfate do not provide relief for patients with symptomatic osteoarthritis of the knee.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2714;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Travasso Ch. BMJ 2014;349:g4740";English;"Indian cardiologists plan campaign to reduce unnecessary investigations.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1947;19;"Choosing Wisely Canada";"Canadian Orthopaedic Association -Canadian Medical Association - University of Toronto";English;"Don?t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.";"In patients with symptomatic osteoarthritis of the knee, the use of lateral wedge or neutral insoles does not improve pain or functional outcomes. Comparisons between lateral and neutral heel wedges were investigated, as were comparisons between lateral wedged insoles and lateral wedged insoles with subtalar strapping. The systematic review concludes that there is only limited evidence for the effectiveness of lateral heel wedges and related orthoses. In addition, the possibility exists that those who do not use them may experience fewer symptoms from osteoarthritis of the knee.";2014;;;"Low value";-;"Link to the recommendation on the website of Choosing Wisely Canada / Enlace a la recomendaci�n en la p�gina web de Choosing Wisely Canada
" 2715;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Sayburn A. BMJ 2014;349:g5055";English;"Prostate cancer screening can save lives but it is too early for a national programme, study finds.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Screeingn, Prostate, Cancer, Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1948;19;"Choosing Wisely Canada";"Canadian Orthopaedic Association -Canadian Medical Association - University of Toronto";English;"Don?t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.";"Routine post-operative splinting of the wrist after the carpal tunnel release procedure showed no benefit in grip or lateral pinch strength or bowstringing. In addition, the research showed no effect in complication rates, subjective outcomes or patient satisfaction. Clinicians may wish to provide protection for the wrist in a working environment or for temporary protection. However, objective criteria for their appropriate use do not exist. Clinicians should be aware of the detrimental effects including adhesion formation, stiffness and prevention of nerve and tendon movement.";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2716;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Travasso Ch. BMJ 2014;349:g5084";English;"India must act to stem rise of unnecessary medical interventions, says World Bank";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2972;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Radioterapia Oncologica (AIRO)";English;"Don?t define a treatment program that includes radiation therapy without the involvement of the radiation oncologist from the beginning (that is, immediately after diagnosis of the disease) in the definition of the program.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Radiation Therapy";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 4764;19;"Choosing Wisely Canada";"Canadian Association of General Surgeons";English;"Avoid repair of minimally symptomatic inguinal hernias where appropriate by offering an option of watchful waiting for up to two years.";"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.";2014;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la iniciativa / Link to the recommendation on the website of the initiative" 1949;19;"Choosing Wisely Canada";"Canadian Rheumatology Association -Canadian Medical Association - University of Toronto";English;"Don?t order ANA as a screening test in patients without specific signs or symptoms of systemic lupus erythematosus (SLE) or another connective tissue disease (CTD).";"ANA testing should not be used to screen subjects without specific symptoms (e.g., photosensitivity, malar rash, symmetrical polyarthritis, etc.) or without a clinical evaluation that may lead to a presumptive diagnosis of SLE or other CTD, since ANA reactivity is present in many non-rheumatic conditions and even in ?healthy? control subjects (up to 20%). In a patient with low pre-test probability for ANA-associated rheumatic disease, positive ANA results can be misleading and may precipitate further unnecessary testing, erroneous diagnosis or even inappropriate therapy.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2205;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use systematically low intensity lasers for the treatment of musculoskeletal pain, without estimating the possible response according to the etiology.";-;2014;;;"Low value";"laser, pain";"Link to the recommendations in the website of the Spanish Ministry of Health " 2717;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kmietowicz Z. BMJ 2014;349:g5664";English;"Screening women over 70 for breast cancer does not produce expected fall in advanced disease, so the decision to participate in the screening program should be personalized.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Screening, C�ncer, Breast";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2973;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Radioterapia Oncologica (AIRO)";English;"Don?t recommend the use of technical or ""special"" radiotherapy equipment without a motivated reason of the radiation oncologist.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Radiotherapy;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1950;19;"Choosing Wisely Canada";"Canadian Rheumatology Association -Canadian Medical Association - University of Toronto";English;"Don?t order an HLA-B27 unless spondyloarthritis is suspected based on specific signs or symptoms.";"HLA-B27 testing is not useful as a single diagnostic test in a patient with low back pain without further spondyloarthropathy (SpA) signs or symptoms (e.g., inflammatory back pain more than 3 months duration with age of onset <45 years, peripheral synovitis, enthesitis, dactylitis, psoriasis or uveitis) because the diagnosis of spondyloarthropathy in these patients is of low probability. If HLA-B27 is used, at least two SpA signs or symptoms, or the presence of positive imaging findings, need to be present to classify a patient as having axial SpA. There is no clinical utility to ordering an HLA-B27 in the absence of positive imaging or the minimally required SpA signs or symptoms.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2718;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2014;349:g5402";English;"No reduction in death rate is seen with bilateral mastectomy, US study finds";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Mastectomy;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2974;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Radioterapia Oncologica (AIRO)";English;"Don?t use, to the extent possible, prolonged radiation therapy treatments when the purpose of radiation therapy is symptomatic and palliative in people with reduced life expectancy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Radiotherapy;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1951;19;"Choosing Wisely Canada";"Canadian Rheumatology Association -Canadian Medical Association - University of Toronto";English;"Don?t repeat dual energy X-ray absorptiometry (DEXA) scans more often than every 2 years.";"The use of repeat DEXA scans at intervals of every 2 years is appropriate in most clinical settings, and is supported by several current osteoporosis guidelines. Because of limitations in the precision of testing, a minimum of 2 years may be needed to reliably measure a change in BMD. If bone mineral densities are stable and/or individuals are at low risk of fracture, then less frequent monitoring up to an interval of 5-10 years can be considered. Shorter or longer intervals between repeat DEXA scans may be appropriate based on expected rate of change in bone mineral density and fracture risk.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2719;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2014;349:g5105";English;"Extending the age of breast cancer screening from 50-70 to the other ages is not necessary.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"C�ncer, Breast, Screening";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2975;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Radioterapia Oncologica (AIRO)";English;"Don?t perform radiation therapy treatment for degenerative joint disease (benign), especially under the age of 60.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Radiotherapy;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1952;19;"Choosing Wisely Canada";"Canadian Rheumatology Association -Canadian Medical Association - University of Toronto";English;"Don?t prescribe bisphosphonates for patients at low risk of fracture.";"There is no convincing evidence that anti-osteoporotic therapy in patients with osteopenia alone reduces fracture risk. The 2008 Cochrane Reviews for three bisphosphonates (Alendronate, Etidronate, Risedronate) found no statistically significant reductions for primary prevention of fracture in postmenopausal women. Fracture risk is determined using either the Canadian Association of Radiologists and Osteoporosis Canada risk assessment tool (CAROC) or FRAX�, a World Health Organization fracture risk assessment tool. Both are available as online calculators of fracture risk. Given the lack of proven efficacy, widespread use of bisphosphonates in patients at low risk of fracture is not currently recommended.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2464;6;"Less Is More Collection - JAMA Network";"Berkowitz S, et al.JAMA Intern Med. 2014;174(12):1955-1962";English;"Initial Choice of Oral Glucose-Lowering Medication for Diabetes Mellitus. A Patient-Centered Comparative Effectiveness Study.";"Despite guidelines, only 57.8% of individuals began diabetes treatment with metformin. Beginning treatment with metformin was associated with reduced subsequent treatment intensification, without differences in rates of hypoglycemia or other adverse clinical events. These findings have significant implications for quality of life and medication costs.

For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2720;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Martin S. BMJ 2014;349:g5432";English;"Mild hypertension in people at low risk";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Hypertension, Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2976;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Italiana di Radioterapia Oncologica (AIRO)";English;"Don?t perform PET, CT, and radionuclide bone scans in the staging of prostate cancer at low risk for metastasis in patients undergoing radical radiation therapy, except in a clinical research setting.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Prostate Cancer, Radiotherapy";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1953;19;"Choosing Wisely Canada";"Canadian Rheumatology Association -Canadian Medical Association - University of Toronto";English;"Don?t perform whole body bone scans (e.g., scintigraphy) for diagnostic screening for peripheral and axial arthritis in the adults.";"The diagnosis of peripheral and axial inflammatory arthritis can usually be made on the basis of an appropriate history, physical exam and basic investigations. Whole body bone scans, such as the Tc-99m MDP scintigraphy, lack specificity to diagnose inflammatory polyarthritis or spondyloarthritis and have limited clinical utility. This approach is cost-effective and reduces radiation exposure.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2721;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2014;349:g5688";English;"Margaret McCartney: We lack the tools to help patients decide about statins.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Statins;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1954;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine -Canadian Medical Association - University of Toronto";English;"Don?t routinely obtain neuro-imaging studies (CT, MRI, or carotid dopplers) in the evaluation of simple syncope in patients with a normal neurological examination.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2466;6;"Less Is More Collection - JAMA Network";"Tjia J et al. JAMA Intern Med. 2014;174(11):1763-1771.";English;"Use of Medications of Questionable Benefit in Advanced Dementia.";"Most nursing home residents with advanced dementia receive medications with questionable benefit that incur substantial associated costs.";2014;;;"Low value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2722;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hawkes N. BMJ 2014;349:g5712";English;"Treatment for advanced prostate cancer can turn from helpful to harmful, research shows";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Cancer, Prostate";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1699;2;"Choosing Wisely�";"American Psychiatric Association";English;"Don?t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1955;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine -Canadian Medical Association - University of Toronto";English;"Don?t place, or leave in place, urinary catheters without an acceptable indication (such as critical illness, obstruction, palliative care).";"Use of urinary catheters without an acceptable indication of use increases the likelihood of infection leading to greater morbidity and health care costs. Catheter-associated bacteriuria often leads to inappropriate antimicrobial use and secondary complications including emergence of antimicrobial-resistant organisms and infection with clostridium difficile. A previous study showed that physicians are often unaware of urinary catheterization among their patients. Use of urinary catheters has found to be inappropriate in up to 50% of cases, with urinary incontinence listed as the most common reason for inappropriate and continued placement of urinary catheters. Clinical practice guidelines support the removal or avoidance of unnecessary urinary catheters in order to reduce the risk of catheter-associated urinary tract infections (CAUTIs).";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2467;6;"Less Is More Collection - JAMA Network";"Roberts J, et al. JAMA Intern Med. 2014;174(11):1723-1724.";English;"Balanced Coagulopathy in Cirrhosis?Clinical Implications. A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2723;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hoffman J. BMJ 2014;349:g5702";English;"Intolerance of error and culture of blame drive medical excess";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Overuso;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1700;2;"Choosing Wisely�";"American Psychiatric Association";English;"Don?t routinely prescribe antipsychotic medications as a first-line intervention for insomnia in adults.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1956;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine -Canadian Medical Association - University of Toronto";English;"Don?t transfuse red blood cells for arbitrary hemoglobin or hematocrit thresholds in the absence of symptoms, active coronary disease, heart failure or stroke.";"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 circulatory overload, and sepsis. Studies of transfusion strategies among multiple patient populations suggest that a restrictive approach is associated with improved outcomes.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2468;6;"Less Is More Collection - JAMA Network";"Najafi N. JAMA Intern Med. 2014;174(11):1855-1856.";English;"A Call for Evidence-Based Telemetry Monitoring. The Beep Goes On.";"Technology evolves quickly; scientific evidence builds slowly. This is as true for inpatient cardiac telemetry monitoring as it is for other medical interventions. Telemetry was invented in 1949 and saw widespread use in the 1960s for detecting arrhythmias in patients with myocardial infarction. Today the use of telemetry is ubiquitous on medical and surgical wards, often for patients without active cardiac conditions.";2014;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n ""Less is More""" 2724;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;349:g5914";English;"Guidelines are often based on evidence not relevant to primary care, study finds";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Guidelines, Primary Care, Evidence";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1701;2;"Choosing Wisely�";"American Psychiatric Association";English;"Don?t routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina de la iniciativa" 1957;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine -Canadian Medical Association - University of Toronto";English;"In the inpatient setting, don?t order repeated CBC and chemistry testing in the face of clinical and lab stability.";"Repetitive inpatient blood testing occurs frequently and is associated with adverse consequences for the hospitalized patient such as iatrogenic anemia, and pain. A Canadian study showed significant hemoglobin reductions as a result of phlebotomy. Given that anemia in hospital patients is associated with increased length of stay, readmission rates and transfusion requirements, reducing unnecessary testing may improve outcomes. Studies support the safe reduction of repetitive laboratory testing without negative effects on adverse events, readmission rates, critical care utilization or mortality. Laboratory reduction interventions have also reported significant cost savings.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2469;6;"Less Is More Collection - JAMA Network";"Dressler R,et al. JAMA Intern Med. 2014;174(11):1852-1854";English;"Altering Overuse of Cardiac Telemetry in Non?Intensive Care Unit Settings by Hardwiring the Use of American Heart Association Guidelines.";"For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n ""Less is More""" 2725;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Arie S. BMJ 2014;349:g5791";English;"Child vaccination campaigns are suspended in Syria after 15 infants die.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Vaccine, Vaccination";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1958;19;"Choosing Wisely Canada";"Canadian Society of Internal Medicine -Canadian Medical Association - University of Toronto";English;"Don?t routinely perform preoperative testing (such as chest X-rays, echocardiograms, or cardiac stress tests) for patients undergoing low risk surgeries.";"Routine preoperative tests for low risk surgeries results in unnecessary delays, potential distress for patients and significant cost for the health care system. Numerous studies and guidelines outline lack of evidence for benefit in routine preoperative testing (e.g., chest X-ray, echocardiogram) in low risk surgical patients. Economic analyses suggest significant potential cost savings from implementation of guidelines.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2470;6;"Less Is More Collection - JAMA Network";"Patel P, et al. JAMA Intern Med. 2014;174(11):1725-1726";English;"Does My Patient Still Need This Central Venous Catheter?. A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Central Venous Catheter";"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la colecci�n ""Less is More""" 2726;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;349:g6054";English;"Decision to recommend drug to cut drink dependence proves controversial.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Alcohol, Drink, Dependence";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1703;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t initiate management of low-risk prostate cancer without discussing active surveillance.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1959;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada -Canadi";English;"Don?t do imaging for lower-back pain unless red fl ags are present.";"Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected. Imaging of the lower spine before six weeks does not improve outcomes.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inciativa
" 2471;6;"Less Is More Collection - JAMA Network";"Nambudiri V. JAMA Intern Med. 2014;174(11):1724-1725.";English;"More Than Skin Deep?The Costs of Antibiotic Overuse.A Teachable Moment";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2727;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ 2014;349:g6246";English;"Evening the score on sex drugs: feminist movement or marketing masquerade?";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Sexual dysfunction";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1704;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1960;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada -Canadi";English;"Don?t use antibiotics for upper respiratory infections that are likely viral in origin, such as infl uenza-like illness, or self-limiting, such as sinus infections of less than seven days of duration.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2472;6;"Less Is More Collection - JAMA Network";"Fenton J, et al. JAMA Intern Med. 2014;174(12):2032-2034";English;"Computer-Aided Detection in Mammography should be restricted since there is a potential risk of false positive and overdiagnosis.";"Since 2001, Medicare has reimbursed computer-aided detection (CAD) during screening mammography. The CAD software tool is used by radiologists to identify lesions suggestive of malignant disease. Research suggests that CAD use increases the rate of false-positive findings of screening mammography and the detection of ductal carcinoma in situ (DCIS). Increased DCIS detection could lead to overdiagnosis of breast cancer, particularly among older women at risk for competing causes of death. We estimated the fraction of diagnostic tests, DCIS treatments, and costs attributable to CAD dissemination within the Medicare population, among whom the risk for overdiagnosis may be elevated.";2014;;;"Low value";-;"Link to the article in the collection JAMA ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2728;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Heath I. BMJ 2014;349:g6123";English;"Role of fear in overdiagnosis and overtreatment?an essay by Iona Heath";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1961;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada -Canadi";English;"Don?t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients.";"There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low risk for coronary heart disease improves health outcomes. False positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment and misdiagnosis. Chest X-rays for asymptomatic patients with no specific indications for the imaging have a trivial diagnostic yield, but a significant number of false positive reports. Potential harms of such routine screening exceed the potential benefit.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2473;6;"Less Is More Collection - JAMA Network";"Maley J, et al. JAMA Intern Med. 2014;174(12):1890-1891";English;"Acute Renal Failure Following Treatment of a Common Culture Contaminant. A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2729;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Mayor C. BMJ 2014;349:g7430";English;"Prehospital use of adrenaline reduces survival in cardiac arrest, study finds";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Adrenaline, Cardiac Arrest";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1706;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely use intensity modulated radiotherapy (IMRT) to deliver whole breast radiotherapy as part of breast conservation therapy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1962;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada -Canadi";English;"Don?t screen women with Pap smears if under 21 years of age or over 69 years of age.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2474;6;"Less Is More Collection - JAMA Network";"Murphy E, et al. Published Online: October 13, 2014.";English;"Doubts About Treating Hypogonadism Due to Long-term Opioid Use With Testosterone Therapy. A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2730;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2014;349:g7480";English;"Margaret McCartney: Industry?s interest in diagnosing more dementia";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Dementia, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1707;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform routine diagnostic laparoscopy for the evaluation of unexplained infertility.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1963;19;"Choosing Wisely Canada";"CMA?s Forum on General and Family Practice Issues and College of Family Physicians of Canada -Canadi";English;"Don?t do annual screening blood tests unless directly indicated by the risk pro file of the patient.";"There is little evidence to indicate there is value in routine blood tests in asymptomatic patients; instead, this practice is more likely to produce false positive results that may lead to additional unnecessary testing. The decision to perform screening tests, and the selection of which tests to perform, should be done with careful consideration of the patient?s age, sex and any possible risk factors.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2475;6;"Less Is More Collection - JAMA Network";"Brett A, et al. JAMA Intern Med. 2014;174(12):2004-2008.";English;"It is potentially not recommended to perform carotid imaging in patients without a history of carotid-territory stroke or transient ischemic attack.";"There is currently no role for carotid imaging in patients without a history of carotid-territory stroke or transient ischemic attack.";2014;;;"Low value";-;"Link to the article in the collection JAMA ""Less is More"" / Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2731;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Goodnough L. BMJ 2014;349:g6897";English;"Do liberal blood transfusions cause more harm than good?";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Transfusion;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2987;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Allergy, Asthma and Clinical Immunology ? SIAAIC";English;"Don?t perform allergy tests for drugs (including anhestetics) and/or foods when there are not clinical history and symptoms suggestive of hypersensitivity reactions.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Allergy Tests";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1708;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform advanced sperm function testing, such as sperm penetration or hemizona assays, in the initial evaluation of the infertile couple.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1964;20;"Choosing Wisely Netherlands Campaign";"Association of Surgeons - Society of Dermatology and Venereology - Dutch OMS Association - ZonMw";English;"In patients with an acute wound, do not clean a wound with (sterile) saline solution.";"Acute wounds only need to be cleansed when the wound is open and contaminated with dirt. In that case, it can be cleansed by rinsing it with lukewarm (potable) tap water.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2476;6;"Less Is More Collection - JAMA Network";"Hamilton K, et al. JAMA Intern Med. 2014;174(12):1891-1892.";English;"In-Hospital Delirium While Awaiting Temporal Artery Biopsy.A Teachable Moment.";"For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Enlace a la publicaci�n en la colecci�n JAMA ""Less is More""" 2732;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Brunet M. BMJ 2014;349:g7235";English;"Target diagnosis rates in primary care are misleading and unethical";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Target, Primary Care";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2988;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Allergy, Asthma and Clinical Immunology ? SIAAIC";English;"Don?t perform the so-called ?food intolerance tests? (apart from those which are validated for suspect celiac disease or lactose enzymatic intolerance).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Food Intolerance Tests";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1709;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform a postcoital test (PCT) for the evaluation of infertility.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1965;20;"Choosing Wisely Netherlands Campaign";"Association of Surgeons in the Netherlands- Dutch Society of Dermatology and Venereology - Dutch OMS";English;"In patients with an acute wound, do not soak the wound in a bath containing a detergent.";"Using a basin of water containing soap or cleansing agents (soda, Biotex, etc.) to soak a wound on feet or hands will have a negative impact on the wound itself and the skin around it. This may increase the risk of infection and slow down the healing process.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2733;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2014;349:g6421";English;"Margaret McCartney: Just enough medicine for all";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2989;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Allergy, Asthma and Clinical Immunology ? SIAAIC";English;"Don?t perform serological allergy tests (i.e.: total IgE, specific IgE, ISAC) as first-line tests or as ?screening? assays.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Allergy Tests";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1710;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t routinely order thrombophilia testing on patients undergoing a routine infertility evaluation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1966;20;"Choosing Wisely Netherlands Campaign";"Association of Surgeons in the Netherlands- Dutch Society of Dermatology and Venereology - Dutch OMS";English;"In patients with an acute wound, do not bandage a primary closure wound.";"Covering a surgically closed wound with dressings after an incision does not lead to fewer wound infections. Changing bandages that adhere to the wound may also be painful. Cover the wound only if it is leaking fluids, if it needs protection from abrasive clothing, or if the patient does not want to see the wound.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2734;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wise J. BMJ 2014;349:g7641";English;"One in 10 women in England takes antidepressants, survey shows";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Depression, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2990;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Allergy, Asthma and Clinical Immunology ? SIAAIC";English;"Don?t treat patients sensitized to allergens or aptens if there is not a clear correlation between exposure to that specific allergen/apten and symptoms suggestive of allergic reaction. This recommendation is particularly strong for allergen immunotherapy";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Allergens, Aptens";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1711;2;"Choosing Wisely�";"American Society for Reproductive Medicine";English;"Don?t perform immunological testing as part of the routine infertility evaluation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1967;20;"Choosing Wisely Netherlands Campaign";"Association of Surgeons in the Netherlands- Dutch Society of Dermatology and Venereology - Dutch OMS";English;"In patients with an acute wound, do not use expensive dressings if gauze is sufficient.";"A non-adhesive gauze dressing (coated in ointment or paraffin) is sufficient for many wounds, including post-operative incisions, lacerations, skin tears or bite wounds.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2735;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Lenzer J. BMJ 2014;349:g7677";English;"US could recycle 10 million unused prescription drugs a year, report says";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Drugs;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2991;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"The Italian Society of Allergy, Asthma and Clinical Immunology ? SIAAIC";English;"Don?t diagnose asthma without having performed lung function tests (including bronchodilating test and/or bronchial challenge).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";Asthma;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1712;2;"Choosing Wisely�";"American Society of Anesthesiologists";English;"Don?t obtain baseline laboratory studies in patients without significant systemic disease (ASA I or II) undergoing low-risk surgery*";"*Specifically complete blood count, basic or comprehensive metabolic panel, coagulation studies when blood loss (or fluid shifts) is/are expected to be minimal.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";preoperative;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1968;20;"Choosing Wisely Netherlands Campaign";"Association of Surgeons in the Netherlands- Dutch Society of Dermatology and Venereology - Dutch OMS";English;"In patients with an acute wound, never send a patient home without wound care instructions.";"A patient with a surgically closed wound may take a shrt shower 24 hours after surgery (but should not shower longer than 10 minutes). Tell the patient what to do if signs of infection appear. Also give the patient instructions about when and how he or she can resume using the body part where the wound is located.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2736;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2014;349:g7817";English;"Massachusetts requires doctors to inform patients about end of life options";"For further information please visit the website of the initiative (link below)";2014;;;"High value";"Palliative Care";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1713;2;"Choosing Wisely�";"American Society of Anesthesiologists";English;"Don?t obtain baseline diagnostic cardiac testing* or cardiac stress testing in asymptomatic stable patients with known cardiac disease** undergoing low or moderate risk non-cardiac surgery.";"*(trans-thoracic/ esophageal echocardiography ? TTE/TEE). **e.g., CAD, valvular disease

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1969;20;"Choosing Wisely Netherlands Campaign";"Dutch Society of Neurosurgery - Dutch OMS Association - ZonMw";English;"In lumbosacral radicular syndrome based on a herniated lumbar disc, do not operate a herniated disc if the only symptom is low back pain.";"If back pain is the sole or primary symptom, lumbar herniated disc surgery is not advisable. A herniated lumbar disc is almost always accompanied by back pain, but pain almost always radiates to the leg as well. An operation will almost certainly eliminate the leg pain (sciatic pain), but rarely affects the back pain unless it is part of the radicular pain pattern.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 1714;2;"Choosing Wisely�";"American Society of Anesthesiologists";English;"Don?t use pulmonary artery catheters (PACs) routinely for cardiac surgery in patients with a low risk of hemodynamic complications*";"*(especially with the concomitant use of alternative diagnostic tools (e.g., TEE).

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1970;20;"Choosing Wisely Netherlands Campaign";"Dutch Society of Neurosurgery - Dutch OMS Association - ZonMw";English;"In lumbosacral radicular syndrome based on a herniated lumbar disc, do not operate if leg pain is brief (<6 weeks), but do not wait too long either (>6 months).";"Research does show that lumbar herniated dis surgery achieves the optimal results if surgery takes place between 3 and 6 months after the start of leg pain symptoms. In nearly all cases, pain caused by a herniated disc resolves by itself within 6 to 18 weeks. If a patient and his/her doctor waits too long to decide for surgery in case of severe nerve pain in a leg, the results of the operation are often less optimal. This is probably due to neural damage by chronic compression of the nerve by a non-resolving herniation of the disc.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 5298;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"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 disturbance and/or weakness, problems with balance, unsteadiness or clumsiness, altered sensation travelling down the back and sometimes into the limbs when bending the neck forwards (Lhermitte's symptom).";"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 focal neurological symptoms or signs. Before referring a person suspected of having MS to a neurologist, exclude alternative diagnoses by performing blood tests including: full blood count, inflammatory markers for example erythrocyte sedimentation rate, C?reactive protein, liver function tests, renal function tests, calcium, glucose, thyroid function, tests vitamin B12, HIV serology. Do not diagnose MS on the basis of MRI findings alone. Refer people suspected of having MS to a consultant neurologist. Speak to the consultant neurologist if you think a person needs to be seen urgently. Only a consultant neurologist should make the diagnosis of MS on the basis of established up?to?date criteria, such as the revised 2010 McDonald criteria[2], after: assessing that episodes are consistent with an inflammatory process excluding alternative diagnoses establishing that lesions have developed at different times and are in different anatomical locations for a diagnosis of relapsing?remitting MS establishing progressive neurological deterioration over 1 year or more for a diagnosis of primary progressive MS. If a person is suspected[2] of having MS but does not fulfil the diagnostic criteria, plan a review. Discuss the timing of the review with the person and ensure they know who to contact for advice if they develop further neurological symptoms or if current symptoms worsen. Offer people suspected of having MS, information about support groups and national charities. Optic neuritis and neuromyelitis optica If a person has an episode of isolated optic neuritis, confirmed by an ophthalmologist, refer them to a consultant neurologist for further assessment. Diagnosis of neuromyelitis optica should be made by an appropriate specialist based on established up?to?date criteria. (...)";2014;;;"High value";"Multiple Sclerosis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1715;2;"Choosing Wisely�";"American Society of Anesthesiologists";English;"Don?t administer packed red blood cells (PRBCs) in a young healthy patient without ongoing blood loss and hemoglobin of ? 6 g/dL unless symptomatic or hemodynamically unstable.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1971;20;"Choosing Wisely Netherlands Campaign";"Dutch Society of Neurosurgery - Dutch OMS Association - ZonMw";English;"In lumbosacral radicular syndrome based on a herniated lumbar disc, do not request routine MRI of the lumbar spine during natural recovery or after disc surgery.";"Most patients with a lumbar hernia (90%) are symptom-free again within 6-18 weeks. If a herniated lumbar disc is suspected based on sciatic leg pain, there is no point in doing an MRI scan at this stage.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";"magnetic resonance";"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1716;2;"Choosing Wisely�";"American Society of Anesthesiologists";English;"Don?t routinely administer colloid (dextrans, hydroxylethyl starches, albumin) for volume resuscitation without appropriate indications.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1972;20;"Choosing Wisely Netherlands Campaign";"Dutch Society of Neurosurgery - Dutch OMS Association - ZonMw";English;"In lumbosacral radicular syndrome based on a herniated lumbar disc, do not operate if the pain dermatome does not correspond to the compressed nerveroot.";"Compression of a nerve root can only cause pain in the specified area served by that nerve in a part of the skin (known as the dermatome). However, pain sometimes radiates to a completely different area of the limb not corresponding to level and site of MRI findings. In that case, an operation will not resolve the pain, but identifying the cause of the pain advanced diagnostic is recommended.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 1717;2;"Choosing Wisely�";"American Association for the Study of Liver Diseases";English;"Don?t perform surveillance esophagogastroduodenoscopy in patients with compensated cirrhosis and small varices without red signs treated* for preventing a first variceal bleed.";"*Treated with non-selective beta blockers

For further information please visit the website of the initiative (link below)";2014;;;"Low value";EGD;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1973;20;"Choosing Wisely Netherlands Campaign";"Dutch Society of Neurosurgery - Dutch OMS Association - ZonMw";English;"In lumbosacral radicular syndrome based on a herniated lumbar disc, only apply new surgical techniques for herniated lumbar discs in randomized clinical trials.";"Surgical techniques for operating on a lumbar herniated disc are in constant development. A new technique, however, should not be applied until it has been confirmed to be safe and effective.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 1718;2;"Choosing Wisely�";"American Association for the Study of Liver Diseases";English;"Don?t continue treatment for hepatic encephalopathy indefinitely after an initial episode with an identifiable precipitant.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1974;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Internal Medicine -Dutch OMS Association - ZonMw";English;"Do not draw blood samples more than twice weekly on the inpatient ward unless strictly indicated.";"Not drawing blood samples more frequent than necessary, is patient-friendly without compromising the quality and safety of the treatment. Less diagnostics tests are considerably cheaper

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2486;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid instituting intravenous (IV) fluids before doing a trial of oral rehydration therapy in uncomplicated emergency department cases of mild to moderate dehydration in children.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1719;2;"Choosing Wisely�";"American Association for the Study of Liver Diseases";English;"Don?t repeat hepatitis C viral load testing outside of antiviral therapy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina de la iniciativa
" 1975;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Internal Medicine -Dutch OMS Association - ZonMw";English;"Avoid inserting indwelling urinary catheters in stable patients in the A&E Department who have spontaneous diuresis.";"Inserting urinary catheters is associated with the risk of hospital acquired urinary tract infection and additional costs. Catheter-associated urinary tract infections are a common problem in Dutch hospitals.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Enlace a la recomendaci�n (archivo PDF de la p�gina web de Choosing Wisely Netherlands Campaign)

Enlace a la p�gina web de Choosing Wisely Netherlands Campaign

" 2487;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid CT of the head in asymptomatic adult patients in the emergency department with syncope, insignificant trauma and a normal neurological evaluation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1720;2;"Choosing Wisely�";"American Association for the Study of Liver Diseases";English;"Don?t perform computed tomography or magnetic resonance imaging routinely to monitor benign focal lesions in the liver unless there is a major change in clinical findings or symptoms.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1976;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Internal Medicine -Dutch OMS Association - ZonMw";English;"Do not test for hereditary thrombophilia after the first thrombo-embolic event.";"The result of the clotting test will not influence the instigated treatment. In addition, it avoids unnecessary screening and thus worries for the patient and his/her family if the result turns out positive. Not doing this test is patient-friendly and saves money.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2232;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Patients with mild major depressive episode should not be treated with antidepressant drugs in the initial phase, unless they have a history of moderate or severe depressive episodes.";-;2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial
" 2488;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid CT pulmonary angiography in emergency department patients with a low-pretest probability of pulmonary embolism and either a negative Pulmonary Embolism Rule-Out Criteria (PERC) or a negative D-d";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1721;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Use appropriate dosis of antiemetic drugs in patients starting on a chemotherapy regimen, acording to the risk of nausea and vomiting";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1977;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Internal Medicine -Dutch OMS Association - ZonMw";English;"Switch from intravenous to oral antibiotics as soon as possible and consider discharging the patient.";"Early switch from intravenous administration of antibiotics to taking tablets is evidence based and safe. An earlier switch is patient-friendly, means less work for nursing staff and leads to considerable cost savings. An additional advantage is that the patient can be discharged earlier, which is not only better for the patient but saves even more money.

For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"

Enlace a la recomendaci�n (archivo PDF de la p�gina web de Choosing Wisely Netherlands Campaign)

Enlace a la p�gina web de Choosing Wisely Netherlands Campaign

" 2233;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"The full column radiographic studies should not be routinely performed in patients with suspected idiopathic scoliosis.*";"* Also in the clinical monitoring of the patient with idiopathic scoliosis, the not-optimized radiographic techniques should not be used.";2014;;;"Low value";-;"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web Essencial" 2489;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid lumbar spine imaging in the emergency department for adults with non-traumatic back pain unless the patient has a serious neurologic deficits or is suspected of having a serious condition.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1722;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t perform PSA testing for prostate cancer screening in men with no symptoms of the disease when they are expected to live less than 10 years.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";screening;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1978;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Internal Medicine -Dutch OMS Association - ZonMw";English;"Avoid standard abdominal X-rays of patients with abdominal pain in the A&E Department.";"Acute abdominal pain is a very common reason for presentation at the A&E department. It?s important to establish the correct diagnosis in a rapid and reliable way. After taking a history of the symptoms and performing a physical examination, X-rays, ultrasound and CT scans may support the physician.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2234;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients with prostate cancer without clinical progression and a favorable response to induction therapy with continuous hormonal therapy, is not recommended routinely maintain this treatment.";-;2014;;;"Low value";"cancer, neoplasm";"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web de Essencial" 2490;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid prescribing antibiotics in the emergency department for uncomplicated sinusitis.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1723;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t use combination chemotherapy (multiple drugs) instead of chemotherapy with one drug when treating an individual for metastatic breast cancer*";"*Unless the patient needs a rapid response to relieve tumor-related symptoms.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1979;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Pediatrics -Dutch OMS Association - ZonMw";English;"In children aged 0-18 years with gastroesophageal reflux disease, Do not perform a gastroscopy to confirm GERD.";"Gastroesophageal reflux (GER) is the passive movement of gastric contents into the esophagus. GERD is defined as GER causing troublesome symptoms and complications. Gastroscopy should not be performed to confirm the diagnosis, unless: ? red-flag symptoms (such as failure to thrive) are present that could indicate a cause other than GERD, such as eosinophilic esophagitis (chronic inflammation of the esophagus); ? surgery is required after drug therapy has failed; ? patient is suffering from therapy-resistant reflux disease.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2491;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid ordering CT of the abdomen and pelvis in healthy emergency department patients (age <50) with symptoms consistent with renal colic and with known histories of kidney stones, or ureterolithiasis.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1724;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Avoid using PET or PET-CT scanning as part of routine follow-up care to monitor for a cancer recurrence in asymptomatic patients who have finished initial treatment to eliminate the cancer*";"*Unless there is high-level evidence that such imaging will change the outcome.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1980;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Pediatrics -Dutch OMS Association - ZonMw";English;"In children aged 0-18 years with gastroesophageal reflux disease, gastric acid inhibitors should not be the standard treatment for reflux disease.";"In infants with reflux symptoms, diagnosis can usually be made based on a comprehensive medical history and physical examination. PH-metry (to measure the efficacyof gastric acid inhibitors) can be a good test for children who are unable to communicate their symptoms clearly. PH-metry can also help confirming the diagnosis in adolescents with therapy-resistant reflux disease.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2492;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t initiate whole breast radiotherapy as a part of breast conservation therapy in women age >50 with early stage invasive breast cancer without considering shorter treatment schedules.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1725;2;"Choosing Wisely�";"American Association for the Study of Liver Diseases";English;"Don?t routinely transfuse fresh frozen plasma and platelets prior to abdominal paracentesis or endoscopic variceal band ligation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1981;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Pediatrics -Dutch OMS Association - ZonMw";English;"In children aged 0-18 years with gastroesophageal reflux disease, X-rays are not the best option to confirm the diagnosis of reflux disease.";"Due to low sensitivity and specificity, it is better not to use X-rays to diagnose reflux disease. X-rays can be used to exclude anatomical abnormalities that have the same symptoms as reflux disease, such as malrotation and volvulus (twisting). An X-ray and gastroscopy are always required before an anti-reflux operation.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2493;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t initiate management of low-risk prostate cancer without discussing active surveillance.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1726;2;"Choosing Wisely�";"American Association of Blood Banks";English;"Don?t transfuse more units of blood than absolutely necessary.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1982;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Pediatrics -Dutch OMS Association - ZonMw";English;"In children aged 0-18 years with gastroesophageal reflux disease, gastric acid inhibitors should not be the standard treatment for reflux disease.";"Reflux is a normal physiological phenomenon that occurs several times a day in healthy infants, children and adults. There is a difference in the therapeutic approach for infants (aged 0 to 18 months) and for older children (aged 18 months to 18 years). Guiding principle is that drug therapy for reflux disease is only an option in exceptional cases (if one or more red-flag symptoms are present) for a period of three months. In such cases, treat younger children with ranitidine or PPIs and treat older children with PPIs. Always evaluate after 2-4 weeks.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2494;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely use extended fractionation schemes (>10 fractions) for palliation of bone metastases.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1727;2;"Choosing Wisely�";"American Association of Blood Banks";English;"Don?t transfuse red blood cells for iron deficiency without hemodynamic instability.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1983;20;"Choosing Wisely Netherlands Campaign";"Dutch Association of Pediatrics -Dutch OMS Association - ZonMw";English;"In children aged 0-18 years with gastroesophageal reflux disease, first evaluate, then continue.";"Drug therapy should be evaluated after 2-4 weeks. The dosage may be adjusted after evaluation. If the prescribed medication is not having the desired effect, another drug may be prescribed.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2495;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely recommend proton beam therapy for prostate cancer outside of a prospective clinical trial or registry.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1728;2;"Choosing Wisely�";"American Association of Blood Banks";English;"Don?t routinely use blood products to reverse warfarin.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiaitve / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1984;20;"Choosing Wisely Netherlands Campaign";"Dutch Urological Association -Dutch OMS Association - ZonMw";English;"Do not perform a bone scan on a patient with prostate cancer when there is a low probability that the cancer has spread.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2496;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely use intensity modulated radiotherapy (IMRT) to deliver whole breast radiotherapy as part of breast conservation therapy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1729;2;"Choosing Wisely�";"American Association of Blood Banks";English;"Don?t perform serial blood counts on clinically stable patients.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1985;20;"Choosing Wisely Netherlands Campaign";"Dutch Urological Association -Dutch OMS Association - ZonMw";English;"Do not administer antibiotics to a patient with prostatitis without fever, unless the urine sample shows bacterial growth.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2497;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t recommend radiation following hysterectomy for endometrial cancer patients with low-risk disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1730;2;"Choosing Wisely�";"American Association of Blood Banks";English;"Don?t transfuse O negative blood except to O negative patients and in emergencies for women of child bearing potential with unknown blood group.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1986;20;"Choosing Wisely Netherlands Campaign";"Dutch Urological Association -Dutch OMS Association - ZonMw";English;"A scrotal ultrasound should not be standard practice for boys with an undescended testicle.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2498;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely offer radiation therapy for patients who have resected non-small-cell lung cancer (NSCLC) negative margins N0-1 disease";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1731;2;"Choosing Wisely�";"Society of Gynecologic Oncology";English;"Don?t delay basic level palliative care for women with advanced or relapsed gynecologic cancer, and when appropriate, refer to specialty level palliative medicine.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1987;20;"Choosing Wisely Netherlands Campaign";"Dutch Urological Association -Dutch OMS Association - ZonMw";English;"An abdominal CT scan should not be standard practice in patients with microscopic hematuria.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2499;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t initiate non-curative radiation therapy without defining the goals of treatment with the patient and considering palliative care referral.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1732;2;"Choosing Wisely�";"Society of Gynecologic Oncology";English;"Avoid routine imaging for cancer surveillance in women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1988;20;"Choosing Wisely Netherlands Campaign";"Dutch Urological Association -Dutch OMS Association - ZonMw";English;"An abdominal ultrasound or cystoscopy should not be standard practice for recurring bladder infections.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"

Link to the recommendation (PDF file of the Choosing Wisely Netherlands Campaign's website)

Link to the website Choosing Wisely Netherlands Campaign

" 2500;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely recommend follow-up mammograms more often than annually for women who have had radiotherapy following breast conserving surgery.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1733;2;"Choosing Wisely�";"Society of Gynecologic Oncology";English;"Don?t perform colposcopy in patients treated for cervical cancer with Pap tests of low-grade squamous intraepithelial lesion (LGSIL) or less.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1989;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended to routinely apply the Ottawa knee rules for traumatic injuries in the emergency room.";"Acute traumatic knee injuries are a very common reason for presentation at the emergency room, and in most cases a X-ray is performed (usually two projections) for studying the presence of a bone injury. However, only a small proportion of cases demonstrate a clinically significant bone fracture (<7%).

The routine application of the rules of Ottawa is recommended and it is strongly recommended training all emergency personnel COT, especially less experienced staff and external personnel.";2014;;;"High value";-;"Link to the full text of the recommendation" 2501;2;"Choosing Wisely�";"American Society for Radiation Oncology";English;"Don?t routinely add adjuvant whole brain radiation therapy to stereotactic radiosurgery for limited brain metastases.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1734;2;"Choosing Wisely�";"Society of Gynecologic Oncology";English;"Don?t perform Pap tests for surveillance of women with a history of endometrial cancer.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1990;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended to routinely apply the Ottawa ankle rules for traumatic ankle and mid-foot injuries in the emergency room.";"Acute traumatic ankle and mid-foot injuries are a very common reason for presentation at the emergency room, and in most cases a X-ray is performed (usually two projections) for studying the presence of a bone injury. However, only a small proportion of cases demonstrate a clinically significant bone fracture (<15% in ankle injuries).

The routine application of the Ottawa ankle rules is recommended and it is strongly recommended training all emergency personnel COT, especially less experienced staff and external personnel.";2014;;;"High value";-;"Link to the full text of the recommendation" 2502;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t transfuse more than the minimum number of red blood cell units necessary to relieve symptoms or to return a patient to a safe hemoglobin range (7-8 g/dL in stable, non-cardiac in-patients).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1735;2;"Choosing Wisely�";"Society of Gynecologic Oncology";English;"Don?t screen low risk women with CA-125 or ultrasound for ovarian cancer.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1991;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended not to prescribe drugs in patients older than 75 years when efficacy or safety profile could be unsuitable, it is recommended to always choose safer alternatives.";"The inappropriate prescribing (IP) of drugs is a common problem in older people and carries a significant risk to patients. The IP also increases unnecessary and inappropriate spending. It is recommended to use criteria of inappropriate drugs in patients older than 75 years.";2014;;;"Low value";-;"Link to the full text of the recommendation" 2503;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t test for thrombophilia in adult patients with venous thromboembolism (VTE) occurring in the setting of major transient risk factors (surgery, trauma or prolonged immobility).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1736;2;"Choosing Wisely�";"Society of General Internal Medicine";English;"Don?t place, or leave in place, peripherally inserted central catheters for patient or provider convenience.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1992;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended to take into account age, comorbidity and the complexity of the procedure when deciding to perform a diagnosis test in a low risk patient during the preoperative assessment.";"Clinical studies point to the importance of patient age and comorbidity, in addition to the complexity of the intervention, as the main factors to consider in deciding the suitability of a preoperative test. There are tables that summarize the appropriateness of various preoperative tests, taking into account on the aforementioned characteristics.";2014;;;"High value";-;"Link to the full text of the recommendation" 2504;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t use inferior vena cava (IVC) filters routinely in patients with acute venous thromboembolism (VTE).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3016;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"Don?t recommend Enteral Artificial Nutrition through Percutaneous Endoscopic Gastrostomy (PEG) or nasogastric tube in patients with advanced dementia; instead, offer oral assisted feeding.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Enteral Artificial Nutrition, Dementia";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1737;2;"Choosing Wisely�";"Society of General Internal Medicine";English;"Don?t recommend cancer screening in adults with life expectancy of less than 10 years.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2505;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t administer plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the conversation on the website of the initiative / Enlace a la conversaci�n en la p�gina web de la iniciativa" 3017;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"Don?t use antipsychotics as a first choice to treat behavioral symptoms of dementia. Identifying and addressing causes of behavior change can make treatment unnecessary.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Antipsychotics, Dementia";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1738;2;"Choosing Wisely�";"Society of General Internal Medicine";English;"Don?t perform routine pre-operative testing before low-risk surgical procedures.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2506;2;"Choosing Wisely�";"American Society of Hematology";English;"Limit surveillance computed tomography (CT) scans in asymptomatic patients following curative-intent treatment for aggressive lymphoma.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3018;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"Don?t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Benzodiazepines, Insomnia";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1739;2;"Choosing Wisely�";"Society of General Internal Medicine";English;"Don?t perform routine general health checks for asymptomatic adults.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2507;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t routinely transfuse patients with sickle cell disease (SCD) for chronic anemia or uncomplicated pain crisis without an appropriate clinical indication.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3019;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"In documented clinical and radiological evidence of dementia, don't ask for brain SPECT (single-photon emission computed tomography) or 18-FDG PET (fluorodeoxyglucose positron emission tomography) or PET (positron emission tomography) with amyloid markers";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Dementia, SPECT, 18-FDG PET, PET";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1740;2;"Choosing Wisely�";"Society of General Internal Medicine";English;"Don?t recommend daily home finger glucose testing in patients with Type 2 diabetes mellitus not using insulin.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2508;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t perform baseline or routine surveillance computed tomography (CT) scans in patients with asymptomatic, early-stage chronic lymphocytic leukemia (CLL).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3020;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Cochrane Neurological Field (CNF)";English;"In subjects asymptomatic for cognitive impairment, even in familial recurrence, or in patients with memory complaints without any neuropsychological evidence, don't ask for brain PET (positron emission tomography) with amyloid markers.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"Cognitive Impairment, Brain PET";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1741;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t use progestogens for preterm birth prevention in uncomplicated multifetal gestations.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2509;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t test or treat for suspected heparin-induced thrombocytopenia (HIT) in patients with a low pre-test probability of HIT.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1742;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t screen for intrauterine growth restriction (IUGR) with Doppler blood flow studies.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2510;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a very low platelet count.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de lainiciativa" 1743;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t offer noninvasive prenatal testing (NIPT) to low-risk patients or make irreversible decisions based on the results of this screening test.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2511;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t automatically initiate continuous electronic fetal heart rate (FHR) monitoring during labor for women without risk factors; consider intermittent auscultation (IA) first.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1744;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t place a cerclage in women with short cervix who are pregnant with twins.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2512;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t let older adults lay in bed or only get up to a chair during their hospital stay.";"For further information please visit the website of the initiative (link below)";2014;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1745;2;"Choosing Wisely�";"Society for Maternal-Fetal Medicine";English;"Don?t do an inherited thrombophilia evaluation for women with histories of pregnancy loss, intrauterine growth restriction (IUGR), preeclampsia and abruption.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2513;2;"Choosing Wisely�";"American Academy of Nursing";Spanish;"Don?t use physical restraints with an older hospitalized patient.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1746;2;"Choosing Wisely�";"Society for Cardiovascular Magnetic Resonance";English;"Don?t perform coronary CMR in the initial evaluation of asymptomatic patients.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2514;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t wake the patient for routine care unless the patient?s condition or care specifically requires it.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1747;2;"Choosing Wisely�";"Society for Cardiovascular Magnetic Resonance";English;"Don?t perform coronary CMR in symptomatic patients with a history of coronary stents.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2515;2;"Choosing Wisely�";"American Academy of Nursing";English;"Don?t place or maintain a urinary catheter in a patient unless there is a specific indication to do so.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1748;2;"Choosing Wisely�";"Society for Cardiovascular Magnetic Resonance";English;"Don?t perform stress CMR in patients with acute chest pain and high probability of coronary artery disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gia web de la iniciativa" 2516;2;"Choosing Wisely�";"American Academy of Physical Medicine and Rehabilitation";English;"Don?t order repeat epidural steroid injections without evaluating the individual?s response to previous injections.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5844;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is evidence that pharmacist-led patient counseling appears to have some benefits";"In this systematic review, the authors searched for randomized trials of pharmacist-delivered counseling or education interventions. They restricted their search to articles published in English, Spanish or Portuguese between 1990 and 2013. They included 101 studies, which they judged to be of generally inadequate quality. The included studies suggest that pharmacist-led interventions produce health improvements in diabetes, asthma, lipid profile, Helicobacter pylori infection, heart conditions, weight loss, pulmonary function improvement, tobacco cessation, depression, schizophrenia, kidney and osteoporosis. The included studies suggest that clinical pharmacist-led interventions improved quality of life and patients? satisfaction with service and led to increased physical activity and consumption of nutritive food and smoking cessation. The relative effects of different types of pharmacist-led interventions (e.g. written or verbal) and the effects for different types of person are uncertain.";2014;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1749;2;"Choosing Wisely�";"Society for Cardiovascular Magnetic Resonance";English;"Don?t perform stress CMR as a pre-operative assessment in patients scheduled to undergo low-risk, non-cardiac surgery";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2517;2;"Choosing Wisely�";"American Academy of Physical Medicine and Rehabilitation";English;"Don?t order an EMG for low back pain unless there is leg pain or sciatica.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1750;2;"Choosing Wisely�";"Society for Cardiovascular Magnetic Resonance";English;"Don?t perform stress cardiovascular magnetic resonance (CMR) in the initial evaluation of chest pain patients with low pretest probability of coronary artery disease.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2518;2;"Choosing Wisely�";"American Academy of Physical Medicine and Rehabilitation";English;"Don?t prescribe bed rest for acute localized back pain without completing an evaluation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the iniatiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1751;2;"Choosing Wisely�";"Heart Rhythm Society";English;"Don?t use Vaughan-Williams Class Ic antiarrhythmic drugs as a first-line agent for the maintenance of sinus rhythm in patients with ischemic heart disease and prior myocardial infarction.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gian web de la iniciativa" 2519;2;"Choosing Wisely�";"American Academy of Physical Medicine and Rehabilitation";English;"Don?t order an imaging study for back pain without performing a thorough physical examination.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1752;2;"Choosing Wisely�";"Heart Rhythm Society";English;"Don?t ablate the atrioventricular node in patients with atrial fibrillation when both symptoms and heart rate are acceptably controlled by well-tolerated medical therapy.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2520;2;"Choosing Wisely�";"American Academy of Physical Medicine and Rehabilitation";English;"Don?t prescribe opiates in acute disabling low back pain before evaluation and a trial of other alternatives is considered.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina de la iniciativa" 1753;2;"Choosing Wisely�";"Heart Rhythm Society";English;"Don?t implant an ICD for the primary prevention of sudden cardiac death in patients unlikely to survive at least one year due to non-cardiac comorbidity.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2265;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request Magnetic Resonance Imaging as a screening test for diagnosis and monitoring of peripheral arthritis";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2521;2;"Choosing Wisely�";"American Academy of Sleep Medicine";English;"Avoid polysomnography in chronic insomnia patients unless symptoms suggest a comorbid sleep disorder.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1754;2;"Choosing Wisely�";"Heart Rhythm Society";English;"Don?t implant an implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death in patients with NYHA* Functional Class IV who are not candidates for other options**";"*NYHA= New York Heart Association **Either cardiac transplantation, a left ventricular assist device as destination therapy or cardiac resynchronization therapy (CRT).

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"http://www.choosingwisely.org/doctor-patient-lists/heart-rhythm-society/" 2522;2;"Choosing Wisely�";"American Academy of Sleep Medicine";English;"Avoid use of hypnotics as primary therapy for chronic insomnia in adults; instead offer cognitive-behavioral therapy, and reserve medication for adjunctive treatment when necessary.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1755;2;"Choosing Wisely�";"Heart Rhythm Society";English;"Don?t implant pacemakers for asymptomatic sinus bradycardia in the absence of other indications for pacing.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2523;2;"Choosing Wisely�";"American Academy of Sleep Medicine";English;"Don?t prescribe medication to treat childhood insomnia, which usually arises from parent-child interactions and responds to behavioral intervention.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1756;2;"Choosing Wisely�";"Endocrine Society and American Association of Clinical Endocrinologists";English;"Don?t prescribe testosterone therapy unless there is biochemical evidence of testosterone deficiency.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2524;2;"Choosing Wisely�";"American Academy of Sleep Medicine";English;"Don?t use polysomnography to diagnose restless legs syndrome, except rarely when the clinical history is ambiguous and documentation of periodic leg movements is necessary.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1757;2;"Choosing Wisely�";"Endocrine Society and American Association of Clinical Endocrinologists";English;"Don?t order a total or free T3 level when assessing levothyroxine (T4) dose in hypothyroid patients.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2525;2;"Choosing Wisely�";"American Academy of Sleep Medicine";English;"Don?t perform positive airway pressure re-titration studies in asymptomatic, adherent sleep apnea patients with stable weight.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1758;2;"Choosing Wisely�";"Endocrine Society and American Association of Clinical Endocrinologists";English;"Don?t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2526;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"Don?t perform surgery for a bunion or hammertoes without symptoms.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1759;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"Avoid ordering a brain CT or brain MRI to evaluate an acute concussion unless there are progressive neurological symptoms, focal neurological findings or there is concern for a skull fracture.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2527;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"Don?t use shoe inserts for symmetric flat feet or high arches in patients without symptoms";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1760;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"Avoid ordering an abdominal ultrasound examination routinely in athletes with infectious mononucleosis.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2528;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"Don?t perform surgery for plantar fasciitis before trying six months of non-operative care.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1761;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"Don?t prescribe oral contraceptive pills as initial treatment for patients with amenorrhea or menstrual dysfunction due to the female athlete triad*";"*Defined as low energy availability with or without disordered eating, menstrual dysfunction and low bone mineral density.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2529;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"Avoid X-ray evaluation of the foot and ankle without standing (weightbearing) in the absence of injury.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1762;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"Avoid ordering a knee MRI for a patient with anterior knee pain without mechanical symptoms or effusion*";"*Unless the patient has not improved following completion of an appropriate functional rehabilitation program.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2530;2;"Choosing Wisely�";"American Orthopaedic Foot & Ankle Society";English;"Don?t use alcohol injections for Morton?s neuromas.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1763;2;"Choosing Wisely�";"American Medical Society for Sports Medicine";English;"Avoid recommending knee arthroscopy as initial management for patients with degenerative meniscal tears and no mechanical symptoms.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2275;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"S. Espa�ola de Rehabilitaci�n y Medicina F�sica - Ministerio de Sanidad.";Spanish;"Don?t routinely order imaging (X-ray, MRI, CT) for patients with acute low back pain without red flags.";-;2014;;;"Low value";"pain, lumbar, image, magnetic resonance";"

Link to the recommendation

Link to the initiative in the website of the Spanish Ministry of Health

" 2531;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t employ passive physical agents except when necessary to facilitate participation in an active treatment program.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1764;2;"Choosing Wisely�";"Society for Cardiovascular Angiography and Interventions";English;"Avoid performing routine stress testing after percutaneous coronary intervention (PCI) without specific clinical indications";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2276;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"In the treatment of patellofemoral syndrome, do not use some therapies (e.g. thermotherapy, TENS) alone.";-;2014;;;"Low value";"patellofemoral pain syndrome";"Link to the recommendations in the website of the Spanish Ministry of Health " 2532;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual?s abilities and goals.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1765;2;"Choosing Wisely�";"Society for Cardiovascular Angiography and Interventions";English;"Avoid coronary angiography in post-CABG and post-PCI patients who are asymptomatic, or who have normal or mildly abnormal stress tests and stable symptoms not limiting quality of life.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"coronary artery bypass graft";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2277;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not recommended bed rest in patients with acute or subacute low back pain.";-;2014;;;"Low value";"lumbar pain";"Link to the recommendations in the website of the Spanish Ministry of Health " 2533;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t recommend bed rest following diagnosis of acute deep vein thrombosis (DVT) after the initiation of anti-coagulation therapy, unless significant medical concerns are present.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1766;2;"Choosing Wisely�";"Society for Cardiovascular Angiography and Interventions";English;"Avoid coronary angiography for risk assessment in patients with stable ischemic heart disease (SIHD) who are unwilling to undergo revascularization or who are not candidates for revascularization base";"*Patients who are unwilling to undergo revascularization or who are not candidates for revascularization based on comorbidities or individual preferences.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2278;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not perform cholecystectomy in patients with asymptomatic cholelithiasis.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2534;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t use continuous passive motion machines for the postoperative management of patients following uncomplicated total knee replacement.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1767;2;"Choosing Wisely�";"Society for Cardiovascular Angiography and Interventions";English;"Avoid coronary angiography to assess risk in asymptomatic patients with no evidence of ischemia or other abnormalities on adequate non-invasive testing.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2279;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not keep an urinary catheter more than 48 hours after a gastrointestinal surgery.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2535;2;"Choosing Wisely�";"American Physical Therapy Association";English;"Don?t use whirlpools for wound management";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1512;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not appropriate to use antibiotic treatment in children with pharyngitis, without a prior suspicion and confirmation of a bacterial etiology.";--;2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1768;2;"Choosing Wisely�";"Society for Cardiovascular Angiography and Interventions";English;"Avoid coronary angioplasty (PCI) in asymptomatic patients with stable SIHD without the demonstration of ischemia on adequate stress testing or with normal fractional flow reserve (FFR) testing.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2280;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not extend any antibiotic prophylaxis more than 24 hours after surgical procedures.";-;2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1513;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Ambulatory oxygen therapy is not recommended in patients with advanced chronic disease who have dyspnea but do not have respiratory failure.";--;2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1769;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t use a targeted therapy intended for use against a specific genetic aberration unless a patient?s tumor cells have a specific biomarker that predicts an effective response to the targeted therapy";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2281;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use routine antibiotic prophylaxis for clean and uncomplicated non-prosthetic surgery.";-;2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1770;2;"Choosing Wisely�";"Endocrine Society and American Association of Clinical Endocrinologists";English;"Avoid routine multiple daily self-glucose monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycemia.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2282;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not offer postoperative antibiotics after an uncomplicated appendicitis.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1771;2;"Choosing Wisely�";"Endocrine Society and American Association of Clinical Endocrinologists";English;"Don?t routinely measure 1,25-dihydroxyvitamin D unless the patient has hypercalcemia or decreased kidney function.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2283;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not keep deep levels of sedation in critically ill patients without a specific indication.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1772;2;"Choosing Wisely�";"Critical Care Societies Collaborative ? Critical Care";English;"Regarding to critical care. Don?t order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2284;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not do a preoperative chest X-ray in low-risk patients under 40 years (ASA I or II).";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1773;2;"Choosing Wisely�";"Critical Care Societies Collaborative ? Critical Care";English;"Don?t transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 g/dL.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n" 2285;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not routinely perform preoperative testing in cataract surgery, unless there is a clear indication, based on clinical history and physical examination.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1518;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not recommended to combine antipyretics for the symptomatic treatment of fever in the pediatric population";"Fever in the pediatric population is one of the most common reasons for consultation in primary care and pediatric emergency services. -The prescription of a combination of antipyretics (usually ibuprofen and paracetamol) is a very common practice. -There is little scientific evidence to support this practice and studies about its safety are lacking. -It is recommended to use only one antipyretic for the treatment of fever in the pediatric population, and follow the clinical evolution to decide any change.";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1774;2;"Choosing Wisely�";"Critical Care Societies Collaborative ? Critical Care";English;"Don?t use parenteral nutrition in adequately nourished critically ill patients within the first seven days of an ICU stay.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";"alimentaci�n, feeding";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2286;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not schedule an elective surgery with high risk of bleeding in patients with anemia before a diagnosis is made and the treatment is completed.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 5358;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (desconexi�n de la ventilaci�n mec�nica)";Spanish;"Is recommended the protocolized versus non?protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients.";"Its suggest the reduced duration of mechanical ventilation, weaning duration and ICU length of stay with use of standardized weaning protocols. Reductions are most likely to occur in medical, surgical and mixed ICUs, but not in neurosurgical ICUs. However, significant heterogeneity among studies indicates caution in generalizing results. Some study authors suggest that organizational context may influence outcomes, however these factors were not considered in all included studies and could not be evaluated. Future trials should consider an evaluation of the process of intervention delivery to distinguish between intervention and implementation effects. There is an important need for further development and research in the neurosurgical population.";2014;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ " 1775;2;"Choosing Wisely�";"Critical Care Societies Collaborative ? Critical Care";English;"Don?t deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2287;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do laboratory testing in patients without a systemic disease (ASA I and II) prior to a low-risk surgery with minimal blood loss estimated.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 5359;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"It is not recommended a daily sedation interruption in critically ill adult patients requiring invasive mechanical ventilation";" we did not have strong evidence that daily sedation interruption reduced the duration of mechanical ventilation, length of stay in the intensive care unit (ICU) or hospital, death, or the amount of drug used. The effect on adverse events such as accidental removal of the breathing tube or invasive devices, or the rate of delirium was uncertain. However, tracheostomy was performed less often in those who were managed with daily sedation interruption. Sedation practices are known to vary worldwide, and as such an analysis of studies conducted in North America showed a reduction in time on the breathing machine for those who were managed with daily sedation interruption compared to those who were not.";2014;;;"Low value";"Patients management";"Link to the recommendation on the website of the initiative/ " 1776;2;"Choosing Wisely�";"Critical Care Societies Collaborative ? Critical Care";English;"Don?t continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and families the alternative of care focused entirely on comfort.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2288;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not do skin tests or in vitro allergen tests without having undertaken a detailed medical history.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2289;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not do diagnostic tests and risky therapeutic procedures in Allergology without a warranty of quality and clinical safety.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2290;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not do unproven diagnostic tests, such as immunoglobulin G (IgG) or an indiscriminate battery of immunoglobulin E (IgE) tests in the evaluation of allergy.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1267;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Don?t prescribe high-dose dexamethasone (0.5mg/kg per day) for the prevention or treatment of bronchopulmonary dysplasia in pre-term infants.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1779;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"In 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*";"* 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.";2014;;;"Low value";-;"Link to the full text of the recommendation" 2291;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"In anaphylactic reactions do not use antihistamines or corticosteroids as first-line of treatment, instead of prioritize the use of epinephrine.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1268;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Don?t perform screening panels for food allergies without previous consideration of medical history.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1780;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It 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";"* (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.";2014;;;"High value";"IAD, CAD";"Link to the recommendation in full text" 2292;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not treat bronchial asthma with long-acting or medium-acting bronchodilators, without inhaled corticosteroids.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1269;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Avoid using acid blockers and motility agents such as metoclopramide (generic) for physiologic gastroesophageal reflux*. Do not use medication in the so-called ?happy-spitter.";"*Effortless, painless and not affecting growth.

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1781;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Asymptomatic bacteriuria should not be treated routinely with antibiotics, except for pregnant women and other very specific cases";"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 exceptionally as bacteremia.

Asymptomatic bacteriuria is more common in women (1% -5%) and in certain groups such as patients with urinary catheter (indwelling catheter in 100% ) and in-patients in health and social care centers (10 % -50 %). The risk also increases with age (15 % over 75 years). Treatment with antibiotics may reduce the incidence of symptomatic infection during the first months, but eventually the incidence may raise again. There is evidence from studies with a follow-up of over ten years showing that a maintained asymptomatic bacteriuria is not related with an impairment in renal function. In addition, asymptomatic bacteriuria often resolves spontaneously.";2014;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 2293;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not order serological tumor markers for mass screening (except for high risk groups defined for each type of tumor).";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1270;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Avoid the use of surveillance cultures for the screening and treatment of asymptomatic bacteruria.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2294;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"In diabetic stable patients, HbA1C should not be make more than twice a year. If more than two tests are needed, the HbA1C should not be make more than once every three months.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1271;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Infant home apnea monitors should not be routinely used to prevent sudden infant death syndrome (SIDS).";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2295;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not do screening of thyroid disease in hospitalized patients. In outpatients, do only TSH. The study may be extend to T4 and other tests when appropriate.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1272;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t transfuse more than the minimum number of red blood cell (RBC) units necessary to relieve symptoms of anemia or to return a patient to a safe hemoglobin range*.";"* (7 to 8 g/dL in stable, non-cardiac in-patients).

For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2296;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not make a reassessment of antinuclear antibodies in less than three months.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2297;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not use CK or CK MB in the diagnosis of acute myocardial infarction.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 1274;2;"Choosing Wisely�";"American Society of Hematology";English;"Don?t use inferior vena cava (IVC) filters routinely in patients with acute VTE.";"For further information please visit the website of the initiative (link below)";2014;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2298;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Don?t use plasma or prothrombin complex concentrates for non-emergent reversal of vitamin K antagonists (severe bleeding and / or intracranial bleeding or emergency surgery).";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2299;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not transfuse more packed red cells than necessary to relieve symptoms of anemia or to return to a stable heart patient to a safe range of hemoglobin (7-8 g / dl)";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2300;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not transfuse packed red blood cells in patients with iron deficiency anemia and without hemodynamic instability.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2301;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"In adults with anemia who are receiving erythropoiesis stimulating agents, it is not recommended achieving normal levels of hemoglobin, it is preferable to maintain the desired level between 10-12g/dl";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2302;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not perform FNA for diagnosing a patient with lymphadenopathy in which a lymphoid origin neoplasm is suspected.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 2303;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Intensiva Cr�tica y Unidades Coronarias - Ministerio de Sanidad";Spanish;"Do not continue empirical antibiotic treatment initiated in the income day for a severe infection, without assessing its relevance and its possible de-escalation.";-;2014;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health " 768;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Clopidogrel should not be used alone as first-line treatment after myocardial infarction.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1792;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The medical treatment for neurocysticercosis (giant subarachnoid cysts) could be enough and avoid surgery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2048;6;"Less Is More Collection - JAMA Network";"Mannis G, et al. JAMA Intern Med. 2013;173(2):96-103.";English;"Risk-Reducing Salpingo-oophorectomy and Ovarian Cancer Screening in 1077 Women After BRCA Testing";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 769;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Fibrates should not be routinely prescribed for primary prevention of cardiovascular disease.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1793;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no benefits of naltrexone in the treatment of alcohol dependence";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2049;6;"Less Is More Collection - JAMA Network";"Chatterjee S, et al. JAMA Intern Med. 2013;173(2):132-139.";English;"Association of Blood Transfusion With Increased Mortality in Myocardial Infarction: A Meta-analysis and Diversity-Adjusted Study Sequential Analysis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 770;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Calcium channel antagonists�should not be routinely used for reducing cardiovascular risk following myocardial infarction.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1794;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no benefits of a low-calcium diet for the prevention of recurrent stones in idiopathic hypercalciuria";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al./ Enlace a la publicaci�n de Prasad, et al. " 2050;6;"Less Is More Collection - JAMA Network";"Kale M, et al. JAMA Intern Med. 2013;173(2):142-148";English;"Trends in the Overuse of Ambulatory Health Care Services in the United States";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 771;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"In patients with left ventricular systolic dysfunction, antiarrhythmic agents should not be used (with special emphasis on the IC group) due to the adverse effects associated with their use*";"*Worsening heart failure, proarrhythmia, death.";2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1795;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The ambulatory monitoring of uterine contractions has no benefits in modifying the risk of spontaneous preterm delivery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2051;6;"Less Is More Collection - JAMA Network";"Katz M, et al. JAMA Intern Med. 2013;173(2):93.";English;"Undertreatment Improves, but Overtreatment Does Not";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 772;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Imaging studies (MRI and/or CT) should not be repeated in patients with primary headache (migraine and tension headache) without changes in the profile of the studies.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 1796;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The screening of neuroblastoma in infants has no benefits in mortality";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al./ Enlace a la publicaci�n de Prasad, et al." 2052;6;"Less Is More Collection - JAMA Network";"Katz M, et al. JAMA Intern Med. 2013;173(3):178.";English;"Opioid Prescriptions for Chronic Nonmalignant Pain: Driving on a Dangerous Road";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 773;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"EEGs should not be routinely repeated in controlled epileptic patients (no change in profile of the crisis) unless there is a desire to withdraw medication.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1797;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Genotype CYP2C19 has shown to not affect outcomes of clopidogrel treatment";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2053;6;"Less Is More Collection - JAMA Network";"Gonzales R, et al. JAMA Intern Med. 2013;173(4):267-273";English;"A Cluster Randomized Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 6;2;"Choosing Wisely�";"American Academy of Hospice and Palliative Medicine";English;"Don?t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Implantable cardioverter-defibrillator (ICD), Arrhythmias";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 774;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Drugs with potential extrapyramidal side effects (antiemetics, antivertiginous, prokinetics) should not be used in patients with Parkinson's disease .";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1798;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Gentamicin?Collagen sponge has shown no benefits for Infection Prophylaxis in colorectal surgery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al./ Enlace a la publicaci�n de Prasad, et al." 2054;6;"Less Is More Collection - JAMA Network";"Rolfe A, et al. JAMA Intern Med. 2013;173(6):407-416.";English;"Reassurance After Diagnostic Testing With a Low Pretest Probability of Serious Disease: Systematic Review and Meta-analysis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 775;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Anticoagulants should not be routinely used in the treatment of acute stroke.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1799;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"No differences have been observed in the effect of early versus late Initiation of dialysis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2055;6;"Less Is More Collection - JAMA Network";"Johansen M, et al. JAMA Intern Med. 2013;173(7):586-588.";English;"A National Survey of the Treatment of Hyperlipidemia in Primary Prevention";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 776;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Long-term corticosteroid treatment in MS patients should not be prescribed.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1800;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Suicide-related events have been described in patients treated with antiepileptic drugs";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2056;6;"Less Is More Collection - JAMA Network";"Prasad V, et al. JAMA Intern Med. 2013;173(7):493-495.";English;"The Inferior Vena Cava Filter: How Could a Medical Device Be So Well Accepted Without Any Evidence of Efficacy? [article about the low value of using inferior vena cava filters in preventing PE]";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 777;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Densitometry should not be routinely requested to assess the risk of osteoporotic fracture without first performing an assessment of risk factors in postmenopausal women.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 1801;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"No benefit have been shown from rescue breathing when added to chest compression versus chest Compression-Only in Out-of- Hospital Cardiac Arrest";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2057;6;"Less Is More Collection - JAMA Network";"Sarosiek S, et al. JAMA Intern Med. 2013;173(7):513-517.";English;"Indications, Complications, and Management of Inferior Vena Cava Filters. The Experience in 952 Patients at an Academic Hospital With a Level I Trauma Center [Study concluding that the use of inferior vena cava filters has not shown benefits in preventing";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 778;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Hormone therapy (estrogens or estrogens with progestin) should not be used to prevent vascular disease in postmenopausal women.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1802;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Routine early surgical reconstruction has no benefits versus a structured rehabilitation in the treatment of acute anterior cruciate ligament tears";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2058;6;"Less Is More Collection - JAMA Network";"Xiao Q, et al. JAMA Intern Med. 2013;173(8):639-646.";English;"Dietary and Supplemental Calcium Intake and Cardiovascular Disease Mortality: The National Institutes of Health?AARP Diet and Health Study";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 779;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Test strips and monitors should not be used in type 2 diabetic patients treated non-hypoglycemic oral medications, except in cases of unstable glycemic control.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1803;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Long-term outcome of open repair of abdominal aortic aneurysm have shown to be better than outcomes with endovascular repair";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2059;6;"Less Is More Collection - JAMA Network";"Daneman N, et al. JAMA Intern Med. 2013;173(8):673-682.";English;"Prolonged Antibiotic Treatment in Long-term Care: Role of the Prescriber";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 780;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas de Medicina de Familia - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"PSA testing should not be systematically performed in asymptomatic individuals without a family history of first grade prostate cancer.";-;2013;;;"Low value";screening;"Link to the recommendation in the website of the Spanish Ministry of Health
" 1804;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Cecal intubation has failed to be shown as a good quality indicator for colonoscopy and the Risk of Interval cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2060;6;"Less Is More Collection - JAMA Network";"Beatty A, et al. JAMA Intern Med. 2013;173(9):763-769.";English;"In patients with stable coronary hearth disease, the use of high-sensitivity cardiac troponin T could be a marker of risk of secondary cardiovascular events.";"For further information please visit the website of the initiative (link below)";2013;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 781;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Rifampicin together with pyrazinamide should not be used during primary chemoprophylaxis of tuberculosis in immunocompetent persons due to high toxicity.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1805;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The use of aspirin plus heparin or aspirin alone have shown no benefits in women with recurrent miscarriage";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2061;6;"Less Is More Collection - JAMA Network";"Morioka-Douglas N, et al. JAMA Intern Med. 2013;173(10):855-856.";English;"No Papanicolaou Tests in Women Younger Than 21 Years or After Hysterectomy for Benign Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection "" Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 782;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Antiarrhythmic drugs are not recommended to maintain sinus rhythm in patients with persistent atrial fibrillation when the cause has been corrected* and when cardioversion has been done successfully**";"*E.g. pulmonary infection or fever **Unless there are risk factors for recurrence.";2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1806;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The intensive blood-pressure control in type 2 diabetes mellitus has not shown relevant effects on cardiovascular morbility or mortality";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2062;6;"Less Is More Collection - JAMA Network";"Dea�o R, et al. JAMA Intern Med. 2013;173(10):887-893";English;"Referral of Patients With Pulmonary Hypertension Diagnoses to Tertiary Pulmonary Hypertension Centers: The Multicenter RePHerral Study";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 15;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In postmenopausal women with low risk of fractures, long-term treatment with bisphosphonates represents a risk that overcomes the benefit.";"By 2012 11% of Catalan women over 55 years of age were treated with oral bisphosphonates. Of these, 38% received long-term treatment (five or more years).

The available scientific evidence suggests an increased risk of atypical femoral fractures (subtrochanteric or diaphyseal) in postmenopausal women with preventive treatment with bisphosphonates after three to five years of starting treatment. Atypical fractures were observed mostly in postmenopausal women who received alendronate because it is the most widely used bisphosphonate. However, cases have also been reported with ibandronate, risedronate, etidronate and zoledronate and, according to a review of the European Medicines Agency, atypical fractures are a class effect of bisphosphonates. Atypical fractures have also been described with prolonged use of other anti-resorptive agents such as denosumab.

Apart from the risk of atypical fractures, there have also been described other adverse effects associated with prolonged use with bisphosphonates, including osteonecrosis of the jaw (especially at high doses); widespread bone, joint, and muscle pain; atrial fibrillation, and ocular inflammation (conjunctivitis, iritis, uveitis, scleritis and episcleritis).

The decision to establish and maintain bisphosphonate therapy beyond five years for the prevention of fragility fractures should consider both the expected benefits and potential risks. Continuation or discontinuation of long-term bisphosphonates must be assessed for all postmenopausal women based on their risk of fragility fracture. In low-risk women at the time of reassessment (T-score> -2.5 femoral neck with DXA technique diagnosed with osteopenia or without previous fracture and low risk of fall) it is recommended drop the treatment.

Women who stop treatment with bisphosphonates should periodically reassess the need to start it again. Healthy lifestyle and measures to prevent falls must be recommended.

This recommendation does not apply for postmenopausal women with Paget's disease, hypercalcemia secondary to malignancy or treatment with aromatase inhibitors and / or systemic glucocorticoids for more than three months accumulated in the past two years.

Discontinuation of bisphosphonate therapy after five years for all women over 55 years with T-score> -2.5 in Catalonia would save five million Euros without if the possible presence of other risk factors to justify continuation are not contemplated.";2013;;;"Low value";"Bisphosphonates, fracture risk, atypical fracture, densitometry, DXA, osteopenia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1807;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Neuroblastoma Screening at One Year of Age may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al./ Enlace a la publicaci�n de Prasad, et al." 2063;6;"Less Is More Collection - JAMA Network";"Berkowitz Z, et al. JAMA Intern Med. 2013;173(10):922-924.";English;"Don't perform routine cervical cancer screening intervals over 4 years period after the endorsement of co-testing in women aged 30 years and older.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 16;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Prescribing proton-pump inhibitors to prevent peptic ulcer disease in polymedicated patients or over 65 years of age who do not receive treatment with NSAIDs does not have any added value.";"The prevention of gastric ulcer disease with proton-pump inhibitors (PPIs) in patients treated with nonsteroidal antiinflammatory drugs (NSAIDs) are indicated for patients who meet any of the following conditions: a history of peptic ulcer, gastrointestinal bleeding or perforation gastroduodenal, elderly (> 65 years), prolonged treatment with high-dose NSAIDs, concomitant use of oral anticoagulants and/or corticosteroids and/or aspirin or other antiplatelet agents, or severe comorbidities (cardiovascular, renal, hepatic, hypertension, diabetes).

Although PPI prescribing criteria are clearly defined, several studies have found overuse. In our environment, PPI hiperprescripci�n is caused by improper use in situations where there is no clinical indication.

In Catalonia, in the year 2012, about 1.5 million people received PPI therapy with an associated cost of 49.5 million Euros. Of the total number of people treated, 43% did not receive concomitant treatment with NSAIDs, 49% were under the age of 65 , and 38% were patients with polypharmacy (5 or more medications). 48% of medicated patients with a PPI were not treated with NSAIDs.

In general, PPIs are safe and well-tolerated drugs. However, they are not completely safe and there administration has been associated with rare but potentially serious side effects, such as osteoporotic fractures, acute interstitial nephritis, and increased risk of lung and enteric infections.

It is recommended to limit the prescription of PPIs for the prevention of ulcer disease in patients treated with NSAIDs and for situations of increased risk of bleeding. It is recommended to periodically reassess the need to continue treatment to prevent chronicity.

The suspension of PPIs in medicated patients without NSAID therapy in Catalonia would save 9 million Euros under the assumption that no other clinical situations justify their administration.";2013;;;"Low value";"Proton-pump inhibitors, PPIs, Omeprazole, Lansoprazole, Esomeprazole, Pantoprazole, NSAIDs";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1808;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Immediate Repair Compared with Surveillance of Small Abdominal Aortic Aneurysms may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2064;6;"Less Is More Collection - JAMA Network";"Katz M, et al. JAMA Intern Med. 2013;173(10):847-848.";English;"Don't neglect to consider that there is insufficient evidence to support routine screening with PSA level in men at appropriate age.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 17;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In cases of normal childbirth, episiotomy should not be done routinely.";"The episiotomy, a perineal incision to facilitate the delivery of the baby during labour, is a common clinical practice, although there is little scientific evidence of its benefits and therefore remains a controversial clinical practice. In Catalonia, 28% of non-instrumental normal deliveries attended in 2011 were performed with episiotomy. It is estimated that this percentage can be much higher, since there is a significant degree of under-reporting of this procedure in many centres.

The conduction of episiotomies in non-instrumental normal deliveries presents significant variability. The 25% of centres that prescribe fewer episiotomies are below 14% , while the 25% that prescribe more are above 38%. Six centres go beyond 80%. The World Health Organization estimates that the percentage of normal deliveries with episiotomy should be around 15%.

It is believed that episiotomy reduces the risk of perineal laceration, pelvic floor dysfunction, and urinary and fecal incontinence due to childbirth. Regarding the fetus, the shortening of the expulsion phase is thought to translate into a greater number of spontaneous deliveiries. Episiotomies became a routine practice, for which adverse effects, such as anal sphincter dysfunction, dyspareunia, or third and fourth grade sprains were underestimated.

Currently, there is ample evidence that the routine performance (or use) of episiotomies compared to selective use (for certain indications) , does not improve health outcomes for women in the short and long term. Even comparative studies have shown that the selective use of this practice increases the number of women with intact perineum and the number of women retaking sexual activities after the first month. Selective use of episiotomies also reduces the need for repair and perineal suturing, and the number of women with pain at discharge . According to a review in the Cochrane Library, the selective strategy of episiotomies has more advantages as compared to a strategy based on routine episiotomy. These are: lower rate of severe perineal trauma (12% reduction), lower need for perineal suturing (29% reduction) and fewer complications at seven days (41% reduction). The only disadvantage was observed increased risk of anterior perineal trauma (84% increase ).

Thus, strategies for normal birth care and current clinical practice guidelines promote the strategy of selective and systematic episiotomy in spontaneous deliveries. Routine episiotomies are not recommended in women with third or fourth grade tears in previous deliveries. An episiotomy is appropriate only for instrumental deliveries or suspected foetal suffering.";2013;;;"Low value";episiotomy;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1809;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Intranasal Mupirocin in the prevention of Postoperative Staphylococcus aureus Infections";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2065;6;"Less Is More Collection - JAMA Network";"Walter L, et al. JAMA Intern Med. 2013;173(10):866-873.";English;"Before performing individualized decisions in men aged 65 years and older with PSA level exceeding 4.0 ng/mL, inform about downstream outcomes.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 18;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients with low back pain (LBP), imaging tests do not add clinical value to patient management during the first six weeks and in the absence of warning signs.";"Low back pain is one of the most common health problems in the Catalan population. A population-based study concluded that 50.9% of people in Catalonia had reported an episode of low back pain in the last six months. Musculoskeletal disorders represent the fourth reason for consultation in primary health care settings among patients15 years of age or more, and the first reason of consultation in specialized care. In addition, musculoskeletal disorders are the leading cause of temporary disability in Catalonia and are involved in one of five sick leaves (20.8 %).

In primary care, most patients (80-90%) who consult for low back pain without warning signs will improve within a month. Scientific evidence shows no significant difference between patients with low back pain who undergo imaging tests (radiography, computed tomography (CT) or magnetic resonance ( MR)) compared to those who do not. Therefore, in the routine study of a patient with low back pain and no warning signs during the first six weeks, performing imaging does not improve patient outcomes. Therefore, this practice is not recommended, except in cases of patients presenting progressive neurological deficits or suspected osteomyelitis.

In addition, radiographies and CTs are not harmless, given the accumulative risk associated with radiation. Studies comparing the indications of CTs and MRIs in low back pain with the recommendations of clinical practice guidelines have shown that one or two thirds of the CT and MRI scans may be unjustified. These unjustified scans can reveal abnormalities in the spine that are unrelated to the pain. These findings may be of concern and can lead to unnecessary diagnostic tests or treatments.";2013;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, image";"Link to the recommendation on the website of Essencial / Enlace a la recomendaci�n en la p�gina web Essencial
" 1810;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2066;6;"Less Is More Collection - JAMA Network";"Sah S, et al. JAMA Intern Med. 2013;173(10):932-933.";English;"The ubiquitous use of simple but unreliable screening tests (like PSA) may lead to consequences beyond the initial cost and patient anxiety of inconclusive results";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Screening, prostate";"Link to the article in the collection ""Less is More"" /Enlace al art�culo de la serie ""Less is More""
" 1811;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Twenty-Five-Year Follow-up of a Randomized Trial Comparing Radical Mastectomy, Total Mastectomy, and Total Mastectomy Followed by Irradiation";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2067;6;"Less Is More Collection - JAMA Network";"Dam A, et al. JAMA Intern Med. 2013;173(11):948.";English;"Care at the end of life. ""Pharmaceutically Less and Holistically More""";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1812;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Sex-Based Differences in the Effect of Digoxin for the Treatment of Heart Failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2068;6;"Less Is More Collection - JAMA Network";"Linos E, et al. JAMA Intern Med. 2013;173(11):1006-1012";English;"Treatment of Nonfatal Conditions at the End of Life: Nonmelanoma Skin Cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 5140;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for adopting the EXOGEN ultrasound bone healing system to treat long bone fractures with non-union (failure to heal after 9 months) is supported by the clinical evidence, which shows high rates of fracture healing.";"The EXOGEN ultrasound bone healing system to treat long bone fractures with non-union is associated with an estimated cost saving of �2,407 per patient compared with current management, through avoiding surgery. [2019] There is some radiological evidence of improved healing when the EXOGEN ultrasound bone healing system is used for long bone fractures with delayed healing (no radiological evidence of healing after approximately 3 months). There are substantial uncertainties about the rate at which bone healing progresses without adjunctive treatment between 3 and 9 months after fracture, and about whether or not surgery would be necessary. These uncertainties result in a range of cost consequences, some cost saving and others that are more costly than current management (see sections 5.12, 5.19 and 5.26).";2013;;;"High value";Fractures;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1813;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Antimicrobial Treatment in Diabetic Women with Asymptomatic Bacteriuria";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2069;6;"Less Is More Collection - JAMA Network";"Heath I, et al. JAMA Intern Med. 2013;173(11):956-957";English;"Waste and Harm in the Treatment of Mild Hypertension";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1814;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Comparison of Rate Control and Rhythm Control in Patients with Atrial Fibrillation";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2070;6;"Less Is More Collection - JAMA Network";"Petroni A, et al. JAMA Intern Med. 2013;173(13):1173.";English;"Overtreatment situations: ""When a Patient Chooses Wisely""";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1815;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Randomized, Controlled Trial of the Use of Pulmonary- Artery Catheters in High-Risk Surgical Patients";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2071;6;"Less Is More Collection - JAMA Network";"Lipitz-Snyderman A, et al. JAMA Intern Med. 2013;173(14):1277-1278.";English;"Overuse of Health Care Services: When Less Is More ? More or Less";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1816;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Imaging Studies after a First Febrile Urinary Tract Infection in Young Children";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication of Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2072;6;"Less Is More Collection - JAMA Network";"Jackevicius C, et al. JAMA Intern Med. 2013;173(14):1379-1381.";English;"Use of Niacin in the United States and Canada";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 793;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Advise people not to take supplements containing beta-carotene.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1817;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Serum Retinol Levels and the Risk of Fracture";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2073;6;"Less Is More Collection - JAMA Network";"Kox M, et al. JAMA Intern Med. 2013;173(14):1369-1372.";English;"?Less Is More? in Critically Ill Patients: Not Too Intensive";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 5657;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediate la telesalud";Spanish;"There is insufficient evidence to assess whether face-to-face interventions or distance and web 2.0 approaches are more effective in promoting physical activity.";"There was only one article that met the inclusion criteria. This study reported the effect of an intervention for promoting physical activity on cardiorespiratory fitness. No data on physical activity, quality of life, or cost-effectiveness were reported.";2013;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 1818;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Factors Associated with Progression of Carcinoid Heart Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2074;6;"Less Is More Collection - JAMA Network";"McCullough B, et al. JAMA Intern Med. 2013;173(16):1514-1521.";English;"Major Medical Outcomes With Spinal Augmentation vs Conservative Therapy";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1819;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Involved-Field Radiotherapy for Advanced Hodgkin's Lymphoma";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2075;6;"Less Is More Collection - JAMA Network";"Mulder M, et al. JAMA Intern Med. 2013;173(20):1896-1904.";English;"Intensive Glucose Regulation in Hyperglycemic Acute Coronary Syndrome: Results of the Randomized BIOMarker Study to Identify the Acute Risk of a Coronary Syndrome?2 (BIOMArCS-2) Glucose Trial";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1820;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Conventional Adjuvant Chemotherapy with or without High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in High-Risk Breast Cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al." 2076;6;"Less Is More Collection - JAMA Network";"Wegwarth O, et al. JAMA Intern Med. 2013;173(22):2086-2087.";English;"Overdiagnosis and Overtreatment: Evaluation of What Physicians Tell Their Patients About Screening Harms";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 285;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When changing catheters in patients with a long-term indwelling urinary catheter, do not offer antibiotic prophylaxis routinely";"Only consider antibiotic prophylaxis for patients who have a history of symptomatic urinary tract infection after catheter change or experience trauma during catheterisation";2013;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1821;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Nebulized Epinephrine in Infants with Acute Bronchiolitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 286;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In-line filters should not be used routinely for infection prevention.";-;2013;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciiativa.

" 1822;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Evaluation of Impermeable Covers for Bedding in Patients with Allergic Rhinitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 1823;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Control of Exposure to Mite Allergen and Allergen- Impermeable Bed Covers for Adults with Asthma";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 1824;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Postmenopausal hormonal replacement with estrogen plus progestin have not shown to modify th risk of coronary heart disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1825;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Outcomes at School Age after Postnatal Dexamethasone Therapy for Lung Disease of Prematurity";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1826;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Neuroblastoma Screening at One Year of Age may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al./ Enlace a la publicaci�n de Prasad, et al." 1827;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Comparison of High-Dose and Standard-Dose Epinephrine in Children with Cardiac Arrest";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1828;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1829;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Folate Therapy and In-Stent Restenosis after Coronary Stenting";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1830;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Methylprednisolone, Valacyclovir, or the Combination for Vestibular Neuritis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1831;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Lumpectomy plus Tamoxifen with or without Irradiation in Women 70 Years of Age or Older with Early Breast Cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al." 1832;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Fresh Whole Blood versus Reconstituted Blood for Pump Priming in Heart Surgery in Infants";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 5416;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";Spanish;"There is no information available to define whether infection control strategies prevent transmission of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes.";"Research studies evaluating the effects of infection prevention and control strategies on MRSA transmission in nursing homes are lacking. Only one study was identified, a group randomized controlled trial in 32 nursing homes that evaluated the effect of an infection control education and training program on the prevalence of MRSA. At the end of the 12-month study, there was no change in the prevalence of MRSA between intervention and control sites, although mean infection control audit scores were significantly higher in intervention residences compared to nursing home residences control. The current lack of research evidence, to inform practice in nursing homes, forces a reliance on evidence and guidelines derived in other settings. Screening those at risk of MRSA (e.g. recent admissions from hospital) may be part of any pragmatic approach adopted in the nursing home environment. Training key staff, who will then be responsible for training all other staff in infection prevention and control procedures should also be implemented, along with adherence to hand hygiene recommendations and high standards of environmental cleaning and decontamination. Isolation processes, although shown to be effective in hospital settings, may not be always practical in nursing homes. These recommendations should be reviewed in the light of ongoing and future research studies which are specific to this setting. � Rigorous studies should be conducted in nursing homes, with the participation of residents and staff, to evaluate interventions that were specifically designed for this setting.";2013;;;Uncertain;"Prevention COVID-19, Nursing Homes, Infection Control, Meticillin?resistant Staphylococcus aureus, MRSA";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 41;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use mucolytic drugs to prevent exacerbations in people with stable chronic obstructive pulmonary disease (COPD).";-;2013;;;"Low value";cough;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1833;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Trandolapril has shown no additional benefits in patients with Stable Coronary Artery Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 42;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Treatment with alpha-tocopherol and beta-carotene supplements, alone or in combination, is not recommended in patients with COPD.";-;2013;;;"Low value";"Chronic obstructive pulmonary disease, COPD, vitamins";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fail if it is modified or deleted by the publishing insitution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 1834;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Secondary Surgical Cytoreduction for Advanced Ovarian Carcinoma";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 3114;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2013;347:f7581";Spanish;"Attention-deficit/hyperactivity disorder (ADHD) drug makers move to expand into adult market";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 1835;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A decade of reversal: an analysis of 146 contradicted medical practices. [Coronary-Artery Revascularization before Elective Major Vascular Surgery]";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 3115;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Wiener R. BMJ 2013;347:f5131";Spanish;"It is potentially not recommended to order imaging for suspected pulmonary embolism in low risk patients without the use of a diagnostic evidence-based algorithm.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace al art�culo en la p�gina web de TheBMJ" 44;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ambulatory oxygen therapy is not recommended in chronic obstructive pulmonary disease if partial pressure of oxygen in arterial blood is greater than 7.3 kPa and there is no exercise desaturation";-;2013;;;"Low value";"Oxygen Inhalation Therapy, COPD, PaO2";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fail if it modified or deleted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 1836;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";Spanish;"Mild Intraoperative Hypothermia during Surgery for Intracranial Aneurysm";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1837;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Clopidogrel versus Aspirin and Esomeprazole to Prevent Recurrent Ulcer Bleeding";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 46;2;"Choosing Wisely�";"The Society of Thoracic Surgeons";English;"Prior to cardiac surgery, there is no need for pulmonary function testing in the absence of respiratory symptoms.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";lung;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1838;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1839;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"UK Controlled Trial of Intrapleural Streptokinase for Pleural Infection";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1840;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The use of Rofecoxib for Colorectal Adenoma Chemoprevention may be a low value practice due to Associated cardiovascular Events";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1841;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The use of Celecoxib for Colorectal Adenoma Chemoprevention may be a low value practice due to Associated cardiovascular Events";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1842;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";Spanish;"The use of COX-2 Inhibitors Parecoxib and Valdecoxib after Cardiac Surgery may be a low value practice due to an increased incidence of cardiovascular events.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1843;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The use of Warfarin in patients with Symptomatic Intracranial Arterial Stenosis may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1844;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Stent Implantation may be a low value practice comparing to Coronary-Artery Bypass Grafting in patients with multivessel disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1589;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended to do bypass surgery over angioplasty in selected patients*. But is necesary to balance the benefit of lower mortality with the increased risk of stroke observed with the bypass.";"*Patients older than 65 years or with diabetes and with multiple coronary artery disease. In patients with multiple coronary artery disease, both coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI, angioplasty) have shown similar risk of all-cause mortality over a period of 5 years of follow-up. However, CABG has shown lower mortality than PCI in patients over 65 years or patients with diabetes. But is necesary to balance the benefit of lower mortality with the increased risk of stroke of the CABG.";2013;;;"High value";-;"http://www.dianasalud.com/docs/MAPACcoronariopatias.pdf" 1845;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Anagrelide may be a low value practice in patients with High- Risk Essential Thrombocythemia compared with Hydroxyurea";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 5685;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"Current research does not provide evidence to support a reduction in access to hospital services or a reduction in the rate of hospital readmissions for children with acute and chronic illnesses through the use of skilled nursing services at home.";"However, the only finding summarized through a few studies was that there is a significant decrease in hospital stay. Preliminary results do not show an adverse impact on physical health outcomes, and several papers reported an improvement in satisfaction with home care. Additional trials that measure long-term health, satisfaction, use of services, and costs are required.";2013;;;Uncertain;"management of patients";"Link to the recommendation on the website of the initiative" 1590;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"The use of Negative Pressure Therapy is recommended for difficult-to-treat wounds in the context where a protocol and prospective evaluation of results are available.";"Although there is an extensive scientific literature on this subject , the quality of the evidence on clinical effectiveness is still limited (mainly due to weak study designs and the low quality of the studies), and hinders drawing conclusions. However, recent technical reports concluded that negative pressure therapy has a significant potential benefit, allowing to recommend their use in certain clinical conditions. Nevertheless, other indications (usually complex and uncommon clinical situations where it is difficult to perform a clinical trial ) would be based on low-level evidence (descriptive studies or clinical series) and mainly in clinical experience. In this scenario it is recommended to implement systems for recording clinical data to evaluate prospectively the clinical results obtained with the negative pressure therapy. This system can also help to clarify specific indications, conditions of use and monitoring.";2013;;;"High value";-;"http://www.dianasalud.com/docs/MAPACTerapiaPresNegativa.pdf" 1846;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Inhaled Nitric Oxide for Premature Infants with Severe Respiratory Failure may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1847;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"An Evaluation of Echinacea angustifolia in Experimental Rhinovirus Infections may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 6711;36;"Choosing Wisely UK";"Chartered Society of Physiotherapy";English;"It is recommended to offer a strength and balance exercise programme, with a minimum of 50 hours? dosage, to older people aged 65 years or older living in the community who have experienced a) more than one fall in the last year, b) problems with balance or walking, c) fear of falling or reduced confidence when walking.";"The risk of falls increases with age, although not everyone falls as they age. A person who has already fallen is more likely to fall again in the future. Falls and the fear of falling can cause older people to lose confidence in their daily activities and affect their independence. And while most falls don't result in serious injury, some cause broken bones, which can be difficult to recover from. Special exercises (sometimes called ""strength and balance training"") can help increase muscle strength and improve balance. In this way, the person stands more firmly on his feet and is less likely to fall. They can be especially helpful for older people who have already suffered one or more falls, or who have problems with balance or walking. This recommendation is supported by several clinical guidelines on risk assessment and intervention.";2013;;;"High value";-;"Link to the recommendation on the website of the initiative" 1848;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There is no difference in development between prompt and delayed tympanostomy tubes in children with middle ear effusions";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1849;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Amnioinfusion for the Prevention of the Meconium Aspiration Syndrome may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 1850;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Early Invasive in patients with Acute Coronary Syndromes may be a low value practice compared to Selectively Invasive Management";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1851;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Long-Term Vasodilator Therapy in Patients with Severe Aortic Regurgitation";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al." 1852;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";Spanish;"Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 1853;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Trial of Contraceptive Methods in Women with Systemic Lupus Erythematosus";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 5693;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"They are encouraged computer self-care interventions for diabetes for the treatment of type 2 diabetes.";"They appear to have a small beneficial effect on blood glucose control and the effect was larger in the cell phone subgroup. There is no evidence to show benefits in other biological results or in cognitive, behavioral or emotional results.";2013;;;"High value";"Management of patients";"Link to the recommendation on the website of the initiative" 1854;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";Spanish;"The Risk Associated with Aprotinin in Cardiac Surgery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1855;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Clozapine Alone versus Clozapine and Risperidone with Refractory Schizophrenia";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 5695;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is insufficient evidence to recommend routine telephone support to patients who have access to maternity services, as the evidence from the included trials is neither robust nor consistent";"Although beneficial effects were found in terms of reduced depression scores, duration of breastfeeding, and increased overall satisfaction, the current trials do not provide sufficient strong evidence to warrant investment in resources.";2013;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 1856;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Saw Palmetto for Benign Prostatic Hyperplasia";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 1857;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Calcium plus Vitamin D Supplementation and the Risk of Fractures";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1858;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Glucosamine, Chondroitin Sulfate or the Two in Combination for Painful Knee Osteoarthritis, a practice of Low-value";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1859;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1860;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 69;2;"Choosing Wisely�";"Commission on Cancer";English;"Don?t perform major abdominal surgery or thoracic surgery without a pathway or standard protocol for postoperative pain control and pneumonia prevention.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";protocol;"

Link to the recommendation on the website of the initiative / Enlace a la recommendaci�n en la p�gina web de la iniciativa

" 1861;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Controlled Trial of Homocysteine Lowering and Cognitive Performance";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 70;2;"Choosing Wisely�";"American College of Physicians";English;"Don?t obtain preoperative chest radiography in the absence of a clinical suspicion for intrathoracic pathology.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"XR, x-ray, preoperative";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
Note: This link may fail if it is modified or deleted by the publishing institution / Nota: el siguiente enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 1862;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effectiveness of Atypical Antipsychotic Drugs in Patients with Alzheimer?s Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1863;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"DHEA in Elderly Women and DHEA or Testosterone in Elderly Men";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 72;2;"Choosing Wisely�";"Commission on Cancer";English;"Don?t use surgery as the initial treatment without considering presurgical (neoadjuvant) systemic and/or radiation for cancer types and stage where it is effective";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Radiotherapy, cancer, neoplasms";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.
Note: This link may fail if it is modified or deleted by the publishing institution / Nota: el siguiente enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 1864;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 73;2;"Choosing Wisely�";"The Society of Thoracic Surgeons";English;"Patients with suspected or biopsy proven Stage I NSCLC do not require brain imaging prior to definitive care in the absence of neurologic symptoms.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Images, magnetic resonance imaging, MRI, computed tomography, CT";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1865;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Coronary Intervention for Persistent Occlusion after Myocardial Infarction";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 74;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t diagnose or manage asthma without spirometry";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";spirometry;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1866;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Tympanostomy Tubes and Developmental Outcomes at 9 to 11 Years of Age";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 75;2;"Choosing Wisely�";"Society of Hospital Medicine. Pediatric Hospital Medicine";English;"Don?t order chest radiographs in children with uncomplicated asthma or bronchiolitis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"XR, x-ray";"

" 1867;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Long-Term Outcomes with Drug- Eluting Stents versus Bare-Metal Stents in Sweden";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 76;2;"Choosing Wisely�";"American College of Radiology";English;"Avoid admission or preoperative chest x-rays for ambulatory patients with unremarkable history and physical exam.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"XR, x-ray, Images, preoperative";"

" 1868;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Influence of Computer-Aided Detection on Performance of Screening Mammography";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication of Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 77;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Performing a preoperative chest radiography in asymptomatic patients has no added value in the patient's management.";"Evidence shows that routine preoperative chest radiography in patients without cardiovascular or respiratory symptoms do not improve patient's management.

In most cases, preoperative chest radiography is not useful to predict postoperative respiratory complications or to change the treatment that ends up being provided.

Chest radiography is a low risk diagnostic tool, but is not harmless. Radiation associated with radiographies is very low but accumulates in the long term.

Preoperative chest radiography is indicated in thoracic surgery, in patients with cardiovascular or respiratory disease, and in patients older than 70 years of age with stable chronic cardiac or pulomonary disease in whom the last radiography was performed 6 months earlier or longer.";2013;;;"Low value";"XR, x-ray, Images, preoperative";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 1869;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Optimal Medical Therapy with or without PCI for Stable Coronary Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 78;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Patients with community-acquired pneumonia should not be hospitalized before an evaluation of severity is done, using validated prognosis scores*.";"*These scores help to predict the level of care required.

Community-acquired pneumonia is a common disease that affects people of all ages. It has different grades of severity and may require hospitalization.

Hospitalization increases the risk of hospital-related infections, and can be uncomfortable for patients and their families.

It is important to apply prognosis scores to establish the level of care required (conventional hospitalization, intensive care, or in-home care) in order to avoid unnecessary hospitalizations.

Hospitalization of patients with community-acquired pneumonia depends on different factors, including the severity of the disease, and is based on clinical judgment.

";2013;;;"Low value";"Hospitalization, Community-acquired pneumonia, CAP, pulmonary infection";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 1870;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2126;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)";English;"Do not routinely order an echocardiography in patients with mild/moderate valvular disease or left ventricular dysfunction in the absence of new symptoms, signs or clinical events. (The Italian Association of Hospital Cardiologists)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1871;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Randomized Comparison of Strategies for Reducing Treatment in Mild Persistent Asthma";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2127;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)";Spanish;"Do not routinely order a stress test (electrocardiogram) in asymptomatic patients after surgical or percutaneous revascularization. (The Italian Association of Hospital Cardiologists)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1872;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2128;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)";Spanish;"Do not order a Holter test in patients with exercise induced chest pain that are able to perform stress tests, unless arrhythmia is also suspected. (The Italian Association of Hospital Cardiologists)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 6736;36;"Choosing Wisely UK";" Royal College of Emergency Medicine";English;"It is not recommended to reduce hospital stay in the emergency department for alcohol intoxicated patients.";"This recommendation is made from a randomized controlled trial. Intravenous 0.9% sodium chloride (normal saline) is frequently used to treat patients with acute alcohol intoxication despite a lack of evidence for its efficacy. Normal saline therapy added to observation alone does not decrease emergency department length of stay compared with observation alone. The bases of the symptoms of intoxication and the general state of intoxication were similar in both groups. The present study suggests that either approach is reasonable, but observation alone might be preferred as it requires fewer resources.";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative" 1873;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"In Vitro Fertilization with Preimplantation Genetic Screening";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2129;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)";Spanish;"Do not order imaging tests in addition to the the stress test in the initial evaluation of ischemic heart disease. (The Italian Association of Hospital Cardiologists)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 5713;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is not enough certainty about the cost-effectiveness of health-related lifestyle counseling given by peer or lay advisors";"The COVID-19 pandemic is placing a strain on health systems and healthcare workers. Existing research on the provision of health-related lifestyle advice from peers and lay advisors might provide useful information for policy makers. In this systematic review, the authors searched for research evaluating the cost-effectiveness of health-related lifestyle advice from peers and lay advisors for adults in developed countries. They did not restrict their searches by date of publication but limited it to publications in English and did the search in September 2008. They included 24 studies. In general, health-related lifestyle advice from peers and lay advisors appeared to only be cost-effective when targeting behaviours likely to have a large impact on overall health-related quality of life. For general chronic disease management, health-related lifestyle advice from peers and lay advisors improved patient self-efficacy and self-care behaviour and appeared to be cost-effective. There was little evidence that health-related lifestyle advice from peers and lay advisors altered diet or exercise.";2013;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1874;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Multicenter, Randomized Controlled Trial of Dexamethasone for Bronchiolitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2130;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)";Spanish;"Do not order a stress test for the coronary artery disease screening in asymptomatic patients at low cardiovascular risk. (The Italian Association of Hospital Cardiologists)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1875;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Saline or Albumin for Fluid Resuscitation in Patients with Traumatic Brain Injury";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1876;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"High-Dose Melphalan versus Melphalan plus Dexamethasone for AL Amyloidosis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al." 1877;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Outcomes at 2 Years of Age after Repeat Doses of Antenatal Corticosteroids";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1878;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Long-Term Outcomes after Repeat Doses of Antenatal Corticosteroids";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1879;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Early Treatment with Prednisolone or Acyclovir in Bell?s Palsy";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 88;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Computed tomography (CT) scans are not necessary in the immediate evaluation of minor head injuries; clinical observation/PECARN criteria should be used to determine whether imaging is indicated.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Images;"

" 1624;2;"Choosing Wisely�";"American College of Surgeons";English;"Don?t do computed tomography (CT) for the evaluation of suspected appendicitis in children until after ultrasound has been considered as an option.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1880;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Lung Transplantation and Survival in Children with Cystic Fibrosis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2136;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Collegio Italiano Primari di Oncologia Medica ? Green Oncology";Spanish;"Don?t prescribe antibiotics to prevent infectious complications from neutropenia in cancer patients treated with standard dose chemotherapy. (The Italian Board of Medical Oncology Directors ? Green Oncology)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 89;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid computed tomography (CT) scans of the head in emergency department patients with minor head injury who are at low risk based on validated decision rules";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Images;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1881;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Rosuvastatin in Older Patients with Systolic Heart Failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2137;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Collegio Italiano Primari di Oncologia Medica ? Green Oncology";Spanish;"Don?t routinely prescribe serum cancer markers during the diagnostic or staging process of cancers. (The Italian Board of Medical Oncology Directors ? Green Oncology)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en italiano)

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en ingl�s)

" 90;2;"Choosing Wisely�";"American College of Physicians";English;"In the evaluation of simple syncope and a normal neurological examination, don?t obtain brain imaging studies (CT or MRI).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"transient loss of consciousness, TLoC, images";"

" 1882;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Dexamethasone in Adolescents and Adults with Bacterial Meningitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2138;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Collegio Italiano Primari di Oncologia Medica ? Green Oncology";Spanish;"Don?t routinely use cancer-directed therapy for solid cancer patients with low performance status (3 or 4) or progressive after 2-3 therapeutic lines, but prioritize palliative care. (The Italian Board of Medical Oncology Directors ? Green Oncology)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1883;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Corticosteroids for Bacterial Meningitis in Adults in developing countries or areas of high HIV prevalence";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2139;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Collegio Italiano Primari di Oncologia Medica ? Green Oncology";Spanish;"Don?t perform laboratory tests (including biochemical profile), imaging (chest x-rays, liver and pelvic ultrasound, ultrasound, PET, CT and radionuclide radionuclide bone scans) or serum cancer markers markers for asymptomatic patients after surgery for b";"** Blood tests, bone-imaging techniques, X-ray, ultrasound of the liver and pelvis, CT, PET and tumor markers

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1884;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Hydrocortisone Therapy for Patients with Septic Shock";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2140;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Collegio Italiano Primari di Oncologia Medica ? Green Oncology";Spanish;"Don?t prescribe chemotherapy in the systemic treatment of ductal carcinoma in situ of the breast. (The Italian Board of Medical Oncology Directors ? Green Oncology)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1885;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2141;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Federazione delle Associazioni dei Dirigenti Ospedalieri Internisti (FADOI)";Spanish;"Don?t recommend percutaneous feeding tubes in advanced dementia; prefer oral assisted feeding instead.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"alimentaci�n, feeding, Alzheimer";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1886;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Aprotinin during Coronary-Artery Bypass Grafting and Risk of Death";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1887;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The effect of Aprotinin on Outcome after Coronary-Artery Bypass Grafting";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1888;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Vasopressin versus Norepinephrine Infusion in Patient with Septic Shock.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2400;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Life skills programmes for people with schizophrenia";"""NICE summary of Cochrane review conclusions Evidence does not support the use of life skills training programmes for people with schizophrenia or schizophrenia-type illnesses. No evidence was available for other chronic mental illnesses. After 12 or 24 weeks of therapy, no difference was seen in life skills performance, mental state outcome scales and quality-of-life scores when life skills programmes were compared with standard therapy or participation in a support group.

The ?Implications for practice? section of the Cochrane review stated: ?Despite the addition of three studies to this review, the quality of the reporting in these studies is very low and they do not address any additional outcomes that were missing from the previous version of this review. The overall conclusions of this review therefore remain unchanged?. ?1. People with serious mental illness Considering that there is severely limited evidence that life skills training programmes are of value to those with serious mental illnesses, their advocates would be well justified in calling for a randomised controlled trial in this area. Until such time as any evidence of benefit is available, it is questionable whether recipients of care should be put under pressure to attend such programmes?. ?2. Clinicians Many healthcare professionals spend significant parts of their jobs training people with chronic mental health problems in the area of life skills. This review shows that there is no evidence indicating that such programmes are helpful or harmful to this vulnerable group. The healthcare profession is responsible for a situation where an almost unevaluated and possibly expensive treatment is provided for a vulnerable population?. ?3. Managers/policy makers It is likely that short-sighted managers or policy makers would see life skills programmes as ripe for closure. Nevertheless, others may see this as an ideal opportunity for evaluation and give full support to those wishing to undertake such work.""";2013;;;"Low value";-;"Link to the recommendation in the NICE website" 1889;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Anestheisia Awareness and the Bispectral Index";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2401;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Therapeutic ultrasound for acute ankle sprains";"""NICE summary of Cochrane review conclusions

Ultrasound has been used to treat a variety of musculoskeletal disorders including acute ankle sprains. Evidence shows that it does not seem to enhance recovery, help reduce the symptoms of pain and swelling, or improve the ability to stand on the affected foot and ankle. Given the limited clinical impact of treatment effects and short-term nature of acute ankle sprains, therapeutic ultrasound should not be routinely used for this condition.

The ?Implications for practice? section of the Cochrane review stated:

?There are still only a few trials evaluating the effectiveness of ultrasound therapy for acute ankle sprains. The evidence from the 5 placebo-controlled trials included in this review does not support the wide use of ultrasound in the treatment of acute ankle sprains. The potential treatment effects of ultrasound appear to be generally small and probably of limited clinical importance, especially in the context of the usually short-term recovery period for these injuries. Due to the limited amount of information on treatment parameters, no conclusions can be made regarding an optimal and adequate dosage schedule for ultrasound therapy or whether such a schedule would improve on the reported effectiveness of ultrasound for ankle sprains.""";2013;;;"Low value";-;"Link to the recommendation in the NICE website" 1890;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Simvastatin with or without Ezetimibe in Familial Hypercholesterolemia";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1891;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Metformin versus Insulin for the Treatment of Gestational Diabetes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2403;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Ursodeoxycholic acid for cystic fibrosis-related liver disease";"""NICE summary of Cochrane review conclusions

Evidence does not support the use of ursodeoxycholic acid (UDCA) for the prevention of cystic fibrosis (CF)-related liver disease. Many of the studies performed to date failed to include important outcomes (for example, number of liver transplants), and showed no significant improvement in the normalisation of any single hepatocellular enzyme, increase in weight or improvement in biliary excretion with the use of UDCA. Therefore at present UDCA cannot be recommended.

The ?Implications for practice? section of the Cochrane review stated:

?Evidence of the effectiveness of UDCA is as yet inconclusive. Routine use of UDCA in people with CF cannot, therefore, be recommended. However, in view of these important preliminary results and because of the lack of any other effective intervention to prevent or treat CF-related liver disease, it is essential that a large multicentre RCT of UDCA in people with CF is undertaken.""";2013;;;"Low value";-;"Link to the recommendation in the NICE website" 1892;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Comparison of Aprotinin and Lysine Analogues in High- Risk Cardiac Surgery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1381;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"HIV screening: nonpregnant adolescents and adults";"The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened. Recommendation Grade A";2013;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1893;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Intensive Blood Glucose Control and Vascular Outcomes in Patient with Type 2 Diabetes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 1382;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"HIV screening: pregnant women";"The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. Recommendation Grade A";2013;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1894;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effects of Intensive Glucose Lowering in Type 2 Diabetes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2150;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Allergologia e Immunologia Pediatrica (SIAIP)";Spanish;"Avoid contraindicating routinely vaccination in case of allergies.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1895;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2151;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Allergologia e Immunologia Pediatrica (SIAIP)";Spanish;"Avoid performing routine allergy testing in children with acute urticaria.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 104;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Initiation of omega-3-acid ethyl esters supplements is not routinely recommended for patients who have had an myocardial infarction (MI) more than 3 months earlier.";.;2013;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1896;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2152;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Allergologia e Immunologia Pediatrica (SIAIP)";Spanish;"Avoid prescribing mucolytics in children with bronchial asthma.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1897;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Arthroscopic Surgery for Osteoarthritis of the Knee";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2153;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Allergologia e Immunologia Pediatrica (SIAIP)";Spanish;"Avoid prescribing routine immunological tests in children with recurrent respiratory infections.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1898;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Prolonged Therapy of Advanced Chroncic Hepatitis C with Low- Dose Peginterferon";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2154;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Allergologia e Immunologia Pediatrica (SIAIP)";Spanish;"Avoid ruling out a food from the diet only for the positivity of skin prick tests and/or specific serum IgE.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1899;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Oral Prednisolone for Preschool Children with Acute Virus- Induced Wheezing";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2155;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Medicina Generale (SIMG)";Spanish;"Don?t recommend routine imaging of the spine in patients with low back pain in the absence of warning signs or symptoms (red flags).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1900;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Quality of Life after Late Invasive Therapy for Occluded Arteries";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2156;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Medicina Generale (SIMG)";Spanish;"Don?t routinely prescribe antibiotics for acute infections of the upper airways. Evaluate their opportunity for patients at risk of lower respiratory tract infections or in the presence of clinical worsening after some days.";"*Consider the opportunity for patients at risk of lower respiratory tract infections, or when the symptoms and signs worsen after several days

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1901;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Intensive versus Conventional Glucose Control in Critically Ill Patients";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2157;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Medicina Generale (SIMG)";Spanish;"Don?t routinely prescribe proton pump inhibitors to patients not at risk for peptic ulcer. For pharmacological treatment of patients with gastroesophageal reflux disease (GERD), they should be titrated to the lowest effective dose needed to achieve therap";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1902;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Prostate-Cancer Screening Trial";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2158;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Medicina Generale (SIMG)";Spanish;"Don?t prescribe non steroidal anti-inflammatory drugs (NSAIDS) without initially assessing, and periodically reassessing, the true clinical indication and the risk of side effects in that moment and for that patient.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1903;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Rosuvastatin and Cardiovascular Events in Patients Undergoing Hemodialysis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2159;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Medicina Generale (SIMG)";Spanish;"Don?t routinely prescribe benzodiazepines or Z-drugs in older adults as first choice for insomnia. Recommend to use them intermittently and to periodically reassess the clinical indication as well as any side effects.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2671;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Quantrill S. BMJ 2013;347:f5121";English;"Risk-benefit ratio favours treating all pulmonary emboli, no matter how small.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Emboli;"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1904;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Efficacy of Esomeprazole for Treatment of Poorly Controlled Asthma";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2672;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Benger J. BMJ 2013;347:f5115";English;"Duplex ultrasound scanning of the lower limbs is recommended in low risk clinically well patients with suspected pulmonary embolism.";"For further information please visit the website of the initiative (link below)";2013;;;"High value";"Pulmonary, Embolism";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1905;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Cognitive Function at 3 Years of Age after Fetal Exposure to Antiepileptic Drugs";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2161;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Radiologia Medica (SIRM)";Spanish;"Don?t perform routine magnetic resonance imaging (MRI) of the knee in the event of acute pain from trauma or chronic pain.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en italiano)

Enlace a las recomendaciones en la p�gina web de Slow Medicine (versi�n en ingl�s)

" 2673;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ 2013;347:f5157";English;"Science of overdiagnosis to be served up with a good dose of humility.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1906;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Early versus Delayed, Provisional Eptifibatide in Acute Coronary Syndromes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2162;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Radiologia Medica (SIRM)";Spanish;"Don?t perform magnetic resonance imaging (MRI) for non-traumatic headache in the absence of warning clinical signs.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2674;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Brito J. BMJ 2013;347:f4706";English;"Zealous imaging in the diagnose of thyroid cancer should be restricted. Because increased imaging has led epidemic in detection and treatment of low risk tumors.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Thyroid, Cancer, Images";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1907;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"The endoscopic vein-graft Harvesting is not recommended, is prefered to do an open Vein-Graft in Coronary-Artery Bypass Surgery.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2163;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Radiologia Medica (SIRM)";Spanish;"Don?t perform preoperative chest x-rays in the absence of clinical signs or symptoms which indicate diseases that could affect the outcome of the surgery.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2675;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Dunn B. BMJ 2013;347:f5328";English;"The word ?cancer?: how language can corrupt thought.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Cancer, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1908;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Vertebroplasty for Painful Osteoporotic Vertebral Fractures";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2164;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Societ� Italiana di Radiologia Medica (SIRM)";Spanish;"Don?t perform routine radiology of the skull in minor head injury.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2676;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hofman M. BMJ 2013;347:f5742";English;"Don't routinely consider every thyroid nodules as cancer through CT and Ultrasonography. It's time to stop over-reporting normal findings and update consensus guidelines.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Thyroid, Nodules, Overdiagnosis";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1909;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Weight Lifting in Women with Breast- Cancer?Related Lymphedema";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication of Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2165;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"IPASVI - Federazione Italiana Collegi Infermier";Spanish;"Don?t perform preoperative hair removal with a razor blade in anticipation of surgery (AICO).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2677;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCartney M. BMJ 2013;347:f5834";English;"Screening programs offered by NHS health checks in adults aged 40-74 should be reviewed since some evidences suggest that it is not cost-effective.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Check, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1910;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Intensity of Continuous Renal- Replacement Therapy in Critically Ill Patients";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2166;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"IPASVI - Federazione Italiana Collegi Infermier";Spanish;"Don?t incorrectly use collection devices for ostomy with convex plate. (AIOSS)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2678;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Van Pottelbergh G. BMJ 2013;347:f5566";English;"It is recommended to consider an alternative classification system for chronic kidney disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Renal, Kidney, Diagnosis";"Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1911;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Revascularization versus Medical Therapy for Renal- Artery Stenosis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2167;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"IPASVI - Federazione Italiana Collegi Infermier";Spanish;"Don?t incorrectly use chemicals for clearing the stomatal complex. (AIOSS)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2679;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Rogers H. BMJ 2013;347:f5734";English;"Don't rely on imaging tests in the diagnose of thyroid cancer. Zealous imaging has increased detection of low risk tumors leading to overdiagnosis and overtreatment.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Thyroid, Cancer, Thyroidectomy";"Link to article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1912;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"A Trial of Darbepoetin Alfa in Type 2 Diabetes and Chronic Kidney Disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2168;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"IPASVI - Federazione Italiana Collegi Infermier";Spanish;"Don?t use abrasive disinfectants on intact skin in the elderly, who are bedridden and with fragile and/or damaged skin. (AIUC)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the website of Choosing Wisely Italy-Slow Medicine (web in Italian/English)

Link to this recommendation

" 2680;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Hoff G. BMJ 2013;347:f5843";English;"New polyps, old tricks: controversy about removing benign bowel lesions.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Polyp, Surgery, Removing";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1913;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Extended-Release Niacin or Ezetimibe and Carotid Intima? Media Thickness";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2169;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"IPASVI - Federazione Italiana Collegi Infermier";Spanish;"Don?t use bladder training (repeated closure of the catheter) before urinary catheter removal. (AIURO - ANIMO)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2681;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Polak L. BMJ 2013;347:f6025";English;"Helping patients make the right decisions about treatment.";"For further information please visit the website of the initiative (link below)";2013;;;"High value";"Treatment, Decisions";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1914;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Preoperative Biliary Drainage for Cancer of the Head of the Pancreas";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2170;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely order allergologic tests routine testing in patients with chronic hives";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2682;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Gordon P. BMJ 2013;347:f5597";English;"CANTABmobile is not recommended as a diagnostic test for dementia.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Dementia;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1915;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Outcomes after Internal versus External Tocodynamometry for Monitoring Labor";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2171;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not schedule clinical/functional monitoring on a fixed date every 6-8 months in patients with well controlled intermittent asthma.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2683;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2013;347:f6388";English;"US endocrinologists release ?choose wisely? list.";"For further information please visit the website of the initiative (link below)";2013;;;"High value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1916;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Comparison of Dopamine and Norepinephrine in the Treatment of Shock";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2172;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request allergy tests in patients with newly diagnosed asthma with no medical records or symptoms attributable to allergopatia.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2684;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Houghton J. BMJ 2013;347:f6024";English;"It is potentially recommended to use the term ""dysplasia"" for precancerous lesions.";"For further information please visit the website of the initiative (link below)";2013;;;"High value";"Dysplasia, Cancer";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1405;2;"Choosing Wisely�";"North American Spine Society";English;"Don?t recommend advanced imaging (e.g., MRI) of the spine within the first six weeks in patients with non-specific acute low back pain in the absence of red flags.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"low back pain, x-ray, radiography, imaging, images, lumbar, resonance";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1917;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Lenient versus Strict Rate Control in Patients with Atrial Fibrillation";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2173;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order an intraoperative pathological test if the result cannot really affect the performance of the surgical procedure.*";"*Besides assessing the resection margins, do not request a intraoperative review if the sample size is small and there is no other available material for the final examination.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2685;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Burns A. BMJ 2013;347:f6125";English;"Alistair Burns and 51 colleagues reply to David Le Couteur and colleagues";"For further information please visit the website of the initiative (link below)";2013;;;"High value";Dementia;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1918;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2174;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request intraoperative pathological diagnosis in clinical cases of particular complexity, without consulting the pathologist.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2686;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Heath I. BMJ 2013;347:f6361";English;"Overdiagnosis: when good intentions meet vested interests?an essay by Iona Heath.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1919;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Rhythm Control in Patients with Recurrent Persistent Atrial Fibrillation may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2175;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Prevent the simultaneous request of intraoperative examinations by more than one operating room.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2687;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Sokol D. BMJ 2013;347:f6426";English;"?First do no harm? revisited.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1920;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Effects of Estrogen plus Progestin on Health-Related Quality of Life may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2176;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request routine blood tests (e.g. Days 2 and 4 and successively). Order them according to the clinical needs of the patient.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2688;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Thomas R. BMJ 2013;347:f6172";English;"It is recommended a stepped diagnostic approach to reduce the risk of overdiagnosis in attention-deficit/hyperactivity disorder (ADHD) in severe patients";"For further information please visit the website of the initiative (link below)Reducing the threshold for diagnosing ADHD devalues the diagnosis in those with serious problems. A conservative stepped diagnostic approach could reduce the risk of overdiagnosis. Harms from overdiagnosis?Medication costs of inappropriately diagnosed ADHD are estimated to be between $320m (�200m; ?230m) and $500m in the US and some children have adverse drug reactions. While a diagnosis may help children and families it also carries stigma; children labelled as having ADHD are perceived as lazier and less clever by peers, and teachers and parents have low academic expectations of them potentially creating a self fulfilling prophecy";2013;;;"Low value";"Hyperactivity, Attention, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 5760;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"In the UK and Ireland midwifery care can be a cost-effective and safe alternative to doctor-led healthcare for pregnant women";"The COVID-19 pandemic is placing a strain on health systems and healthcare workers. Existing research on different models of healthcare delivery, such as midwife-led obstetric care, might provide useful information for policy makers. In this systematic review, the authors searched for comparative effectiveness studies of the cost-effectiveness of midwife-led care, compared with medical-led care for pregnant women, which had been done in the UK or similar settings. They restricted their searches to articles published in English. The search period was not stated, but the review was submitted for publication in June 2011. The authors included 4 randomised trials (3 from the UK and 1 from Ireland), and synthesized the economic analyses from the three largest studies (total: 6403 participants). They concluded that there was a paucity of evidence on this topic. Midwife-led care may be a cost-effective model for delivery of obstetric care, and appears to be as safe as medical-led care. The cost-effectiveness of midwife-led obstetric care in settings outside the UK and Ireland is uncertain.";2013;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1921;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Hormone Therapy and the Progression of Coronary-Artery Atherosclerosis in Postmenopausal Women may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2177;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform Angio-CT scans before discharge in patients undergoing uncomplicated aortic surgery (replacement of the ascending aorta)*.";"*Limiting it only to patients undergoing complex aortic surgery (replacement of the ascending aorta and aortic arch or patient with residual dissection) is recommended.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2689;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ 2013;347:f7141";English;"Too Much Medicine: from evidence to action";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Overdiagnosis, Overtreatment";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 1922;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Combined Oral Contraceptives in Women with Systemic Lupus Erythematosus may be a low value practice";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2690;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Moynihan R. BMJ�2013;347:f6119";English;"Act now to fight chronic procrastination disorder.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Procrastination, Overdiagnosis";"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2179;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order routine examinations after those carried out during admission, when no precise clinical reasons exist.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2691;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Cornell J. BMJ 2013;347:f6969";English;"Another cause of overdiagnosis: fear of litigation.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Overdiagnosis;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2180;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order daily INR monitoring in patients with anticoagulation therapy, when INR is inside therapeutic range and no treatment discontinuation is expected.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2692;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Dowrick C. BMJ 2013;347:f7140";English;"Don't consider grief and other responses to loss into a mental disorder leading to overdiagnosis and over treatment.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";Depression;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2181;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order serial measurements of inflammatory markers (PCR-PCT) except under particular conditions (critical patients for which a close monitoring of the response to therapy is required).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2693;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"McCarthy M. BMJ 2013;347:f7581";English;"Attention-deficit/hyperactivity disorder drug makers move to expand into adult market.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Deficit, Attention, Hyperactivity";"Link to the article in the BMJ collection ""Too Much Medicine "" / Enlace al art�culo de la serie BMJ ?Too Much Medicine?" 2182;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"""Do not request routine echocardiograms in patients with known mild to moderate asymptomatic systolic dysfunction or valve disease*.";"*Adherence to the timings indicated by the GPCs for monitor echocardiograms in clinically stable patients with valvular heart disease is recommended.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2183;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request specialised consultations in acute patients, which are being treated for diabetes, recently admitted, which may have altered glycemic profiles due to the acute situation.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2184;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not proceed with the removal of asymptomatic third molars.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2185;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order skull radiographies in cases of middle-third trauma and in post-operative monitoring.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2186;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order MRI of the TMJ in onset algic-dysfunctional pathology of the temporo-mandibular joint.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2187;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely use antibiotic solutions (amikacin/clindamycin) in intraoperative wash of breast implants*.";"*it is preferable to flush the prosthetic space with a mild antiseptic and to use protection devices for risk areas.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2188;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely use topical solution, cream or ointment antibiotics in uninfected non complicated surgical wounds or burns*.";"*it is preferable to use sterile dressings potentially with silver medication (not ointment) and to clean it with mild antiseptics (hypochlorites).

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 5772;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The introduction of medical assistants in primary care is recommended";"The COVID-19 pandemic is placing a strain on healthcare systems and healthcare workers. Existing research on the effects of extended roles for physician assistants in primary care may provide useful information for policy makers. In this systematic review, the authors searched for research evaluating the effects of certified physician assistants on general practice and family medicine care. They restricted their searches to studies published in English and did the search in September 2010. They included 49 studies, which were from Australia (1 study), the Netherlands (1), UK (1) and USA (46); and judged the evidence to be of weak to moderate quality. Physician assistants are acceptable to patients in primary care and are able to provide satisfactory care. The introduction of physician assistants in primary care may increase productivity; but with a different patient caseload to clinicians (including having a higher proportion of younger patients, acute presentations, minor illnesses and preventive consultations). The retention of physician assistants in primary care is good, under suitable working locations and circumstances. The cost-effectiveness of using physician assistants in primary care is uncertain.";2013;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2189;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform sentinel lymph node biopsy or other diagnostic tests for the assessment of early and superficial melanomas, as these interventions do not improve survival*.";"*Complex biochemical analysis, CT and PET are neither indicated, as they have a high rate of false positives: these investigations are performed in case of clinical suspicion or according to the patint's or disease's history.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2190;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order a pre-discharge monitoring angio-CT in patients undergoing endovascular treatment of the abdominal aorta, if the intraoperative result is satisfactory.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2191;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request Eco Doppler in patients with asymptomatic peripheral arterial disease if ABI> 0.8";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2193;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe oral antifungal therapy for suspected onychomycosis without bacterioscopic confirmation or confirmation by a fungal-infection culture.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1170;2;"Choosing Wisely�";"American Academy of Neurology";English;"Don?t perform electroencephalography (EEG) for headaches.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2194;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform the sentinel lymph node biopsy or other diagnostic tests for evaluation of early and thin melanoma.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1171;2;"Choosing Wisely�";"American Academy of Neurology";English;"Don?t perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�ne n la p�gina web de la iniciativa" 2195;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use oral antibiotics for the treatment of atopic dermatitis unless there is clinical evidence of infection.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1172;2;"Choosing Wisely�";"American Academy of Neurology";English;"Don?t use opioid or butalbital treatment for migraine except as a last resort.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2196;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Avoid Artificial Nutrition (AN) in clinical situations in which an evidence-based approach has not shown benefit, such as in patients with advanced dementia or terminal cancer.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1173;2;"Choosing Wisely�";"American Academy of Neurology";English;"Don?t prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2197;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use food intolerance tests as a tool for the dietary treatment of obesity or for diagnosis in cases of suspected food intolerances.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1174;2;"Choosing Wisely�";"American Academy of Neurology";English;"Don?t recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina de la iniciativa" 2198;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Avoid in children restrictive approaches to overweight and obesity, not proven and not involving the family.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1175;2;"Choosing Wisely�";"American Academy of Ophthalmology";English;"Don?t perform preoperative medical tests for eye surgery unless there are specific medical indications.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2199;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request doses of total or free T3 in the evaluation of the appropriateness of the therapy with levothyroxine (T4) in patients with hypothyroidism.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1176;2;"Choosing Wisely�";"American Academy of Ophthalmology";English;"Don?t routinely order imaging tests for patients without symptoms or signs of significant eye disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2200;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely prescribe daily multiple glucose monitoring with type 2 diabetes with good management and/or treatment with non glucose-lowering antidiabetic drugs.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1177;2;"Choosing Wisely�";"American Academy of Ophthalmology";English;"Don?t order antibiotics for adenoviral conjunctivitis (pink eye).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2201;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request bone densitometry in postmenopausal women with no risk factors.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1178;2;"Choosing Wisely�";"American Academy of Ophthalmology";English;"Don?t routinely provide antibiotics before or after intravitreal injections.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2202;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe intravenous route of administration when the patient is stabilized: immediate evaluation of the possibility of transition to oral therapy is recommended.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1179;2;"Choosing Wisely�";"American Academy of Ophthalmology";English;"Don?t place punctal plugs for mild dry eye before trying other medical treatments.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2203;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not allow urgent requests by the departments of Class C drugs (SOP, OTC, RR) and supplements.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1180;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform echocardiography as routine follow-up for mild, asymptomatic native valve disease in adult patients with no change in signs or symptoms.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2204;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Reducing orders to wholesale drug company in compendium or out of compendium at high cost is recommended.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1181;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t order computed tomography (CT) scan of the head/brain for sudden hearing loss.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1182;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t perform population based screening for 25-OH-Vitamin D deficiency.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2206;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request routine blood tests at the time of admission of patients in the ward.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1183;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t perform low risk HPV testing.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2207;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request endoscopic monitoring before the age of 3 in the presence of a diagnosis of Barrett's esophagus without dysplasia.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1184;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Avoid routine preoperative testing for low risk surgeries without a clinical indication";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2208;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request monitoring colonoscopies before the recommended monitoring intervals of polypectomies performed during a good-quality colonoscopy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1185;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Only order Methylated Septin 9 (SEPT9) to screen for colon cancer on patients for whom conventional diagnostics are not possible.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2209;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe PEG, SNG and CVC in patients with terminal dementia. Trying to provide assisted feeding by mouth is recommended.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 5793;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"School closings recommended to reduce transmission of pandemic and seasonal flu among schoolchildren";"The COVID-19 pandemic is placing a strain on schools and the services they provide. Existing research on school closure during influenza outbreaks may provide information to help policy makers with this. School closure reduced transmission of seasonal and pandemic influenza among school children, in some studies. Influenza incidence increased in some studies when schools reopened. School closure often occurred late in the outbreaks and it is unclear whether this influenced the decline in influenza. The optimum timing and duration of closure are uncertain because studies differed in several respects, including whether individual schools closed or school closure was widespread. In most of the pandemic influenza studies, other interventions were used in addition to school closures, which may also have contributed to a reduction in incidence.";2013;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1186;2;"Choosing Wisely�";"American Society for Clinical Pathology";English;"Don?t use bleeding time test to guide patient care.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2210;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not extend the diagnosis of all diseases of the elderly patient, focus on the pathology that led to hospitalization.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1187;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Cough and cold medicines should not be prescribed or recommended for respiratory illnesses in children under four years of age.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2211;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe ASA as a result of brain CT findings of lacunar vascular encephalopathy due to small vessel disease, in the absence of clinically evident brain events.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1188;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Neuroimaging (CT, MRI) is not necessary in a child with simple febrile seizure.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2212;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe vaginal gemeprost after taking mifepristone for the interventions of pharmacological pregnancy interruption before the 49th day of gestation*.";"*Prescribing oral misoprostol is recommended instead.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1189;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Computed tomography (CT) scans are not necessary in the routine evaluation of abdominal pain in children.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2213;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Reducing the dose of immunoglobulin administered to RH-negative pregnant women with immunoprophylactic purposes within 20 weeks of gestation is recommended.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1190;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks 0 days gestational age.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2214;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe routine blood tests for minor procedures or elective surgery for benign disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1191;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t schedule elective, non-medically indicated inductions of labor between 39 weeks 0 days and 41 weeks 0 days unless the cervix is deemed favorable.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2215;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe a chest radiograph to check for community-acquired pneumonia if clinical and laboratory results are normal.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1192;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t perform routine annual cervical cytology screening (Pap tests) in women 30?65 years of age.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2216;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request serological tests prescribed where a clinical diagnosis is possible (e.g. measles, chickenpox).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1193;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t treat patients who have mild dysplasia of less than two years in duration.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2217;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe intravenous antibiotics if absorption is equivalent to oral administration.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 682;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t perform unproven diagnostic tests, such as immunoglobulin G (IgG) testing or an indiscriminate battery of immunoglobulin E (IgE) tests, in the evaluation of allergy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2218;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not insert peripheralvenous catheter to patients evaluated in the emergency department who need venipuncture and with supposedly no need for infusion therapy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1195;2;"Choosing Wisely�";"American College of Obstetricians and Gynecologists";English;"Don?t screen for ovarian cancer in asymptomatic women at average risk.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2219;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform radiography of the cervical spine in conscious, asymptomatic, and clinically evaluable patients with polytrauma without neurologic deficit (Nexus criterion + Canadian Study).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2220;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform a CT in patients with minor head injury, considered in low risk of brain damage (age, comorbidities, dynamics, symptoms), according to a validated clinical score.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2221;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not extend the duration of antibiotic therapy in cases of uncomplicated community-acquired pneumonia for more than a week oral route if conditions are appropriate*";"* (integrate consciousness, appropriate swallowing reflex, absence of malabsorption conditions), or switch to oral route as soon as possible.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2222;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use proton pump inhibitors in preventing serious complications of upper gastrointestinal tract, except in patients on chronic NSAID or low-dose ASA.* long as there is a risk of the following";"""*As long as the risk of the following conditions exists: ? gastrointestinal bleeding background, ? Concomitant therapy with steroids or anticoagulant drugs, ? Age> 65 Do not use as prophylaxis of the stress ulcer in patients that are not at risk.""

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2223;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use multiple biomarkers in the diagnosis and monitoring of CAP.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2224;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not ask for PET/CT for the detection of cancer (screening).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2225;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe stress test with myocardial scintigraphy after a coronary revascularization as a routine annual examination.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2226;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request neurological PET imaging in the study of dementia before the patient is evaluated by a specialist.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2227;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request 24 hour urine test more than 3 times/year in chronic renal disease (CKD) Stage IV and V.";"*do not request fundus oculi in artery hypertension stages I/II and in CKD; do not request creatinine clearance (only in the first control associated with e-GFR), but only e-GFR to assess the kidney function.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2228;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not administer intravenous proton pump inhibitors if oral administration is available.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2229;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"In case of septicaemia through tunneled central venous catheter for haemodyalisis, reduce antibiotic therapy to 2 weeks if inflamation markers have normalised.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2230;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request annual viraemia of BK virus (a polyomavirus) after the first year of renal transplantation (TX)*.";"*""Do not request CMV IgG / IgM and EBV IgG / IgM, but only the viraemia within the first year of TX. Do not routinely request lymphocyte typification (CD4 / CD8)"".

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2231;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Reduce the programming of blood tests in neurosurgery postoperative as follows:*";"* ""- lumbar disc herniation: no examination except if indicated by surgeon -lumbar stenosis: CBC the day after surgery -skull/spine stabilisation: CBC, glucose, creatinine and electrolytes on days 1 and 3 after surgery.""

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1208;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t use cancer-directed therapy for solid tumor patients with certain characteristics*";"*Characteristics: low performance status (3 or 4), no benefit from prior evidence-based interventions, not eligible for a clinical trial, and no strong evidence supporting the clinical value of further anticancer treatment

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1209;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t perform PET, CT, and radionuclide bone scans in the staging of early prostate cancer at low risk for metastasis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1210;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t perform PET, CT, and radionuclide bone scans in the staging of early breast cancer at low risk for metastasis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1211;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2235;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Limit the request of packed red blood cells depending on the type of surgery";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1212;2;"Choosing Wisely�";"American Society of Clinical Oncology";English;"Don?t use white cell stimulating factors for primary prevention of febrile neutropenia for patients with less than 20 percent risk for this complication.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2236;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request Doppler ultrasound of supra-aortic trunks for syncope study";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1213;2;"Choosing Wisely�";"American College of Physicians";English;"Don?t obtain screening exercise electrocardiogram testing in individuals who are asymptomatic and at low risk for coronary heart disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2237;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request Doppler ultrasound of supra-aortic trunks for the study of vertigo";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1214;2;"Choosing Wisely�";"American College of Physicians";English;"Don?t obtain imaging studies in patients with non-speci?c low back pain.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"low back pain, x-ray, radiography, imaging, images, lumbar";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2238;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not rourinely request electromyography for patients with low-back pain in the absence of radicular signs or symptoms";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1215;2;"Choosing Wisely�";"American College of Physicians";English;"In patients with low pretest probability of venous thromboembolism don?t obtain imaging studies as the initial diagnostic test*.";"*Obtain a high-sensitive D-dimer measurement as the initial diagnostic test.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2239;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request antiepileptic drug levels and haematologic and chemical profiles in patients with drug-treated epilepsy";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1216;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t do imaging for uncomplicated headache.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2240;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Medical Radiology";Spanish;"Don?t perform magnetic resonance imaging (MRI) for non-traumatic headache in the absence of warning clinical signs.";"Too many MRIs are performed at the first sign of non-traumatic headache; In addition, the clinical suspicion is rarely mentioned in the request, which would suggest how to perform an appropriate examination, as there are different ways to perform an MRI examination depending on the question to resolve. Performing an MRI (with and without contrast agents) in patients with a headache, without specific risk factors for structural diseases, does not change the management nor improve clinical outcomes. Patients with a significant probability of structural sickness that require immediate attention are identified by clinical history and / or examination. Eventual incidental findings as a result of MRI examination may lead to further additional testing and expensive treatments that don?t improve the welfare of the patient.";2013;;;"Low value";"magnetic resonance";"

Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 1217;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t image for suspected pulmonary embolism (PE) without moderate or high pre-test probability of PE.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2241;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely perform CT of the skull in cases of minor head trauma, in paediatric patients at low risk of brain damage according to the score of a validated clinical test.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2242;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe MRI with contrast in patients with impaired vestibulocochlear function with no worsening or during the follow-up of vestibular schwannomas.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"magnetic resonance-";"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1219;2;"Choosing Wisely�";"American College of Radiology";English;"Don?t recommend follow-up imaging for clinically inconsequential adnexal cysts.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2243;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request a monitoring TC scan in the emergency department in patients with known epilepsy presenting a new seizure.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1220;2;"Choosing Wisely�";"American College of Rheumatology";English;"Don?t test ANA sub-serologies without a positive ANA and clinical suspicion of immune-mediated disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2244;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request additional neuroimaging tests without q clear suspicion suggested by the initial test.*";"* E.g., request a MRI in patients with cognitive impairment after a CT scan, or a MRI in patients with degenerative spine condition who already have a CT scan.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1221;2;"Choosing Wisely�";"American College of Rheumatology";English;"Don?t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2245;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe antibiotics in adenovirus keratoconjunctivitis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1222;2;"Choosing Wisely�";"American College of Rheumatology";English;"Don?t perform MRI of the peripheral joints to routinely monitor inflammatory arthritis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2246;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe antibiotic prophylaxis for intravitreal injections.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2247;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Doing routinely use laboratory assays and instrumental tests for the preoperative evaluation of cataract surgery with topical anesthesia.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1224;2;"Choosing Wisely�";"American College of Rheumatology";English;"Don?t routinely repeat DXA scans more often than once every two years.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2248;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe oral antibiotics for uncomplicated otitis externa.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1225;2;"Choosing Wisely�";"American Gastroenterological Association";English;"For pharmacological treatment of patients with gastroesophageal re?ux disease, long-term acid suppression therapy* should be titrated to the lowest efective dose needed to achieve therapeutic goals.";"*Proton pump inhibitors or histamine2 receptor antagonists

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2249;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request imaging tests in patients who meet diagnostic criteria for acute uncomplicated rhinosinusitis.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1226;2;"Choosing Wisely�";"American Gastroenterological Association";English;"Do not repeat colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2250;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use mannitol in the treatment protocol for idiopathic sudden sensorineural deafness (excluding forms of hydrops).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1227;2;"Choosing Wisely�";"American Gastroenterological Association";English;"Do not repeat colonoscopy for at least ?ve years for patients who have one or two small (< 1 cm) adenomatous polyps, without highgrade dysplasia, completely removed via a high-quality colonoscopy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2251;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use aerosol bronchodilators in children with bronchiolitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2252;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not combine CRP and procalcitonin as infection markers for the diagnosis and monitoring of infectious diseases (excluding septicaemia)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1229;2;"Choosing Wisely�";"American Gastroenterological Association";English;"Computed tomography scans should not be repeated in patients with functional abdominal pain syndrome (ROME III criteria), unless there is a major change in clinical ?ndings or symptoms.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2253;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not always use the double antibiotic therapy (cephalosporin + macrolide) in children admitted with community-acquired pneumonia";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2254;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform a chest CT angiography to assess the presence of pulmonary embolism in patients with low clinical probability and negative D-dimer (using high sensitivity test).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2255;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely order a chest radiography after a thoracentesis performed without complications";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 2256;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not renew the prescription of oxigen therapy without first checking the persistence of hypoxemia in patients discharged with oxigen therapy after hospitalization for acute respiratory failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2257;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely prescribe antidepressant medication and benzodiazepines to patients admitted for the first time with anxiety and depression symptoms in the first days of hospitalization*";"*and limit the use of benzodiazepines in the treatment of insomnia, anxiety and agitation, especially in elderly patients.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 2258;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request brain TC scans in patients with cerebral vascular disease diagnostic hypothesis*";"*except in cases where the test can acheive the first diagnosis of the cerebral vascular disease, and in situations in which the hypothesis of an acute ischemic event may be arise, on the basis of clinical symptoms.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1235;2;"Choosing Wisely�";"Commission on Cancer";English;"Don?t perform surgery to remove a breast lump for suspicious findings unless needle biopsy cannot be done.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2259;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request brain TC scans other than to rule out neurologic causes of psychiatric symptoms, in cases with atypical symptomatology or an unclear psychopathlogical clinical presentation";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1236;2;"Choosing Wisely�";"Commission on Cancer";English;"Don?t initiate surveillance testing after cancer treatment without providing the patient a survivorship care plan.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2260;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe patient restraint, especially in elderly with delirium.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1237;2;"Choosing Wisely�";"Commission on Cancer";English;"Don?t initiate cancer treatment without defining the extent of the cancer (through clinical staging) and discussing with the patient the intent of treatment.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2261;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not routinely request preoperative chest radiographies, but do so selectively based on medical records and clinical indications";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1238;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid placing indwelling urinary catheters in the emergency department for either urine output monitoring in stable patients who can void, or for patient or staff convenience.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2262;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order cranial CT after minor trauma, except after applying an appropriate diagnostic algorithm";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1239;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Don?t delay engaging available palliative and hospice care services in the emergency department for patients likely to benefit.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2263;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request more imaging studies (X-ray, CT or MRI) in low back pain not attributable to a specific clinical presentation according to the anamnesis and the physical exam";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 1240;2;"Choosing Wisely�";"American College of Emergency Physicians";English;"Avoid antibiotics and wound cultures in emergency department patients with uncomplicated skin and soft tissue abscesses after successful incision and drainage and with adequate medical follow-up.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2264;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not request the whole autoimmune pattern in all patients";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1242;2;"Choosing Wisely�";"AMDA, The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t insert percutaneous feeding tubes in individuals with advanced dementia. Instead, offer oral assisted feedings.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2266;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe biological drugs to patients who respond to conventional treatment";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 1243;2;"Choosing Wisely�";"AMDA. The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t use sliding scale insulin (SSI) for long-term diabetes management for individuals residing in the nursing home.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"insulin, diabetes, nursing home, old people, elderly";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2267;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order a chest radiography to monitor the evolution of pleural effusions. Using lung ultrasound may allow a reduction in the number of radiographies";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 220;2;"Choosing Wisely�";"American Society of Echocardiography";English;"Don?t order follow up or serial echocardiograms for surveillance after a finding of trace valvular regurgitation on an initial echocardiogram.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 732;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not recommended to offer chemotherapy when two lines of treatment have been already used, and patient?s condition is unsatisfactory and the possibility of improving is low.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1244;2;"Choosing Wisely�";"AMDA. The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t obtain a urine culture unless there are clear signs and symptoms that localize to the urinary tract.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2268;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Lower blood tests in long-stay patients by tailoring the applications for laboratory tests is recommended";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 221;2;"Choosing Wisely�";"American Society of Echocardiography";English;"Don?t repeat echocardiograms in stable, asymptomatic patients with a murmur/click, where a previous exam revealed no significant pathology.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 733;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not screen and treat patients with asymptomatic bacteriuria , including patients with urinary catheter, except in pregnancy or urological surgical procedures.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1245;2;"Choosing Wisely�";"AMDA. The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t prescribe antipsychotic medications for behavioral and psychological symptoms of dementia (BPSD) in individuals with dementia without an assessment for an underlying cause of the behavior.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1501;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients without pharmacologic treatment to prevent fragility fractures, the interval between DEXA tests for follow up should be at least two years.";"La osteoporosis es una condici�n cl�nica frecuente que hace que el hueso sea m�s fr�gil y, por tanto, m�s susceptible de sufrir fracturas por fragilidad. La t�cnica para realizar un control de la evoluci�n de la densidad mineral �sea es la densitometr�a �sea tipo DXA (radiolog�a dual) , que permite medir la densidad que tiene el hueso y da informaci�n sobre la resistencia que puede tolerar. Esta t�cnica ha demostrado extraordinariamente precisa para el control evolutivo de la densidad mineral �sea . Sin embargo , es necesario que pase un tiempo determinado para asegurar que los cambios observados en la densitometr�a �sea DXA son derivados de cambios en la persona y no , por el contrario , de alteraciones en la metodolog�a o el equipo de medici�n. La p�rdida de densidad mineral �sea no es igual en todos los casos. Contribuyen factores como la edad, el sexo, el estado ginecol�gico, la actividad f�sica, el peso, el h�bito tab�quico, as� como la presencia de otros factores secundarios. En las personas consideradas de bajo riesgo de fractura por fragilidad sin tratamiento farmacol�gico preventivo, la densitometr�a �sea DXA no se deber�a realizar antes de los dos a�os para el control evolutivo.";2013;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2269;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not continue with empirical antibiotic treatment prescribed at birth, even in extremely low birth weight (ELBW) infants*";"*when the result of the blood culture is negative, in the absence of clinical signs of infection.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 222;2;"Choosing Wisely�";"American Society of Echocardiography";English;"Avoid echocardiograms for preoperative/perioperative assessment of patients with no history or symptoms of heart disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 734;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use aspirin for primary prevention in people without cardiovascular disease.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1246;2;"Choosing Wisely�";"AMDA. The Society for Post-Acute and Long-Term Care Medicine";English;"Don?t routinely prescribe lipid-lowering medications in individuals with a limited life expectancy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1502;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"An extended rehabilitation treatment beyond twelve months in patients with sequelae after a stroke do not improve neither the neurological recovery nor the functional recovery.";"El tratamiento rehabilitador en personas que han sufrido un ictus (apoplej�a, accidente cerebral vascular) debe iniciarse precozmente, preferiblemente en las primeras 48 horas del ictus siempre que la situaci�n m�dica del paciente lo permita. El tratamiento rehabilitador del paciente con ictus debe estar guiado por unos objetivos concretos establecidos por un equipo de profesionales expertos. La evidencia cient�fica demuestra que la recuperaci�n cognitiva, neurol�gica y funcional derivada del tratamiento rehabilitador se produce mayoritariamente durante los primeros meses tras el ictus. A partir del duod�cimo mes del ictus no se ha demostrado que los programas rutinarios de rehabilitaci�n produzcan mejoras significativas en el proceso de recuperaci�n neurol�gica y funcional de las personas afectadas por un ictus.";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2270;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not perform routine ultrasound in children born from diabetic mothers on insulin treatment.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 5342;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"Penicillin/ampicillin plus gentamicin over chloramphenicol is recommended for hospitalized children with severe and very severe community-acquired pneumonia.";"The other alternative drugs for children hospitalised with severe and very severe community-acquired pneumonia are co?amoxyclavulanic acid and cefuroxime. Until more studies are available, these can be used as second?line therapies. For treatment of patients with community-acquired pneumonia in ambulatory settings, amoxycillin is an alternative to co?trimoxazole. With limited data on other antibiotics, co?amoxyclavulanic acid and cefpodoxime may be alternative second?line drugs. Children with severe pneumonia without hypoxaemia can be treated with oral amoxycillin in an ambulatory setting. Recommendations are applicable to countries with high case fatalities due to pneumonia in children without underlying morbidities and where point of care tests for identification of aetiological agents for pneumonia are not available.";2013;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 223;2;"Choosing Wisely�";"American Society of Echocardiography";English;"Avoid using stress echocardiograms on asymptomatic patients who meet ?low risk? scoring criteria for coronary disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 735;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Medicina Interna - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use benzodiazepines to treat insomnia, agitation or delirium in the elderly.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1247;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t rely on antihistamines as first-line treatment in severe allergic reactions.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1503;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"The electrocardiogram and cardiac testing images do not provide relevant information in people without symptoms or comorbidities or significant cardiovascular risk.";"Las enfermedades del aparato circulatorio (coraz�n, sistema cerebrovascular y vasos perif�ricos) son la principal causa de mortalidad en Catalu�a. Hay factores de riesgo (sedentarismo, hiperlipemia, tabaquismo, diabetes, obesidad, hipertensi�n) que, junto con la edad y el sexo, influyen en la aparici�n de estas enfermedades. La modificaci�n de estos factores de riesgo es importante para prevenir las enfermedades del aparato circulatorio. Para poder valorar el riesgo cardiovascular y ayudar a la toma de decisiones cl�nicas, el instrumento m�s adecuado son las tablas de riesgo validadas en el entorno comunitario local. No est� demostrada la utilidad de realizar pruebas complementarias card�acas (electrocardiograma y pruebas de imagen card�acas) en personas sin s�ntomas card�acos o riesgos significativos. Su realizaci�n no aporta informaci�n relevante para la predicci�n del riesgo cardiovascular. Adem�s, puede conllevar perjuicios como la realizaci�n de procedimientos innecesarios o el sobretratamiento a que se puede someter al paciente.";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2271;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not use bronchodilators and corticosteroids in case of bronchiolitis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 5343;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (asistencia respiratoria y ventilaci�n mec�nica)";Spanish;"There is no certainty to recommend high versus low positive end?expiratory pressure (PEEP) levels for mechanically ventilated adult patients with acute lung injury and acute respiratory distress syndrome";"In summary, the present systematic review provides evidence that the use of high levels of PEEP does not reduce mortality before hospital discharge, although the forest plot indicated a trend towards a mortality benefit in the higher?PEEP group. Moreover, in practice, we cannot recommend the routine use of high levels of PEEP in patients with ALI and ARDS because no agreement has been reached among the various studies reported here as to which group of patients should receive that specific intervention and how those high PEEP levels should be applied.";2013;;;Uncertain;"Treatment - Covid19";"

Link to the recommendation on the website of the initiative

" 224;2;"Choosing Wisely�";"American Society of Echocardiography";English;"Avoid transesophageal echocardiography (TEE) to detect cardiac sources of embolization if a source has been identified and patient management will not change.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 736;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Testing natriuretic peptides is not recommended for treatment decision making in chronic heart failure.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1248;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t perform food IgE testing without a history consistent with potential IgE-mediated food allergy.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1504;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not recommended to do routine screening with mammography In women younger than 50 years without additional risk factors for breast cancer*.";"* The frequency of the screening program for breast cancer (in women aged 50-69 years) should be every two years.";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2272;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not order a whole-body bone scintigraphy in patients with low-risk prostate cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Enlace no disponible porque la p�gina web de la iniciativa no se encuentra accesible." 225;2;"Choosing Wisely�";"American Society of Nuclear Cardiology";English;"Don?t perform stress cardiac imaging or coronary angiography in patients without cardiac symptoms unless high-risk markers are present.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 737;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"In most cases where high blood pressure is detected, there is no indication to initiate antihypertensive treatment immediately.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1249;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t routinely order low- or iso-osmolar radiocontrast media or pretreat with corticosteroids and antihistamines for patients with a history of seafood allergy, who require radiocontrast media.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1505;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"In patients with headache and without complications or additional neurological symptoms, imaging tests do not add value to the management.";--;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2273;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not prescribe testosterone in patients with erectile dysfunction and normal testosterone levels";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 226;2;"Choosing Wisely�";"American Society of Nuclear Cardiology";English;"Don?t perform cardiac imaging for patients who are at low risk.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 738;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not schedule revisions, or colonoscopy within 5 years postpolypectomy in patients with one or two adenomas and certain characteristics*";"*Smaller than 1cm, without high-grade dysplasia , completely removed in a high quality colonoscopy.";2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1250;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t routinely avoid influenza vaccination in egg-allergic patients.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1506;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Antitussives or similar medication should not be used routinely in children with common cold, unless they have specific comorbidities that require treatment.";--;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 2274;21;"Choosing Wisely Italy. Doing more does not mean doing better (Fare di pi� non significa fare meglio)";"Hospital S. Croce e Carle Cuneo";Spanish;"Do not treat asymptomatic bacteriuria in elderly patients to improve urinary continence";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"

Link to the recommendations in the Slow Medicine website (Italian version)

Link to the recommendations in the Slow Medicine website (English version)

" 227;2;"Choosing Wisely�";"American Society of Nuclear Cardiology";English;"Don?t perform radionuclide imaging as part of routine follow-up in asymptomatic patients.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 739;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not prescribe antibiotic prophylaxis to people with mild acute pancreatitis.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1251;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t overuse non-beta lactam antibiotics in patients with a history of penicillin allergy, without an appropriate evaluation.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1507;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"PSA levels should not be used at mass screening for prostate cancer, because this intervention has not shown benefits in terms of reducing mortality.";--;2013;;;"Low value";"screening, prostate";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 740;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not prescribe PPI as gastric protection in patients without risk factors for gastrointestinal complications.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1508;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Acute otitis media should not be routinely treated with antibiotics. In children older than 2 years with mild disease and no risk factors, expectant management should be considered.";"La otitis media aguda es el tercer diagn�stico m�s frecuente en una consulta pedi�trica de atenci�n primaria, despu�s del resfriado com�n y la revisi�n peri�dica de salud. Para el tratamiento de la otitis media aguda, la indicaci�n sistem�tica de antibi�ticos es la pr�ctica cl�nica m�s extensa en nuestro medio. La mayor parte de otitis medias agudas se resuelven espont�neamente sin tratamiento antibi�tico y s�lo hay que adoptar medidas sintom�ticas contra el dolor y la fiebre. Por este motivo, los antibi�ticos no deber�an utilizarse de forma rutinaria en el tratamiento de la otitis media aguda.";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 229;2;"Choosing Wisely�";"American Society of Nuclear Cardiology";English;"Use methods to reduce radiation exposure in cardiac imaging, whenever possible, including not performing such tests when limited benefits are likely.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 741;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not restrict fluid intake in patients with ascites , except in the presence of dilutional hyponatremia less than 125 mEq / L sodium level.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1509;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"It is not recomended to use routinely a combination of angiotensin converting enzyme inhibitors and angiotensin receptor blockers II in patients with heart failure";--;2013;;;"Low value";"ACE inhibitor";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 230;2;"Choosing Wisely�";"Society of Cardiovascular Computed Tomography";English;"Don?t use coronary artery calcium scoring for patients with known coronary artery disease (including stents and bypass grafts).";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 742;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use detecting IgA or IgG anti -gliadin antibodies for celiac disease diagnosis.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1510;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Do not use urinary catheters routinely in patients with acute stroke and urinary incontinence";--;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 231;2;"Choosing Wisely�";"Society of Cardiovascular Computed Tomography";English;"Don?t order coronary artery calcium scoring for preoperative evaluation for any surgery, irrespective of patient risk.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 743;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not prescribe two or more anti-inflammatory drugs (NSAIDs) simultaneously since it does not increase the efficacy and may increase toxicity.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1511;3;"Essencial: Afegint valor a la pr�ctica cl�nica [Essencial: Adding value to the clinical practice]";"Ag�ncia de Qualitat i Avaluaci� Sanit�ries de Catalunya (AQuAS)";Spanish;"Systematic prescription of statins for primary prevention of cardiovascular disease in people with low or moderate coronary risk is not recommended.";--;2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 232;2;"Choosing Wisely�";"Society of Cardiovascular Computed Tomography";English;"Don?t order coronary artery calcium scoring for screening purposes on low risk asymptomatic individuals except for those with a family history of premature coronary artery disease.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 744;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad.";Spanish;"Do not use injectable drugs locally for nonspecific low back pain.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 2536;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Kamerow D. BMJ 2013;347:f5071";English;"How to decrease overtreatment in cancer";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace a la publicaci�n en la p�gina web de TheBMJ" 233;2;"Choosing Wisely�";"Society of Cardiovascular Computed Tomography";English;"Don?t routinely order coronary computed tomography angiography for screening asymptomatic individuals.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 745;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"The arthroscopic lavage with debridement is not indicated in patients with knee osteoarthritis, except clear history of mechanical locking .";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 2537;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Haldar S, et al. BMJ 2013;347:f5127";Spanish;"Most patients with isolated subsegmental pulmonary embolism do not need anticoagulants";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace a la publicaci�n en la p�gina web de TheBMJ" 234;2;"Choosing Wisely�";"Society of Cardiovascular Computed Tomography";English;"Don?t use coronary computed tomography angiography in high risk* emergency department patients presenting with acute chest pain.";"* Risk defined by the Thrombolysis In Myocardial Infarction (TIMI) risk score for unstable angina/acute coronary syndromes

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 746;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not use neither QUS (quantitative ultrasound) nor plain x-ray for diagnosis of osteoporosis.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 2538;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Quantrill SJ. BMJ 2013;347:f5121";English;"Risk-benefit ratio favours treating all pulmonary emboli, no matter how small";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article on the website of the BMJ / Enlace a la publicaci�n en la p�gina web de TheBMJ
" 235;2;"Choosing Wisely�";"Society for Vascular Medicine";English;"Don?t do work up for clotting disorder (order hypercoagulable testing) for patients who develop first episode of deep vein thrombosis (DVT) in the setting of a known cause.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 747;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"S.Espa�ola de Reumatolog�a - Ministerio de Sanidad";Spanish;"It is not recommended to do a CT or MRI in nonspecific low back pain or neck pain, without alarm signs";-;2013;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, image";"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 2539;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Roach P. BMJ 2013;347:f5119";English;"Don't routinely order CT pulmonary angiography as the primary imaging test for patients with suspected pulmonary embolism unless clinically indicated. V/Q spect may be superior.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace a la publicaci�n en la p�gina web de TheBMJ" 3051;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults at average risk of depression,* we recommend not routinely screening for depression.(Weak recommendation; very-low-quality evidence)";"*The average-risk population includes all individuals 18 years of age or older with no apparent symptoms of depression who are not considered to be at increased risk.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 236;2;"Choosing Wisely�";"Society for Vascular Medicine";English;"Don?t reimage DVT in the absence of a clinical change.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 748;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Endocrinolog�a y Nutrici�n";Spanish;"No use glitazones in diabetic patients with heart failure.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 2540;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Ripley D. BMJ 2013;347:f5118";English;"Limit CT triple rule-out examination in patients with acute chest pain. Since it's leading to high exposure to ionizing radiation with no confirmed clinical benefit.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace a la publicaci�n en la p�gina web de TheBMJ" 3052;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults in subgroups of the population who may be at increased risk of depression,* we recommend not routinely screening for depression**. (Weak recommendation; very-low-quality evidence)";"*Subgroups of the population who may be at increased risk of depression include people with a family history of depression, traumatic experiences as a child, recent traumatic life events, chronic health problems, substance misuse, perinatal and postpartum status, or Aboriginal origin.

**Clinicians should be alert to the possibility of depression, especially in patients with characteristics that may increase the risk of depression, and should look for it when there are clinical clues, such as insomnia, low mood, anhedonia and suicidal thoughts.

For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 5612;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (desconexi�n de la ventilaci�n mec�nica)";Spanish;"Non-invasive positive pressure ventilation is advised as a disconnection strategy for intubated adults with respiratory failure";"16 predominantly moderate to good quality trials were identified that included 994 participants, most with chronic obstructive pulmonary disease (COPD). Compared to disconnection with VPPI, disconnection with VPPN significantly reduced mortality. The beneficial effects on mortality were significantly greater in trials that exclusively included participants with COPD (hazard ratio [RR] 0.36; 95% confidence interval [CI] 0.24 to 0.56) versus populations mixed (RR 0.81, 95% CI 0.47 to 1.40). NPPV significantly reduced disconnection failure (RR 0.63, 95% CI 0.42 to 0.96) and ventilation-associated pneumonia (RR 0.25, 95% CI 0.15 to 0.43); shortened the stay in the intensive care unit (mean difference [DM] ?5.59 days; 95% CI ?7.90 to ?3.28) and in the hospital (DM ?6.04 days, CI 95%: ?9.22 to ?2.87); and decreased the total duration of ventilation (DM ?5.64 days, 95% CI ?9.50 to ?1.77) and the duration of endotracheal mechanical ventilation (DM ?7.44 days, 95 CI). %: -10.34 to -4.55), with significant heterogeneity. Noninvasive disconnection also significantly reduced the rates of tracheostomy (RR 0.19, 95% CI 0.08 to 0.47) and reintubation (RR 0.65, 95% CI 0.44 to 0.97). ). Non-invasive disconnection had no effect on the duration of disconnection-related ventilation. The exclusion of a single quasi-randomized trial did not alter these results. Subgroup analyzes indicate that the beneficial effects on mortality were significantly greater in trials that exclusively included participants with COPD versus mixed populations.";2013;;;"High value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 237;2;"Choosing Wisely�";"Society for Vascular Medicine";English;"Avoid cardiovascular testing for patients undergoing low-risk surgery.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 749;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Endocrinolog�a y Nutrici�n";Spanish;"Do not use sulfonylureas in the treatment of elderly patients with renal insufficiency.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 2541;24;"Too Much Medicine - theBMJ [Demasiada Medicina-TheBMJ]";"Rogers H. BMJ 2013;347:f5116";English;"To avoid overdiagnosis in pulmonary embolism, don't forget that the accuracy of CT pulmonary angiography is not as high as purported.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the BMJ collection ""Too Much Medicine"" / Enlace a la publicaci�n en la p�gina web de TheBMJ" 3053;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged < 20 we recommend not routinely screening for cervical cancer. (Strong recommendation; high quality evidence)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of theCanadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 238;2;"Choosing Wisely�";"Society for Vascular Medicine";English;"Refrain from percutaneous or surgical revascularization of peripheral artery stenosis in patients without claudication or critical limb ischemia.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 750;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Endocrinolog�a y Nutrici�n";Spanish;"Do not do thyroglobulin testing in the initial assessment of a malignant thyroid nodule.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 3054;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 20 to 24 we recommend not routinely screening for cervical cancer. (Weak recommendation; moderate quality evidence)";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the recommendation on the website of theCanadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 239;2;"Choosing Wisely�";"Society for Vascular Medicine";English;"Don?t screen for renal artery stenosis in patients without resistant hypertension and with normal renal function, even if known atherosclerosis is present.";"For further information please visit the website of the initiative (link below).";2013;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 751;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Endocrinolog�a y Nutrici�n";Spanish;"Do not repeat the antithyroid antibodies tests in patients with thyroid dysfunction when they have a previous positive test.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 3055;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 25 to 29 we recommend routine screening for cervical cancer every 3 years. (Weak recommendation; moderate quality evidence)";"For further information please visit the website of the initiative (link below)";2013;;;"High value";-;"Link to the recommendation on the website of theCanadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 752;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedades cient�ficas espa�olas - Ministerio de Sanidad, Servicios Sociales e Igualdad";Spanish;"Do not perform thyroid ultrasound in all patients with subclinical hypothyroidism.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 3056;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 30 to 69 we recommend routine screening for cervical cancer every 3 years (Strong recommendation; high quality evidence)";"For further information please visit the website of the initiative (link below)";2013;;;"High value";-;"Link to the recommendation on the website of theCanadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 753;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Neumolog�a y Cirug�a Tor�cica";Spanish;"Do not prescribe�ambulatory oxygen therapy in COPD patients with partial pressure of oxygen in arterial blood ( PaO2) higher than 55 mmHg, and without exercise-induced desaturation.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1777;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Don?t routinely avoid vaccinations just due to concerns about vaccinations preceding relapses of multiple sclerosis*.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";vaccines;"Link to the publication on Mayo Clinic Proceedings / Enlace a la publicaci�n en Mayo Clinic Proceedings" 3057;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged ? 70 who have been adequately screened (i.e., 3 successive negative Pap tests in the last 10 years), we recommend that routine screening may cease. For women aged 70 or over who have not been adequately screened we recommend continued scree";"For further information please visit the website of the initiative (link below)";2013;;;"High value";-;"Link to the recommendation on the website of theCanadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 754;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Neumolog�a y Cirug�a Tor�cica";Spanish;"Do not use LABA 's (long-acting ?2-agonist) as sole treatment In patients with bronchial asthma";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1778;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Don?t routinely avoid hepatits B, tetanus or influenza vaccinations just due to concerns about vaccinations preceding the onset or relapses of multiple sclerosis*.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";vaccines;"Link to the publication on Mayo Clinic Proceedings / Enlace a la publicaci�n en Mayo Clinic Proceedings" 755;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Neumolog�a y Cirug�a Tor�cica";Spanish;"Do not perform routinely a MRI to assess the stage of the primary tumor in non-small cell lung cancer.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 756;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Neumolog�a y Cirug�a Tor�cica";Spanish;"Do not use antibiotics routinely to treat exacerbations in COPD patients without severity data and a single Antonhisen criteria (other than purulent sputum)";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 5364;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (desconexi�n de la ventilaci�n";Spanish;"Non-invasive positive pressure ventilation (NPVP) provides respiratory support without the need for invasive airways.";"The use of non-invasive ventilation (mask ventilation) is encouraging as a method that makes it easier to separate adults from conventional ventilators. Interest has emerged in the use of NPPV to facilitate early endotracheal extubation and decrease complications associated with prolonged intubation. Patients with acute respiratory failure often require endotracheal intubation and mechanical ventilation (invasive positive pressure ventilation) to sustain life. Complications of mechanical ventilation include weakness of the respiratory muscles, upper respiratory tract injury, pneumonia associated with ventilation, sinusitis, and associated death. For these reasons, it is important to decrease the duration of mechanical ventilation. Non-invasive positive pressure ventilation is accomplished by connecting an oronasal, nasal, or full face mask to a positive pressure ventilator and does not require an artificial airway. The results of 16 predominantly moderate to good quality randomized controlled trials involving 994 selected participants, approximately two-thirds with chronic obstructive pulmonary disease presenting with respiratory failure and spontaneous breathing, demonstrate that support with non-invasive ventilation can decrease death , the failure of disconnection, pneumonia and the stay in the intensive care unit and in the hospital. Noninvasive disconnection also decreased the total duration of ventilation and time with invasive ventilation, as well as the number of participants who underwent a tracheostomy. Although non-invasive disconnection had no effect on the duration of mechanical ventilation related to disconnection, it did not increase the reintubation rate. There was insufficient data to assess the impact on quality of life. Noninvasive disconnection significantly reduced mortality in studies with populations with chronic obstructive pulmonary disease versus studies with mixed populations. ";2013;;;"High value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 757;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";"Sociedad Espa�ola de Neumolog�a y Cirug�a Tor�cica";Spanish;"Do not use hypnotics�in patients who have difficulty maintaining sleep, without prior etiologic diagnosis.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 758;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Asociaci�n Espa�ola de Pediatr�a";Spanish;"Empiric antibiotic therapy should not be delayed for obtaining cultures (blood and/or cerebrospinal fluid) in suspected invasive meningococcal disease.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1782;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There is no benefit of induction of hypothermia after acute brain injury";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 759;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Asociaci�n Espa�ola de Pediatr�a";Spanish;"Electroencephalogram or neuroimaging studies (CT, MRI) should not be performed routinely in children with simple febrile seizure.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 1783;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are possible treatment differences based on sex when considering Initial Plasma HIV-1 RNA Levels and Progression to AIDS";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";"antirretroviral, HIV";"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 760;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Asociaci�n Espa�ola de Pediatr�a";Spanish;"Antibiotics should not be routinely given to children with gastroenteritis.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1784;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Anticonvulsants during pregnancy may increase the risk of fetal malformation.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 761;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Asociaci�n Espa�ola de Pediatr�a";Spanish;"Serological tests for the diagnosis of celiac disease in children should not be used before the introduction of gluten into their diets.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1785;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"No differences have been observed in the effect of Early versus delayed insertion of tympanostomy tubes for Persistent Otitis Media on Developmental Outcomes in children";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 762;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Asociaci�n Espa�ola de Pediatr�a";Spanish;"The routine use of chest radiography in acute bronchiolitis is not recommended.";-;2013;;;"Low value";-;"Link to the recommendation on the website of the Spanish Ministry of Health / Enlace a las recomendaciones en la p�gina web del Minsiterio de Sanidad de Espa�a
" 1786;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"No benefits have been observed in the effect of chelation therapy with succimer regarding to neuropsychological development in Children Exposed to Lead";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 763;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola de Nefrolog�a";Spanish;"Renal replacement therapy with dialysis should not be initiated without appropriate decision-making in which the patient, family, and physician are involved.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1787;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no long-term benefits of prophylaxis with indomethacin in extremely-low-birth- weight infants";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 764;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola de Nefrolog�a";Spanish;"A target blood pressure of less than 130/80 should not be sought in elder patients with chronic kidney disease (CKD) and proteinuria.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1788;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no benefits of prolonged courses of antibiotics in patients with persistent symptoms and a history of lyme disease";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 765;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola de Nefrolog�a";Spanish;"The combination of a direct renin inhibitor and an angiotensin-converting-enzyme inhibitor (ACE inhibitor) or an angiotensin II receptor antagonist (ARB) should not be routinely used.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1789;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no benefits of one year of oral anticoagulant therapy versus three months for idiopathic deep venous thrombosis";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 766;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola de Nefrolog�a";Spanish;"Folic acid or vitamin C should not be specifically prescribed for the treatment of anaemia in chronic kidney disease (CKD).";-;2013;;;"Low value";-;"http://www.msssi.gob.es/gabinete/notasPrensa.do?id=3140" 1790;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"Failure of Metronidazole to Prevent Preterm Delivery among Pregnant Women with Asymptomatic Trichomonas vaginalis Infection";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. / Enlace a la publicaci�n de Prasad, et al. " 2046;6;"Less Is More Collection - JAMA Network";"Drekonja D, et al. JAMA Intern Med. 2013;173(1):62-68.";English;"Urinary Tract Infection in Male Veterans: Treatment Patterns and Outcomes";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 767;13;"Compromiso por la calidad de las Sociedades Cient�ficas en Espa�a";" Sociedad Espa�ola de Nefrolog�a";Spanish;"Plasma renin levels should not be systematically measured as a prognostic marker of hypertension in children with permanent kidney damage.";-;2013;;;"Low value";-;"Link to the recommendations in the website of the Spanish Ministry of Health
" 1791;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"There are no benefits of prone positioning on the survival of patients with acute respiratory failure";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the publication Prasad, et al. /Enlace a la publicaci�n de Prasad, et al. " 2047;6;"Less Is More Collection - JAMA Network";"Drekonja D, et al. JAMA Intern Med. 2013;173(1):71-72.";English;"Preoperative Urine Cultures in asymptomatic adult patients is not recommended except before urological procedures.";"For further information please visit the website of the initiative (link below)";2013;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 256;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use moist cotton gauze to manage surgical wounds that are healing by secondary intention.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 1024;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use serum-specific IgG testing in the diagnosis of food allergy.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1280;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use conventional photon irradiation in comparison to protons in patients with chordoma";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 1;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t order annual electrocardiograms (EKGs) or any other cardiac screening for low-risk patients without symptoms.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"electrocardiogram, Coronary heart disease, screening";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 257;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use mercuric antiseptic solutions to manage surgical wounds that are healing by secondary intention.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 513;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vinflunine is not recommended* for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract that has progressed after treatment with platinum-based chemotherapy";"*Within its marketing authorisation";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1025;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use serological testing for coeliac disease in infants before gluten has been introduced to the diet.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1281;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer adjuvant external beam radiotherapy as part of routine treatment in patients with intermediate or high-risk endometrial cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t screen for carotid artery stenosis (CAS) in asymptomatic adult patients.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Carotid artery stenosis, screening";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 258;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use Eusol and gauze for debridement in the management of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: this link may fail if it is modified or deleted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n." 514;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with paclitaxel and carboplatin is not recommended for first-line treatment of advanced ovarian cancer*";"*International Federation of Gynaecology and Obstetrics [FIGO] stages IIIB, IIIC and IV epithelial ovarian, fallopian tube or primary peritoneal cancer.";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1026;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use riboflavin to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1282;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use hypothermia in patients with head trauma";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 259;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use dextranomer for debridement in the management of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fail if is modified or deleted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n." 515;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with gemcitabine and carboplatin is not recommended within its marketing authorisation in patients with ovarian cancer*";"*That is, for treating people with the first recurrence of platinum-sensitive advanced ovarian cancer (including fallopian tube and primary peritoneal cancer) who have not received prior therapy with bevacizumab or other vascular endothelial growth factor (VEGF) inhibitors or VEGF receptor-targeted agents.";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1027;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use renal scintigraphy for routine surveillance in people with neurogenic lower urinary tract dysfunction.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 4;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform an open surgery in high-risk patients with carotid occlusive disease compared to Stenting and Angioplasty with Protection";"For further information please visit the website of the initiative (link below)";2012;;;"High value";"Carotid occlusive disease, Carotid artery stenosis, stent";"

Enlace a la p�gina web de la iniciativa

" 260;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use enzymatic treatments for debridement in the management of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fail if it is modified or deleted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n." 516;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ruxolitinib is not recommended within its marketing authorisation*";"*That is, for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (also known as chronic idiopathic myelofibrosis), post polycythaemia vera myelofibrosis or post essential thrombocythaemia myelofibrosis.";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1028;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use rectal medications for disimpaction unless all oral medications have failed and only if the child or young person and their family consent.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 261;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use hair removal routinely to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 517;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer ultrasound surveillance to women at moderate or high risk of breast cancer*";"*But consider it: -when MRI surveillance would normally be offered but is not suitable (for example, because of claustrophobia) - when results of mammography or MRI are difficult to interpret.";2012;;;"Low value";-;"

Link to the recommendation on the website of the initaitive / Enlace a la recomendaci�n en la p�gina de la iniciativa.

" 1029;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use reagent strips to identify proteinuria unless they are capable of specifically measuring albumin at low concentrations and expressing the result as an albumin:creatinine ratio (ACR).";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 262;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use razors for hair removal, because they increase the risk of surgical site infection.";-;2012;;;"Low value";wound;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 518;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer MRI to women with breast cancer*";"*Women: -of any age at moderate risk of breast cancer - of any age at high risk of breast cancer but with a 30% or lower probability of being a BRCA or TP53 carrier - aged 20???29 years who have not had genetic testing but have a greater than 30% probability of being a BRCA carrier - aged 20???29 years with a known BRCA1 or BRCA2 mutation - aged 50???69 years who have not had genetic testing but have a greater than 30% probability of being a BRCA or a TP53 carrier, unless mammography has shown a dense breast pattern - aged 50???69 years with a known BRCA1 or BRCA2 mutation, unless mammography has shown a dense breast pattern. See also - Summary of recommendations on surveillance for women with no personal history of breast cancer. Http://publications.nice.org.uk/familial-breast-cancer-cg164
ecommendations#summary-of-recommendations-on-surveillance-for-women-with-no-personal-history-of-breast-cancer";2012;;;"Low value";-;"

Link to the recommendation.

Note: The link may fail if it has been modified or deleted by the  publishing institution.

" 1030;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use prolonged antibiotic therapy for mild soft tissue infections.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 7;8;"Prasad, et al. article A Decade of Reversal: An Analysis of 146 Contradicted Medical Practices";"Autores de diferentes centros de investigaci�n y universidades de Estados Unidos";English;"C-Reactive Protein adds only a marginally value to the predictive value of established risk factors in the prediction of Coronary Heart Disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"C-reactive protein, CRP, coronary artery disease, coronary heart disease";"Link to the publication on Mayo Clinic Proceedings / Enlace al art�culo publicado en Mayo Clinic Proceedings
" 263;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use nasal decontamination with topical antimicrobial agents aimed at eliminating staphylococcus aureus routinely to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 519;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer mammographic surveillance to women with some characteristics*";"*Aged 29 years and under - aged 30 - 39 years at moderate risk of breast cancer - aged 30 - 49 years who have not had genetic testing but have a greater than 30% probability of being a TP53 carrier - of any age with a known TP53 mutation.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1031;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use plain abdominal radiography for routine surveillance in people with neurogenic lower urinary tract dysfunction.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 264;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use mechanical bowel preparation routinely to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 520;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer MRI surveillance to any women aged 50 years and over without a TP53 mutation unless mammography has shown a dense breast pattern.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fail if it is modified or delted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 1032;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use phototherapy in babies whose bilirubin does not exceed the phototherapy threshold levels [refer to the threshold table and treatment threshold graphs within the guideline].";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 9;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"Open surgery is recommended in the elective treatment of abdominal aortic aneurysm except for some specific clinical situations.";"The review of current evidence showed that open surgery is the most appropriate surgical procedure for elective treatment of abdominal aortic aneurysm (AAA). This intervention is more cost-effective, while endovascular repair would only be indicated for elder patients, patients with increased risk of intraoperative mortality (associated morbidity or hostile abdomen) and, in addition, patients with a favourable anatomy so that the anchoring and sealing of the stent be correct and durable.

Initiative partially funded by the Fondo de Investigaciones Sanitarias del Instituto de Salud Carlos III of Spain through the research project ""Analysis and appropriateness improvement in abdominal aortic aneurysm surgery"" (project number PI12 / 0530)";2012;;;"High value";"abdominal aortic aneurysm, aneurysm, abdominal aortic, aortic, open surgery, endovascular surgery";"Link to the full text of the recommendation" 265;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antibiotic prophylaxis routinely for clean non-prosthetic uncomplicated surgery.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 521;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer surveillance to women who have undergone a bilateral mastectomy.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1033;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use perineometry or pelvic floor electromyography as biofeedback as a routine part of pelvic floor muscle training.";-;2012;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 266;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use non-iodophor-impregnated incise drapes routinely for surgery as they may increase the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 522;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should not be prescribed the oral contraceptive pill purely for prevention of cancer, although in some situations reduction in ovarian cancer risk may outweigh any increase in risk of breast can";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1034;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use pad tests in the routine assessment of women with urinary incontinence.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 267;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use diathermy for surgical incision to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

Note: This link may fiel if it modified or deleted by the publishing institution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 523;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer tamoxifen or raloxifene to women who were at high risk of breast cancer but have had a bilateral mastectomy.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1035;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use oxcarbazepine to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n de la p�gina web de la iniciativa.

Note: This link may fail if it is not modified or deleted by the publishing insitution / Nota: el enlace puede fallar en caso que haya sido modificado o eliminado por la instituci�n que publica la recomendaci�n.

" 268;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not give insulin routinely to patients who do not have diabetes to optimise blood glucose postoperatively as a means of reducing the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 524;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not continue treatment with tamoxifen or raloxifene beyond 5 years in women with breast cancer.";-;2012;;;"Low value";-;"

Link to the recommendation.

Note: The link may fail if it has been modified or deleted by the  publishing institution.

" 1036;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use oral food challenges to diagnose IgE-mediated food allergy in primary care or community settings.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 269;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use wound irrigation to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 525;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer risk-reducing surgery (for people with personal history of breast cancer) to people with comorbidities that would considerably increase the risks of surgery.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1037;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use of self-tests and/or point-of-care tests for coeliac disease as a substitute for laboratory-based testing.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 270;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use intracavity lavage to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina de la iniciativa.

" 526;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer risk-reducing surgery (for people with personal history of breast cancer) to people who have a limited life expectancy from their cancer or other conditions.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1038;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use nicotinic acid preparations and derivatives routinely for people with type 2 diabetes.*";"*They may have a role in a few people who are intolerant of other therapies and have more extreme disorders of blood lipid metabolism, when managed by those with specialist expertise in this area.";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 271;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use intraoperative skin re-disinfection or topical cefotaxime in abdominal surgery to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 527;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Crizotinib is not recommended for treating adults with previously treated anaplastic-lymphoma-kinase-positive advanced non-small-cell lung cancer.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 783;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"[In laboratory investigations for assessing dehydration], do not routinely perform blood biochemical testing.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1039;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use morphine to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 272;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use topical cefotaxime in abdominal surgery to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 528;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Treatment with crizotinib for previously treated ALKpositive advanced non-small-cell lung cancer should not be recommended for use within the NHS.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 784;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"[There is] insufficient evidence on the efficacy of lamotrigine, sodium valproate or phenytoin for the treatment of neuropathic pain.";-;2012;;;"Low value";-;"

Link to the recommendation.

Note: The link may fail if it has been modified or deleted by the  publishing institution.

" 1040;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use metalloporphyrins to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 273;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Telbivudine is not recommended for the treatment of chronic hepatitis B.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 529;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A serum ferritin test should not routinely be carried out on women with heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 785;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A dietary approach to weight loss alone is not recommended in children. It is essential that any dietary recommendations are part of a multicomponent intervention.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1041;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use manna to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 274;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform a repeat lumbar puncture in neonates who are receiving the appropriate antibiotic and are making a good clinical recovery and/or before stopping antibiotic if they are clinically well.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recomendaci�n.

" 530;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Female hormone testing should not be carried out on women with heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 786;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Abatacept is not recommended (within its marketing authorisation) for the treatment of people with rheumatoid arthritis.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 1042;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use lamotrigine to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa.

" 19;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t do imaging for low back pain within the first six weeks, unless red flags are present.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, images";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 275;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cranial computed tomography (CT) to decide whether it is safe to perform a lumbar puncture. CT is unreliable for identifying raised intracranial pressure";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 531;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Saline infusion sonography should not be used as a first-line diagnostic tool in women with heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 787;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Absorbent products should not be considered as a routine treatment for urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1043;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use lacosamide to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 276;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not treat people with meningococcal septicaemia with high-dose corticosteroids";"High-dose defined as dexamethasone 0.6 mg/kg/day or an equivalent dose of other corticosteroids";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 532;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance imaging (MRI) should not be used as a first-line diagnostic tool in women with heavy menstrual bleeding";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 788;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Acupuncture is not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1044;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use intravaginal and intraurethral devices for the routine management of urinary incontinence in women.*";"* Do not advise women to consider such devices other than for occasional use when necessary to prevent leakage, for example during physical exercise.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1300;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use standard central venous catheters in comparison to anti-infective catheters";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 21;6;"Less Is More Collection - JAMA Network";"Srinivas et al. Arch Intern Med. 2012;172(13):1016-1020";English;"It is not recommended offer imaging to patients with acute low back pain, their use increases costs and may increase adverse effects.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, image";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 277;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use activated protein C in children and young people with meningococcal septicaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 533;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dilatation and curettage alone should not be used as a diagnostic tool in women with heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 789;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Acute levodopa and apomorphine challenge tests should not be used in the differential diagnosis of parkinsonian syndromes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1045;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use immunoglobulin G (IgG) anti-gliadin antibody (AGA) test in the diagnosis of coeliac disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1301;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer cognitive behavioural therapy as a treatment in patients with schizofrenia or bipolar disorder";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 22;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform lumbar imaging in patients with lower back pain without more serious underlying conditions";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, image";"

Enlace a la p�gina web de la iniciativa

" 278;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not test children and young people for complement deficiency who have had either a single episode of meningococcal disease caused by serogroup B meningococcus, or unconfirmed meningococcal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 534;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Danazol should not be used routinely for the treatment of heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 790;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with Dravet syndrome Do not offer carbamazepine, gabapentin, lamotrigine, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1046;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use immunoglobulin A (IgA) anti-gliadin antibody (AGA) test in the diagnosis of coeliac disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1302;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Stem Cell transplantation is of low value for at-risk acute myeloid leukemia patients in first complete remission";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 279;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not test children and young people for immunoglobulin deficiency if they have had meningococcal disease, unless they have a history suggestive of an immunodeficiency";"Suggestive history includes a history of serious, persistent, unusual, or recurrent infections";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 535;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral progestogens given during the luteal phase only should not be used for the treatment of heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 791;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with myoclonic seizures Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the iniatiative /Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1047;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use imaging (MRI, CT, X-ray) for the routine assessment of women with urinary incontinence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1303;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform widespread neonatal circumcision for the prevention of sexually transmitted infections, urinary tract infections and penile cancer.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 280;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use skin biopsies when investigating for possible meningococcal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 536;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Etamsylate should not be used for the treatment of heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 792;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with tonic or atonic seizures Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1048;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use human leukocyte antigen (HLA) DQ2/DQ8 testing in the initial diagnosis of coeliac disease.*";"*However, its high negative predictive value may be of use to gastrointestinal specialists in specific clinical situations.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1304;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform vertebral biopsy in vertebral fractures";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 281;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use petechial or purpuric lesion aspirates (obtained with a needle and syringe) when investigating for possible meningococcal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 537;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dilatation and curettage should not be used as a therapeutic treatment in women with heavy menstrual bleeding";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1049;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use homeopathy to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1305;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform radiotherapy in patients with neovascular age-related macular degeneration";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 282;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use throat swabs when investigating for possible meningococcal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 538;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hysterectomy should not be used as a first-line treatment solely for heavy menstrual bleeding (HMB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 794;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"An EEG should not be performed in the case of probable syncope because of the possibility of a false-positive result.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1050;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use hair analysis in the diagnosis of food allergy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1306;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Radiotherapy is a potential low value intervention in patients with metastatic spinal cord disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 283;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use recombinant bacterial permeability-increasing protein in children and young people with meningococcal septicaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 539;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Removal of healthy ovaries at the time of hysterectomy should not be undertaken";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1051;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use glycerin to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1307;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Radiotherapy is a potential low value intervention in patients with asymptomatic spinal metastases for the prevention of metastatic spinal cord compression";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 284;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bladder instillations or washouts must not be used to prevent catheter associated infections. [2003]";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 540;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Measuring menstrual blood loss directly (alkaline haematin) is not routinely recommended for (heavy menstrual bleeding) HMB.";"Whether menstrual blood loss is a problem should be determined not by measuring blood loss but by the woman herself.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la recommendaci�n " 796;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotics are not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1052;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use gastrointestinal endoscopy to investigate idiopathic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1308;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Radiotherapy is a potential low value intervention in patients with metastatic spinal cord compression and planned surgery.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 541;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Measuring menstrual blood loss indirectly (Pictorial blood loss assessment chart) is not routinely recommended for (heavy menstrual bleeding)";"Whether menstrual blood loss is a problem should be determined not by measuring blood loss but by the woman herself.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 797;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Anticonvulsant medicines should not be used routinely for musculoskeletal pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1053;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use flavoxate, propantheline and imipramine for the treatment of urinary incontinence or overactive bladder syndrome in women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1309;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a post-operative radiotherapy in non-small cell lung cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 542;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Acupuncture, acupressure and hypnosis should not be provided, but women who wish to use these techniques should not be prevented from doing so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 798;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antiviral agents should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1054;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use fibreoptic phototherapy as first-line treatment for hyperbilirubinaemia for babies with a gestational age 37 weeks or more.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1310;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer complementary therapies to chronic fatigue syndrome patients";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 287;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotic lock solutions should not be used routinely to prevent catheter related bloodstream infections (CRBSI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 543;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Transcutaneous electrical nerve stimulation (TENS) should not be offered to women in established labour";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 799;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Any person with multiple sclerosis at risk of urinary tract infections should not be recommended prophylactic use of antibiotics or cranberry juice.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1055;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use fall risk prediction tools to predict inpatients' risk of falling in hospital.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1311;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture acupressure and hypnosis to women in labour";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 288;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Systemic antimicrobial prophylaxis should not be used routinely to prevent catheter colonisation or catheter-related bloodstream infections (CRBSI)";"Either before insertion or during the use of a central venous catheter.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 544;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oxytocin should not be used as a matter of routine in the second stage of labour for women with regional analgesia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 800;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bioimpedance is not recommended as a substitute for BMI as a measure of general adiposity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1056;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use end-tidal carbon monoxide (ETCOc) measurement to predict significant hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1312;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture acupressure and hypnosis for induction of labour";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 289;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Systemic anticoagulants should not be used routinely to prevent catheter-realted blood stream infections (CRBSI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 545;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The package known as active management of labour* should not be offered routinely.";"*One-to-one continuous support; strict definition of established labour; early routine amniotomy; routine 2-hourly vaginal examination; oxytocin if labour becomes slow";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 801;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bosutinib is not recommended within its marketing authorisation for treating Philadelphia-chromosome-positive chronic myeloid leukaemia (CML).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1057;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use duloxetine as a first-line treatment for women with predominant stress urinary incontinence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1313;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture acupressure for women with uterine fibroids";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 290;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use polythene gloves for clinical interventions.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 546;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In normally progressing labour, amniotomy should not be performed routinely.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 802;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Brisk walking is an intervention that cannot be recommended for falls prevention.There is no evidence that brisk walking reduces the risk of falling.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1058;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use dietary interventions alone as first-line treatment for idiopathic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1314;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture to patients with improvement in global symptoms";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 291;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely give antibiotic treatment to babies without risk factors for infection or clinical indicators or laboratory evidence of possible infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 547;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Combined early amniotomy with use of oxytocin should not be used routinely.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 803;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Corneal implants should not be used for the treatment of refractive error in the absence of other ocular pathology such as keratoconus.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1059;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cystoscopy in the initial assessment of women with urinary incontinence alone.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1315;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture to patients with otitis media with effusion";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 292;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely perform urine microscopy or culture as part of the investigation for early-onset neonatal infection";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 548;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Perineal massage should not be performed by healthcare professionals in the second stage of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 804;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cranial osteopathy is not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1060;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cystoscopy for routine surveillance in people with neurogenic lower urinary tract dysfunction.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1316;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture for patients with lower urinary tract symptoms in men";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 293;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform skin swab microscopy or culture as part of the investigation for early-onset neonatal infection in the absence of clinical signs of a localised infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 549;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lidocaine spray should not be used to reduce pain in the second stage of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 805;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dapagliflozin in a triple therapy regimen in combination with metformin and a sulfonylurea is not recommended for treating type 2 diabetes, except as part of a clinical trial.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1061;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use corticosteroids in the management of an uncomplicated acute painful sickle cell episode.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1317;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer Acupuncture to children with neonatal jaundice";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 38;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In most patients with COPD routine spirometric reversibility testing is not necessary as a part of the diagnostic process or to plan initial therapy with bronchodilators or corticosteroids.";-;2012;;;"Low value";"COPD, Spirometry, Chronic obstructive pulmonary disease, bronchitis";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 294;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer G-CSF for the prevention of neutropenic sepsis in adults receiving chemotherapy";"It could be used when they are receiving G-CSF as an integral part of the chemotherapy regimen or in order to maintain dose intensity. G-CSF means granulocyte-colony stimulating factor";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 550;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A routine episiotomy should not be carried out during spontaneous vaginal birth.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 806;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dexamphetamine should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1062;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use clofibrate to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1318;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer laser Acupuncture to patients with carpal tunnel syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 39;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Amantadine is not recommended for the prophylaxis of influenza";-;2012;;;"Low value";"flu, virus, viral infection, respiratory infection";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 295;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For further assessment of neutropenic sepsis, after completing the initial clinical assessment try to identify the underlying cause of the sepsis. Do not perform a chest X unless clinically indicated";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 551;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Episiotomy should not be offered routinely at vaginal birth following previous third- or fourth-degree trauma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 807;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dietary modification, including probiotics is not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1063;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cholestyramine to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1319;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use Uro4 HB&L system compared to the standard culture method respiratory tract infections in intensive care unit";"For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"

Enlace a la p�gina web de la iniciativa

" 40;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral corticosteroid reversibility tests do not predict response to inhaled corticosteroid therapy and should not be used to identify which patients should be prescribed inhaled corticosteroids.";-;2012;;;"Low value";"Chronic obstructive pulmonary disease, COPD, bronchitis";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 296;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Forehead chemical thermometers are unreliable and should not be used by healthcare professionals";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 552;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Until the induction is commenced or if expectant management beyond 24 hours is chosen by the woman: lower vaginal swabs should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 808;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not add a new oral anticoagulant (rivaroxaban, apixaban or dabigatran) in combination with dual antiplatelet therapy in people who otherwise need anticoagulation, who have had an MI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1064;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use charcoal to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1320;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer laser Acupuncture to patients with depression";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 297;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Children with symptoms and signs suggesting pneumonia who are not admitted to hospital should not routinely have a chest X-ray";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 553;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Until the induction is commenced or if expectant management beyond 24 hours is chosen by the woman maternal C-reactive protein should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 809;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not carry out further blood tests to test kidney function, electrolytes, full blood count, transaminases, bilirubin if no proteinuria at subsequent visits";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1065;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use capsaicin patch to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 298;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not prescribe oral antibiotics to children with fever without apparent source";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 554;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If there are no signs of infection in the woman, antibiotics should not be given to either the woman or the baby, even if the membranes have been ruptured for over 24 hours.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 810;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not delay imaging in an emergency solely to assess for risk of acute kidney injury.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1066;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cannabis sativa extract to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 43;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Anti-tussive therapy should not be used in the management of stable chronic obstructive pulmonary disease (COPD).";-;2012;;;"Low value";Cough;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 299;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely perform blood tests and chest X-rays in children with fever who have no features of serious illness (that is, the 'green' group).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 555;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Blood, cerebrospinal fluid and/or surface culture tests should not be performed in an asymptomatic baby.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 811;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not measure bilirubin levels routinely in babies who are not visibly jaundiced.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1067;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use biofeedback for ongoing treatment in children and young people with idiopathic constipation.";-;2012;;;"Low value";"Nutrici�n, alimentaci�n, feeding, nutrition";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 300;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antipyretic agents do not prevent febrile convulsions and should not be used specifically for this purpose.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 556;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Amnioinfusion should not be used for the treatment of women with meconium-stained liquor.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 812;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer acupuncture for treating lower urinary tract symptoms (LUTS) in men.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1068;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer botulinum toxin type A treatment if the child or young person has certain circumstances*";"*- Has severe muscle weakness, had a previous adverse reaction or allergy to botulinum toxin type A or is receiving aminoglycoside treatment.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 45;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Angiotensin-converting enzyme inhibitors are not recommended for the treatment of cor pulmonale.";-;2012;;;"Low value";"cor pulmonale, ACEI, ACE inhibitor";"

Link to the recommendation in the NICE website

" 301;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tepid sponging is not recommended for the treatment of fever.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 557;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Suctioning of the nasopharynx and oropharynx prior to birth of the shoulders and trunk should not be carried out.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 813;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer alpha-blockers to people as a treatment for bladder emptying problems caused by neurological disease";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1069;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not modify the ACE inhibitor/ARB dose if the change in estimate of glomerular filtration rate (eGFR) is less than 25% or the change in plasma creatinine is less than 30%*";"*ACE: angiotensin-converting enzyme

ARB: angiotensin-II receptor blockers";2012;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la recomendaci�n en la p�gina web de la NICE " 302;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Children with fever should not be underdressed or over-wrapped.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 558;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Where there is clear evidence of acute fetal compromise*, fetal blood sample should not be undertaken and urgent preparations to expedite birth should be made.";"*For example, prolonged deceleration greater than 3 minutes";2012;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la recomendaci�n en la p�gina web de la NICE " 814;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer autologous fat or polytetrafluoroethylene used as intramural bulking agents for the treatment of stress urinary incontinence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1070;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not include systematic retroperitoneal lymphadenectomy* as part of standard surgical treatment in women with suspected ovarian cancer whose disease appears to be confined to the ovaries**";"""*Block dissection of lymph nodes from the pelvic side walls to the level of the renal veins *That is, who appear to have stage I disease.""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 303;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antipyretic agents with the sole aim of reducing body temperature in children with fever.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 559;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women with confirmed delay in the second stage should be assessed by an obstetrician but oxytocin should not be started.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 815;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer combined treatment with an ACE inhibitor and an angiotensin II receptor blocker (ARB) to people after an MI, unless there are other reasons to use this combination.";-;2012;;;"Low value";"ACE inhibitor, ACEI, ARB";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1071;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not administer phosphate enemas for disimpaction unless under specialist supervision in hospital/health centre/clinic, and only if all oral medications and sodium citrate enemas have failed.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 48;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Alpha-1 antitrypsin replacement therapy is not recommended for patients with alpha-1 antitrypsin deficiency.";-;2012;;;"Low value";"Chronic obstructive pulmonary disease, COPD";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 304;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When using paracetamol or ibuprofen in children with fever, do not give both agents simultaneously.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 560;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Intravenous infusion of oxytocin should not be used to assist the delivery of the placenta.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 816;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer ergots or opioids for the acute treatment of migraine";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1072;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"*There is uncertainty about the transcranial magnetic stimulation clinical efficacy in patients with severe depression. It may depend on certain characteristics**";"*Current evidence suggests that there are no major safety concerns associated with transcranial magnetic stimulation (TMS) for severe depression.

**higher intensity, greater frequency, bilateral application and/or longer treatment durations than have appeared in the evidence to date.

TMS should therefore be performed only in research studies designed to investigate these factors.";2012;;;"Low value";-;"Link to the recommendation on the webstie of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 49;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients who have their exacerbation of COPD managed in primary care, sending sputum samples for culture is not recommended in routine practice.";-;2012;;;"Low value";"Chronic obstructive pulmonary disease";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 305;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer liver biopsy to adults with a transient elastography score less than 6 kPa who have normal ALT and HBV DNA less than 2000 IU/ml";"Normal ALT defined as less than 30 IU/ml in males and less than 19 IU/ ml in females. These patients are unlikely to have advanced liver disease or need antiviral treatment.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 561;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Paired cord blood gases do not need to be taken routinely. They should be taken when there has been concern about the baby either in labour or immediately following birth.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 817;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer homeopathy for treating lower urinary tract symptoms (LUTS) in men.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1073;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Clinical specialists do not recommend treating children and young people and their mothers (if they also have hepatitis C) at the same time because the adverse reactions might affect adherence";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 50;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A course of corticosteroid treatment longer than 14 days in patients with COPD is not recommended as there is no advantage in prolonged therapy.";-;2012;;;"Low value";"corticoids, Chronic obstructive pulmonary disease";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 306;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer genotype testing to determine initial treatment in people with chronic hepatitis B.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 562;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Team midwifery (a group of midwives providing care and taking shared responsibility for a group of women from the antenatal, through intrapartum to the postnatal period) is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 818;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer injections of therapeutic substances into the back for non-specific low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1074;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Advice to undertake unsupervised, or unstructured, vigorous exercise* should not be offered to people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) because this may worsen symptoms";"*Such as simply go to the gym or exercise more";2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 51;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patients with COPD exacerbations without more purulent sputum do not need antibiotic therapy unless there is consolidation on a chest radiograph or clinical signs of pneumonia.";-;2012;;;"Low value";"antibiotic, Chronic obstructive pulmonary disease";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 307;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adefovir dipivoxil for treatment of chronic hepatitis B";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 563;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of injected water papules is not recommended in the Intrapartum care";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 819;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer interferential therapy, as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1075;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with idiopathic generalised epilepsy do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 52;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Daily monitoring of peak expiratory flow (PEF) or forced expiratory volume in 1 second (FEV1) should not be performed routinely to monitor recovery from an exacerbation of COPD";"The magnitude of changes is small compared with the variability of the measurement";2012;;;"Low value";"Spirometry, Chronic obstructive pulmonary disease, bronchitis";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 308;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer peginterferon alfa-2a to people with chronic hepatitis B and decompensated liver disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 564;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of admission cardiotocography (CTG) in low-risk pregnancy is not recommended in any birth setting.";-;2012;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la NICE " 820;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer laser therapy, as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1076;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with any absence epilepsy syndrome Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 53;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Calcium channel blockers are not recommended for the treatment of cor pulmonale.";-;2012;;;"Low value";"Chronic obstructive pulmonary disease, COPD";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 309;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer prophylaxis to people who are HBsAg negative and anti-HBc and anti-HBs positive who are not taking rituximab or other B cell-depleting therapies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 565;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Iron supplementation should not be offered routinely to all pregnant women. It does not benefit the mothers or the babys health and may have unpleasant maternal side effects.";-;2012;;;"Low value";-;"Link to the reommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 821;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer low-dose dopamine to treat acute kidney injury.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1077;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t prescribe oral antibiotics for uncomplicated acute tympanostomy tube otorrhea.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 54;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Alpha-blockers are not recommended for the treatment of cor pulmonale.";-;2012;;;"Low value";"Chronic obstructive pulmonary disease, COPD";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 310;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Psychosocial interventions designed specifically to reduce the likelihood of developing a mental disorder during pregnancy for the postnatal period should not be part of routine care";"Psychosocial interventions such as group psychoeducation";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 566;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy.";"Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 822;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer lumbar supports, as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link tot the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1078;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t prescribe oral antibiotics for uncomplicated acute external otitis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 55;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Digoxin (unless there is atrial fibrillation) is not recommended for the treatment of cor pulmonale";-;2012;;;"Low value";"Chronic obstructive pulmonary disease, COPD";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 311;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Single-session formal debriefing focused on the birth should not be routinely offered to women who have experienced a traumatic birth.";"However, maternity staff and other healthcare professionals should support women who wish to talk about their experience, encourage them to make use of natural support systems available from family and friends, and take into account the effect of the birth on the partner.";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 567;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The effectiveness and safety of oral treatments for vaginal candidiasis in pregnancy are uncertain and these treatments should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 823;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer myectomy to men to manage detrusor overactivity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1079;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t routinely obtain radiographic imaging for patients who meet diagnostic criteria for uncomplicated acute rhinosinusitis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 56;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Omalizumab is not recommended for the treatment of severe persistent allergic asthma in children aged 6 to 11 years.";-;2012;;;"Low value";"monoclonal antibody, humanized antibody";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 312;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Group-based psychoeducational interventions that give some information* for people who misuse drugs should not be routinely provided.";"*Information about reducing exposure to blood-borne viruses and/or about reducing sexual and injection risk behaviours for people who misuse drugs should not be routinely provided.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 568;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine anomaly scan (at 18 weeks 0 days to 20 weeks 6 days) should not be routinely used for Down's syndrome screening using soft markers.";"The presence of an isolated soft marker, with an exception of increased nuchal fold, on the routine anomaly scan, should not be used to adjust the a priori risk for Down???s syndrome. The presence of an increased nuchal fold (6 mm or above) or two or more soft markers on the routine anomaly scan should prompt the offer of a referral to a fetal medicine specialist or an appropriate healthcare professional with a special interest in fetal medicine.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 824;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer nicorandil to reduce cardiovascular risk in patients after an MI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1080;2;"Choosing Wisely�";"American Academy of Otolaryngology - Head and Neck Surgery Foundation";English;"Don?t obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary complaint of hoarseness prior to examining the larynx.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 313;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cognitive behavioural therapy and psychodynamic therapy focused on the treatment of drug misuse should not be offered routinely to some patients*";"*People presenting for treatment of cannabis or stimulant misuse or those receiving opioid maintenance treatment.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 569;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women should not be offered routine screening for bacterial vaginosis.";"The evidence suggests that the identification and treatment of asymptomatic bacterial vaginosis does not lower the risk of preterm birth and other adverse reproductive outcomes.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 825;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vitamin E should not be used as a neuroprotective therapy for people with Parkinson's disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1081;2;"Choosing Wisely�";"American Academy of Pediatrics";English;"Antibiotics should not be used for apparent viral respiratory illnesses (sinusitis, pharyngitis, bronchitis).";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 58;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Postoperative radiotherapy is not recommended for patients with non-small-cell lung cancer (NSCLC) after complete resection";-;2012;;;"Low value";"cancer, neoplasms, lung";"

http://admin.nice.org.uk/usingguidance/donotdorecommendations/detail.jsp?action=details&dndid=800

" 314;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Opioid detoxification should not be routinely offered to people.";"Peolpe with a medical condition needing urgent treatment: in police custody, or serving a short prison sentence or a short period of remand. Consideration should be given to treating opioid withdrawal symptoms with opioid agonist medication: who have presented to an acute or emergency setting; the primary emergency problem should be addressed and opioid withdrawal symptoms treated, with referral to further drug services as appropriate.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 570;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Chlamydia screening should not be offered as part of routine antenatal care.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 826;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ultrasound should not be used routinely for musculoskeletal pain.";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 59;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A twice-weekly dosing regimen should not be used for the treatment of active tuberculosis (TB).";-;2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 315;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Clonidine should not be used routinely in opioid detoxification.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 571;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The available evidence does not support routine cytomegalovirus screening in pregnant women and it should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 827;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The coprescribing of orlistat with other drugs aimed at weight reduction is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1083;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use barbiturates to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 60;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients with spinal tuberculosis (TB), anterior spinal fusion should not be performed routinely.";-;2012;;;"Low value";Arthrodesis;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 316;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dihydrocodeine should not be used routinely in opioid detoxification";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 572;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women should not be offered routine screening for hepatitis C virus because there is insufficient evidence to support its clinical and cost effectiveness.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 828;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer opioids for the acute treatment of tension-type headache";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1084;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use atopy patch testing to diagnose IgE-mediated food allergy in primary care or community settings.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 61;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Follow-up clinic visits should not be conducted routinely after treatment completion.";-;2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 317;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ultra-rapid and rapid opioid detoxification using precipitated withdrawal should not be routinely offered.";"This is because of the complex adjunctive medication and the high level of nursing and medical supervision required.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 573;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women should not be offered routine antenatal screening for group B streptococcus because evidence of its clinical and cost effectiveness remains uncertain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 829;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence on carbamazepine for the treatment of neuropathic pain overall is very limited and dated. Carbamazepine should not be recommended for use across all neuropathic pain conditions.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1085;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use argon plasma coagulation, laser ablation or multipolar electrocoagulation alone, or in combination with each other, unless as part of a clinical trial.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 62;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Treatment for latent tuberculosis (TB) infection should not be started in close contacts of people with sputum-smear-positive multidrug-resistent (MDR) TB who are strongly Mantoux positive (?15 mm)";"No regimen is of proven benefit, and only a small proportion of people infected will develop the disease.";2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 318;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Accelerated detoxification, using opioid antagonists at lower doses to shorten detoxification, should not be routinely offered.";"This is because of the increased severity of withdrawal symptoms and the risks associated with the increased use of adjunctive medications.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 574;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine antenatal serological screening for toxoplasmosis should not be offered because the risks of screening may outweigh the potential benefits.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 830;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When testing for the presence of haematuria, use reagent strips rather than urine microscopy. Do not use urine microscopy to confirm a positive result.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1086;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use applied kinesiology in the diagnosis of food allergy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 63;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine Bacille Calmette-Guèrin (BCG) vaccination is not recommended for children aged 10 - 14.";-;2012;;;"Low value";"Vaccine, TB, tuberculosis, prevention";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 319;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Universal screening for attention deficit hyperactivity disorder (ADHD) should not be undertaken in nursery, primary and secondary schools.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 575;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Screening for gestational diabetes using fasting plasma glucose, random blood glucose, glucose challenge test and urinalysis for glucose should not be undertaken.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 831;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When measuring the bilirubin level: do not use an icterometer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1087;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antigranulocyte Fab' fragment antibody scintigraphy to diagnose osteomyelitis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 64;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Casual contacts of people with tuberculosis (TB), who will include the great majority of workplace contacts, should not normally be assessed";-;2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 320;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Primary care practitioners should not make the initial diagnosis or start drug treatment in children or young people with suspected attention deficit hyperactivity disorder (ADHD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 576;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine screening for preterm labour should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 832;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Treatment of acute episodes: Frequent (more than three times a year) or prolonged (longer than 3 weeks) use of corticosteroids should be avoided in patients with multiple sclerosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1088;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antidiarrhoeal medications.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 5696;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Coronavirus (Covid-19): asistencia en remoto mediante la telesalud";Spanish;"There is insufficient evidence to support or refute the use of telemedicine technology to support parents of high-risk newborns receiving intensive care.";"Clinical trials are needed to assess the application of telemedicine to support parents and families of newborns in the NICU, with the length of hospital stay and their perception of care in the NICU as main outcomes.";2012;;;Uncertain;"Management of patients";"Link to the recommendation on the website of the initiative" 65;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Following diagnosis of tuberculosis (TB) in an aircraft traveller, contact tracing of fellow passengers should not routinely be undertaken.";-;2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 321;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"A diagnosis of attention deficit hyperactivity disorder (ADHD) should not be made solely on the basis of rating scale or observational data.";"However rating scales such as the Conners rating scales and the Strengths and Difficulties questionnaire are valuable adjuncts, and observations (for example, at school) are useful when there is doubt about symptoms.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 577;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ultrasound estimation of fetal size for suspected large for gestational age unborn babies should not be undertaken in a low risk population.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 833;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topiramate should not be recommended for the treatment of neuropathic pain in non-specialist settings.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1089;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use anorectal manometry to exclude Hirschsprung s disease in children and young people with chronic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 66;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the tuberculosis (TB) index case is an aircraft crew member, contact tracing of passengers should not routinely take place.";-;2012;;;"Low value";TB;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 322;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dietary fatty acid supplementation is not recommended for the treatment of Attention deficit hyperactivity disorder (ADHD) in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 578;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine doppler ultrasound should not be used in low risk pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 834;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical tacrolimus is not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1090;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use albumin to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 67;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance imaging (MRI) should not routinely be performed to assess the stage of the primary tumour (T-stage) in non-small cell Lung Cancer (NSCLC).";-;2012;;;"Low value";neoplasms;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 323;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Drug treatment is not recommended for pre-school children with attention deficit hyperactivity disorder (ADHD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 579;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fetal presentation should be assessed by abdominal palpation at 36 weeks or later, when presentation is likely to influence the plans for the birth.";"Routine assessment of presentation by abdominal palpation should not be offered before 36 weeks because it is not always accurate and may be uncomfortable.";2012;;;"Low value";-;"Link to the recommendation on the webpage of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 835;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical or systemic steroids are not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1091;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use agar to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 324;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antipsychotics are not recommended for the treatment of attention deficit hyperactivity disorder (ADHD) in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 580;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine formal fetal-movement counting should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 836;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical or systemic decongestants are not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1092;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use acupuncture to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 325;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antipsychotics are not recommended for the treatment of attention deficit hyperactivity disorder (ADHD) in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la NICE " 581;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence does not support the routine use of antenatal electronic cardiotocography for fetal assessment in women with an uncomplicated pregnancy and therefore it should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 837;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical or systemic antihistamines are not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1093;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use abdominal ultrasound to make a diagnosis of idiopathic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 326;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people taking methylphenidate, dexamfetamine and atomoxetine, routine blood tests and electrocardiograms (ECGs) are not recommended unless there is a clinical indication.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 582;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The evidence does not support the routine use of ultrasound scanning after 24 weeks of gestation and therefore it should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 838;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Toileting aids should not be considered as a routine treatment for urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1094;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a plain abdominal radiograph to make a diagnosis of idiopathic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 327;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Liver damage is a rare and idiosyncratic adverse effect of atomoxetine and routine liver function tests are not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 583;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine breast examination during antenatal care is not recommended for the promotion of postnatal breastfeeding.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 839;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Thyroxine should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1095;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use 99mTc-MDP-labelled scintigraphy to diagnose osteomyelitis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 328;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Drug treatment is not indicated as the first-line treatment for all school-age children and young people with attention deficit hyperactivity disorder (ADHD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 584;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 840;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence to recommend the routine use of drugs to lower uric acid in people with chronic kidney disease (CKD) who have asymptomatic hyperuricaemia.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1096;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use 99mTc-labelled monoclonal antigranulocyte antibody scintigraphy to diagnose osteomyelitis:.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 329;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Additional interventions targeted specifically at the parents of children with conduct problems should not be provided routinely alongside parent-training programmes.";"Additional interventions such as interventions for parental, marital o interpersonal problems. They are unlikely to have an impact on the child s conduct problems.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 585;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine screening for cardiac anomalies using nuchal translucency is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 841;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence on the primary pain outcomes for oxycodone.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1097;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use 99mTc-HMPAO-labelled scintigraphy to diagnose osteomyelitis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 330;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder or associated behaviours of aggression, anger and impulsivity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 586;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Although there is a great deal of material published on alternative screening methods* for pre eclampsia, none of these has satisfactory sensitivity and specificity, and they are not recommended";"*For example, Alpha-Fetoprotein; B-hCG and uterine artery Doppler (bilateral notching)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 842;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of separate surgical knives to incise the skin and the deeper tissues at Caesarian section is not recommended because it does not decrease wound infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1098;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not treat people with suspected chronic open angle glaucoma (COAG) and normal intraocular pressure (IOP).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 331;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder";"Behaviour such as repeated self-harm, marked emotional instability, risk-taking behaviour and transient psychotic symptoms.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 587;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Auscultation of the fetal heart may confirm that the fetus is alive but is unlikely to have any predictive value and routine listening is therefore not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 843;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of reflexology should not be encouraged for the treatment of irritable bowel syndrome (IBS).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1099;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not start treatment with opioids (such as morphine or oxycodone) other than tramadol without an assessment by a specialist pain service or a condition-specific service.*";"*A specialist service that provides treatment for the underlying health condition that is causing neuropathic pain. Examples include neurology, diabetology and oncology services.";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 332;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antipsychotic drugs should not be used for the medium- and long-term treatment of borderline personality disorder.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 588;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When routine ultrasound screening is performed to detect neural tube defects, alpha-fetoprotein testing is not required.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa " 844;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of multi-channel cystometry is not recommended before starting conservative treatment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1100;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use phototherapy (narrowband UVB, broadband UVB or PUVA) as maintenance therapy to people with plaque or guttate pattern psoriasis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 333;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use brief psychological interventions (<3m) specifically for borderline personality disorder or for the individual symptoms of the disorder, outside a service that has some characteristics";"Characteristics: an explicit and integrated theoretical approach used by both the treatment team and the therapist, which is shared with the service user structured care in accordance with this guideline provision for therapist supervision.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 845;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of glucosamine products is not recommended for the treatment of osteoarthritis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1101;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use opioids for painless imaging procedures.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 334;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a loading dose of antipsychotic medication (often referred to as rapid neuroleptisation).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 590;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"HbA1c should not be used routinely for assessing glycaemic control in the second and third trimesters of pregnancy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 846;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of chondroitin products is not recommended for the treatment of osteoarthritis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1102;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use ketamine for painless imaging procedures.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 79;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use vena caval filters to prevent pulmonary embolism";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"venacaval filters, pulmonary emboli, Pulmonary embolism, PE";"

Enlace a la p�gina web de la iniciativa

" 335;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 591;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Estimated glomerular filtration rate (eGFR) should not be used during pregnancy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 847;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of ambulatory urodynamics or videourodynamics is not recommended before starting conservative treatment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1103;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use electrical stimulation in the treatment of women with overactive bladder syndrome .";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 80;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform chest physiotherapy in adults with pneumonia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"physical therapy";"

Enlace a la p�gina web de la iniciativa

" 336;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer counselling and supportive psychotherapy (as specific interventions) to people with schizophrenia.";"However, take service user preferences into account, especially if other more efficacious psychological treatments, such as cognitive behavioural therapy (CBT), family intervention and arts therapies, are not available locally.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 592;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Betamimetic drugs should not be used for tocolysis in women with diabetes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 848;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of acupuncture should not be encouraged for the treatment of irritable bowel syndrome (IBS).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1104;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use electrical stimulation in combination with pelvic floor muscle training.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 81;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"Measuring troponin levels in patients with acute pulmonary thromboembolism has low clinical value since high troponin levels do not discern those at low risk of death from those at high risk.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"PE, pulmonary emboly";"

Enlace a la p�gina web de la iniciativa

" 337;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adherence therapy (as a specific intervention) to people with schizophrenia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 593;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Babies of women with diabetes should not be transferred to community care until they are at least 24 hours old*";"*And not before healthcare professionals are satisfied that the babies are maintaining blood glucose levels and are feeding well.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 849;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The the head-up tilt test should not be done routinely to aid diagnosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1105;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use antibiotic prophylaxis for urinary tract infections in people with neurogenic lower urinary tract dysfunction.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 82;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform spirometry in patients with COPD during exacerbation or for In-treatment monitoring";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";spirometry;"

Enlace a la p�gina web de la iniciativa

" 338;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer social skills training (as a specific intervention) to people with schizophrenia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 594;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine monitoring of fetal well-being before 38 weeks is not recommended in pregnant women with diabetes, unless there is a risk of intrauterine growth restriction.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 850;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine measurement of vitamin D levels in people with stage 1, 2, 3A or 3B chronic kidney disease (CKD) is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1106;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely repeat serological tests while the donor is donating breast milk.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 83;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use electroencephalogram (EEG) in the investigation of transient loss of consciousness (TLoC)";.;2012;;;"Low value";syncope;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 339;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"[For pharmacological interventions], do not use targeted, intermittent dosage maintenance strategies routinely.";"However, consider them for people with schizophrenia who are unwilling to accept a continuous maintenance regimen or if there is another contraindication to maintenance therapy, such as side-effect sensitivity.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 595;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If a woman has preterm prelabour rupture of membranes, induction of labour should not be carried out before 34 weeks unless there are additional obstetric indications*";"*For example, infection or fetal compromise";2012;;;"Low value";-;"Link the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1107;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely refer children and young people with idiopathic constipation to a psychologist or child and adolescent mental health services.*";"*Unless the child or young person has been identified as likely to benefit from receiving a psychological intervention.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 84;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with a suspected cardiac arrhythmic cause of syncope, offer an ambulatory electrocardiogram (ECG) and do not offer a tilt test as a first-line investigation";.;2012;;;"Low value";"transient loss of consciousness, TLoC";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 340;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When prescribing drugs other than serotonin reuptake inhibitors (SSRIs), dosulepin should not be prescribed.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 596;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Induction of labour should not routinely be offered on maternal request alone. However, under exceptional circumstances* induction may be considered at or after 40 weeks.";"*For example, if the woman's partner is soon to be posted abroad with the armed forces";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1108;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely perform screening for thrombophilia in women who have had pre-eclampsia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 5460;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.";"The response to COVID-19 has led to shortages of antispetics and other over-the-counter products that might be used to clean minor wounds. For many people, tap water is an easily accessible and efficient way that might be used to clean minor wounds. In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials that compared the use of tap water with other solutions (e.g. saline) for wound cleansing. They did not restrict by date or language of publication and did their search in November 2011. They identified 11 eligible studies. Tap water that is safe to drink (potable) is unlikely to be harmful if used to cleanse acute wounds in adults or children. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.";2012;;;"High value";"Treatment COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 85;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a tilt test to people who have a diagnosis of vasovagal syncope on initial assessment";.;2012;;;"Low value";"transient loss of consciousness, TLoC, syncope";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la NICE

" 341;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Medication management as a separate intervention for people with depression should not be provided routinely by services.";"It is likely to be effective only when provided as part of a more complex intervention.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 597;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Induction of labour to avoid a birth unattended by healthcare professionals should not be routinely offered to women with a history of precipitate labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 853;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine measurement of calcium levels in people with stage 1, 2, 3A or 3B chronic kidney disease (CKD) is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1109;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer warfarin in combination with prasugrel or ticagrelor to people who need anticoagulation who have had an MI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1365;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer laser Acupuncture to patients with peripheral joint osteoarthritis";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 86;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not diagnose carotid sinus syncope if carotid sinus massage causes asymptomatic transient bradycardia or hypotension";.;2012;;;"Low value";"transient loss of consciousness, TLoC, syncope";"

Link to the recommendation on the website / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 342;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Augmentation of an antidepressant with buspirone*, carbamazepine*, lamotrigine* or valproate* [should not be used routinely] as there is insufficient evidence for their use.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 598;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In the absence of any other indications, induction of labour should not be carried out simply because a healthcare professional suspects a baby is large for gestational age (macrosomic).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 854;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who do not have symptoms of urinary tract infection (UTI) and whose urine tests negative* are unlikely to have UTI and should not have a urine sample sent for culture.";"*Test negative for either leucocytes or nitrites";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1110;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer ultrasound of the urinary tract when the cause of the acute kidney injury has been identified.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1366;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer laser Acupuncture to patients with Bell's palsy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 87;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For all people with unexplained syncope (including after negative carotid sinus massage test in those for whom this is appropriate), offer ambulatory electrocardiogram (ECG). Do not offer a tilt test";"For all people with unexplained syncope (including after negative carotid sinus massage test in those for whom this is appropriate), offer ambulatory electrocardiogram (ECG). Do not offer a tilt test before the ambulatory ECG";2012;;;"Low value";"transient loss of consciousness, TLoC, syncope";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 343;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Augmentation of an antidepressant with pindolol* or thyroid hormones* [should not be used routinely] as there is inconsistent evidence of effectiveness";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 599;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral and intravenous prostaglandin E2 (PGE2) should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 855;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Waist circumference is not recommended as a routine measure of overweight or obesity but may be used to give additional information on the risk of developing other long-term health problems.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1111;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mechanical ventilation (including non-invasive mechanical ventilation) to people with idiopathic pulmonary fibrosis who develop life-threatening respiratory failure.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1367;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform open operative treatment for rupturer of Achilles tendon";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 344;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Current evidence suggests that there are no major safety concerns associated with transcranial magnetic stimulation (TMS) for severe depression.";"There is uncertainty about the procedure's clinical efficacy, which may depend on higher intensity, greater frequency, bilateral application and/or longer treatment durations than have appeared in the evidence to date. TMS should therefore be performed only in research studies designed to investigate these factors.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 600;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Extra-amniotic and intracervical prostaglandin E2 (PGE2) should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 856;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Treatment should not be routinely offered to people over the age threshold* unless there are likely to be benefits from the treatment over an appropriate timescale.";"*This threshold varies according to intraocular pressure (IOP) and central corneal thickness (CCT) (see 'Table 6 Treatment for people with OHT or suspected COAG').";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1112;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer loop diuretics to treat acute kidney injury.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 345;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk benefit ratio is poor.";"Consider them for people with: A past history of moderate or severe depression or: Initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or Subthreshold depressive symptoms or mild depression that persist(s) after other interventions.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 601;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Intravenous oxytocin alone should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 857;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Whole-body occlusive dressings (including wet wrap therapy) and dry bandages (including tubular bandages and garments) should not be a first-line treatment for atopic eczema in children.";"* It should only be initiated by a healthcare professional trained in their use.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1113;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer inpatient withdrawal for medication overuse headache";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 346;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Although there is evidence that St John s wort may be of benefit in mild or moderate depression, practitioners should not prescribe or advise its use by people with depression";"This is because of uncertainty about appropriate doses, persistence of effect, variation in the nature of preparations and potential serious interactions with other drugs (including oral contraceptives, anticoagulants and anticonvulsants)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 602;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hyaluronidase should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 858;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When changing catheters in patients with a long-term indwelling urinary catheter, only consider antibiotic prophylaxis for certain patients.*";"* Patients who have a history of symptomatic urinary tract infection after catheter change or experience trauma during catheterisation.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1114;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer imaging of the upper urinary tract to men with uncomplicated lower urinary tract symptoms (LUTS) at initial assessment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 91;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"Whole brain radiotherapy is a potential low value intervention to treat multiple brain metastases";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"cancer, neoplasms";"

Enlace a la p�gina web de la iniciativa

" 347;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not switch to, or start, dosulepin because evidence supporting its tolerability relative to other antidepressants is outweighed by the increased cardiac risk and toxicity in overdose.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 603;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Corticosteroids should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 859;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Use of the tumor necrosis factor a (TNF) inhibitors for the treatment of severe, active and progressive rheumatoid arthritis in adults not previously treated.*";"*With methotrexate or other disease-modifying antirheumatic drugs (DMARDs) is not recommended.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1115;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer flow-rate measurement to men with lower urinary tract symptoms (LUTS) at initial assessment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 92;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"CT scans (head) after trauma is a potential low value intervention in children with low risk of clinically important brain injuries";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Images, x-ray";"

Enlace a la p�gina web de la iniciativa

" 348;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use electroconvulsive therapy (ECT) routinely for people with moderate depression but consider it if their depression has not responded to multiple drug treatments and psychological treatment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la NICE " 604;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oestrogen should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 860;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Propiverine should be considered as an option to treat frequency of urination in women with overactive bladder syndrome (OAB), but is not recommended for the treatment of urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1116;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use any of the drugs below, either alone or in combination, to modify disease progression in idiopathic pulmonary fibrosis.*";"*-ambrisentan -azathioprine -bosentan -co-trimoxazole -mycophenolate mofetil -prednisolone -sildenafil -warfarin.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1372;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Cervical cancer screening";"The USPSTF recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. Recommendation Grade A";2012;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 2396;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral budesonide for induction of remission in ulcerative colitis";"""Evidence shows that oral budesonide is not an effective treatment for acute ulcerative colitis and should not be used.

Oral mesalazine is significantly more effective at inducing remission in people with an acute exacerbation of ulcerative colitis. Therefore oral mesalazine can be considered effective as first-line treatment for mild to moderately active disease. For moderately active disease prednisolone is appropriate for patients in whom mesalazine has been ineffective.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 93;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"Plain X-rays of the skull is a potential low value intervention for diagnosing significant brain injury.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"XR, x-ray, Images";"

Enlace a la p�gina web de la iniciativa

" 349;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When prescribing antidepressants, be aware that dosulepin should not be prescribed";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 605;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vaginal nitric oxide donors should not be used for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 861;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Mother-to-child transmission of hepatitis B can be reduced if the baby receives immunoglobulin and vaccination. In these situations pregnant women should not be offered a planned C-section.*";"*Because there is insufficient evidence that this reduces mother-to-child transmission of hepatitis B virus.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1117;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer duloxetine as a second-line treatment for women with stress urinary incontinence.*";"*It may be offered as second-line therapy if women prefer pharmacological to surgical treatment or are not suitable for surgical treatment. If duloxetine is prescribed, counsel women about its adverse effects.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2397;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Aminosalicylates for induction of remission or response in Crohn's disease";"""Evidence shows that mesalazine and olsalazine are not effective for the induction of remission in Crohn?s disease and should not be used. Sulfasalazine may be beneficial in patients with disease confined to the colon but not in more extensive disease. Sulfasalazine can be considered along with other first-line drugs for the treatment of colonic Crohn?s disease. However, mesalazine and olsalazine are not effective and a different first-line treatment should be substituted for the induction of remission.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 94;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia?s Medicare Benefits Schedule (MBS)";English;"Neurosurgical clipping is a potential low value intervention in patients with aneurysmal subarachnoid hemorrhage";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"hemorrhagic stroke";"

Enlace a la p�gina web de la iniciativa

" 350;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer phenytoin to treat alcohol withdrawal seizures.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 606;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Amniotomy, alone or with oxytocin, should not be used as a primary method of induction of labour unless there are specific clinical reasons for not using vaginal prostaglandin E2 (PGE2)*";"*In particular the risk of uterine hyperstimulation.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 862;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical tacrolimus and pimecrolimus are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1118;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer cystoscopy to men with uncomplicated lower urinary tract symptoms (LUTS) (that is, without evidence of bladder abnormality) at initial assessment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2398;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Inhaled corticosteroids for cystic fibrosis";"""NICE summary of Cochrane review conclusions Evidence does not support the routine use of inhaled corticosteroids (ICS) as anti-inflammatory agents in children and adults with cystic fibrosis (CF). There is no evidence of objective improvements in lung function or subjective improvements in exercise tolerance or quality of life. ICS should only be used for the symptomatic relief of recurrent wheezing that is not responsive to bronchodilators alone. Outside of this indication they are likely to result in more harm than benefits.

The ?Implications for practice? section of the Cochrane review stated: ?This review has found little evidence from existing trials to support the practice of routinely prescribing inhaled steroids in CF. Specifically, we cannot conclude that inhaled steroids are beneficial but there is some evidence that at a high dose, they adversely effect growth. There is also some evidence that withdrawal of ICS in the majority of those already being treated with them is safe. We recommend that the use of ICS should be restricted to those with symptomatic wheezing and in whom benefit has been proven. Individuals should be regularly reassessed to see whether ICS are having an effect and consideration should always be given to reducing the dose or stopping the drugs altogether.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 95;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patients should be advised not to take supplements containing beta-carotene, and should not be advised to take antioxidant supplements (vitamin E and/or C) or folic acid to reduce cardiovascular risk.";.;2012;;;"Low value";vitamins;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 351;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Structural neuroimaging techniques (either MRI or CT scanning) are not recommended as a routine part of the initial investigations for the management of first-episode psychosis.";-;2012;;;"Low value";"magnetic resonance imaging, computed axial tomography";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 607;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Mechanical procedures (balloon catheters and laminaria tents) should not be used routinely for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 863;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical pimecrolimus are not recommended for the treatment of mild atopic eczema or as first-line treatments for atopic eczema of any severity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1119;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer complex psychological interventions such as cognitive behavioural therapy";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2399;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Tailored interventions based on exhaled nitric oxide versus clinical symptoms for asthma in children and adults";"""NICE summary of Cochrane review conclusions The current level of evidence does not support the routine measurement of fractional exhaled nitric oxide (FENO) to tailor corticosteroid therapy in adults or children with asthma. Tailoring the dose of inhaled corticosteroids (ICS) based on FENO did not significantly reduce exacerbations or improve forced expiratory volume in one second (FEV1) or asthma symptoms. In addition the use of FENO to tailor ICS dose in children was associated with higher dosages of ICS, which can have harmful side effects.

The ?Implications for practice? section of the Cochrane review stated: ?The studies included in this review highlight the difficulties involved in tailoring the dose of inhaled corticosteroids based on exhaled nitric oxide, instead of primarily on clinical symptoms. At present this approach cannot be advocated as routine clinical practice.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 96;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the patient has not been treated with a combination of aspirin and clopidogrel during the acute phase of an myocardial infarction (MI), this combination should not routinely be initiated.";.;2012;;;"Low value";antiplatelets;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 352;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform urinalysis routinely in children and young people with bedwetting";"Unless any of the following apply: - bedwetting started in the last few days or weeks - there are daytime symptoms - there are any signs of ill health - there is a history, symptoms or signs suggestive of urinary tract infection - there is a history, symptoms or signs suggestive of diabetes mellitus.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 608;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support herbal supplements for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 864;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tocilizumab is not recommended for the treatment of systemic juvenile idiopathic arthritis* when the disease continues to respond to methotrexate or who have not been treated with methotrexate.";"*In children and young people aged 2 years and older.";2012;;;"Low value";-;"Link to the recommendation on the website of the iniatitive / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1120;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer co-therapy with acitretin when administering PUVA.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 97;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"After a proven myocardial infarction in the past, patients with preserved left ventricular function who are asymptomatic should not be routinely offered treatment with a beta-blocker";"After a proven myocardial infarction in the past, patients with preserved left ventricular function who are asymptomatic should not be routinely offered treatment with a beta-blocker, unless they are identified to be at increased risk of further cardiovascular events, or there are other compelling indications for beta-blocker treatment.";2012;;;"Low value";"beta-blocker treatment";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 353;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use desmopressin in the treatment of children and young people who only have daytime wetting.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 609;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support acupuncture for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1121;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer calcium channel blockers to reduce cardiovascular risk after an MI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 98;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For patients who have had an myocardial infarction (MI), high-intensity warfarin (INR >3) should not be considered as an alternative to aspirin in first-line treatment.";.;2012;;;"Low value";"antiplatelet, anticoagulant";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 354;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely measure weight, serum electrolytes, blood pressure and urine osmolality in children and young people being treated with desmopressin for bedwetting.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 610;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support homeopathy for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1122;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer a post void residual volume measurement to men with lower urinary tract symptoms (LUTS) at initial assessment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2402;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children";"""Evidence shows that biofeedback for treating functional faecal incontinence is not effective in children and should not be used. NICE has previously recommended against the use of biofeedback to treat functional constipation; but biofeedback also demonstrates no efficacy in non-retentive functional incontinence. It is appropriate to focus resources on interventions for which there is evidence of efficacy, including other behavioural interventions and laxative use.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 99;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Calcium channel blockers should not routinely be used to reduce cardiovascular risk after an myocardial infarction.";.;2012;;;"Low value";MI;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 355;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use an anticholinergic alone for the management of bedwetting in children and young people without daytime symptoms.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 611;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support castor oil for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 867;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence that complementary therapies are effective for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), and therefore their use is not recommended.*";"*However, some people with CFS/ME choose to use some of these therapies for symptom control, and find them helpful.";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1123;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely monitor for changes in bone mineral density in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 100;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine prescription of angiotensin receptor blockers after an acute myocardial infarction is not recommended.";.;2012;;;"Low value";"ARBs, MI, Angiotensin II receptor antagonists, AT1-receptor antagonists, sartans";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 356;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer an anticholinergic combined with imipramine for the treatment of bedwetting in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 612;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support hot baths for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 868;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence for the use of supplements for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), hence they should not be prescribed for treating its symptoms. *";"*Supplements such as vitamin B12, vitamin C, co enzyme Q10, magnesium, NADH (nicotinamide adenine dinucleotide) or multivitamins and minerals, which some people with CFS/ME have reported finding them helpful as a part of a self-management strategy for their symptoms.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1124;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely monitor anti epileptic drug (AED) levels during pregnancy. If seizures increase or are likely to increase, monitoring AED levels may be useful when making dose adjustments*.";"*Particularly levels of lamotrigine and phenytoin, which may be particularly affected in pregnancy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 101;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The combination of aspirin and clopidogrel is not recommended for routine use for any longer than 12 months after the acute phase of myocardial infarction";"The combination of aspirin and clopidogrel is not recommended for routine use for any longer than 12 months after the acute phase of myocardial infarction (MI), unless there are other indications to continue dual antiplatelet therapy, and the combination is usually recommended for a shorter duration after an ST-segment-elevation MI.";2012;;;"Low value";"antiplatelet, anticoagulant";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 357;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use tricyclics as the first-line treatment for bedwetting in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 613;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support enemas for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 869;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjuvant growth hormone treatment with gonadotrophin-releasing hormone agonist and/or human menopausal gonadotrophin during ovulation induction is not recommended in certain women.*";"*Women with polycystic ovary syndrome who do not respond to clomifene citrate, because it does not improve pregnancy rates.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1125;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely measure bone mineral density (BMD) to assess fracture risk without prior assessment using FRAX (without a BMD value) or Qfracture.*";"*FRAX is the World Health Organisation fracture risk assessment tool, which can be used for people aged between 40 and 90 years, either with or without BMD values, as specified";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 102;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nicorandil is not recommended to reduce cardiovascular risk in patients after an (myocardial infarction) MI.";.;2012;;;"Low value";vasodilatory;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 358;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use strategies that recommend the interruption of urinary stream or encourage infrequent passing of urine during the day in kids or teenegers with enuresis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 614;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Healthcare professionals should inform women that the available evidence does not support sexual intercourse for induction of labour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 870;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Planned CS should not routinely be carried out before 39 weeks, as the risk of respiratory morbidity is increased in babies born by Caesarian section (CS) before labour. *";"*But this risk decreases significantly after 39 weeks.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1126;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely give antibiotics to children with gastroenteritis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 103;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine monitoring of creatine kinase in asymptomatic patients who are being treated with a statin after an myocardial infarction (MI) is not recommended";.;2012;;;"Low value";"creatine phosphokinase, CPK, phospho-creatine kinase, creatinine kinase";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 359;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use dry-bed training with or without an alarm for the treatment of bedwetting in children and young people.";"Dry-bed training is a training programme that may include combinations of a number of different behavioural interventions, and that may include rewards, punishment, training routines and waking routines, and may be undertaken with or without an alarm.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 615;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"To reduce the likelihood of cord prolapse, which may occur at the time of amniotomy, the following precautions should be taken: amniotomy should be avoided if the baby s head is high.";-;2012;;;"Low value";-;"Link to the recommendation on the website of te initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 871;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Though the risk of neonatal morbidity and mortality is higher with 'small for gestational age' babies, CS should not routinely be offered outside a research context.*";"* As the effect of planned Caesarian section (CS) in improving these outcomes remains uncertain.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1127;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely assess fracture risk in people aged under 50 years, because they are unlikely to be at high risk.*";"*Unless they have major risk factors (for example, current or frequent recent use of oral or systemic glucocorticoids, untreated premature menopause or previous fragility fracture).";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 360;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Benzodiazepines are associated with a less good outcome in the long term and should not be prescribed for the treatment of individuals with panic disorder.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 616;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Laparoscopic uterine nerve ablation (LUNA) for chronic pelvic pain should not be used.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 872;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The progestogen-only pill is not recommended as reliable contraception in women and girls taking enzyme-inducing anti epileptic drugs (AEDs).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1128;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not refer people for radiofrequency facet joint denervation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 105;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Chlorhexidine mouthwash should not be offered as prophylaxis against infective endocarditis to people at risk of infective endocarditis undergoing dental procedures.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 361;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sedating antihistamines or antipsychotics should not be prescribed for the treatment of panic disorder.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 617;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Prolonged use of maternal facial oxygen therapy may be harmful to the baby and should be avoided.";"There is no research evidence evaluating the benefits or risks associated with the short-term use of maternal facial oxygen therapy in cases of suspected fetal compromise.";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 873;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The potency of topical corticosteroids should be tailored to the severity of the child's atopic eczema*. Do not use very potent preparations in children without specialist dermatological advice.";"*The severity of the eczema may vary according to body site.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1129;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not refer people for percutaneous intradiscal radiofrequency thermocoagulation (PIRFT)";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 106;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"[NICE] recommends that antibiotic prophylaxis solely to prevent infective endocarditis (IE) should not be given to people at risk of IE undergoing dental and non-dental procedures.";"The basis to support this recommendation is: There is no consistent association between having an interventional procedure, dental or non-dental, and the development of IE: Regular toothbrushing almost certainly presents a greater risk of IE than a single dental procedure because of repetitive exposure to bacteraemia with oral flora: The clinical effectiveness of antibiotic prophylaxis is not proven: Antibiotic prophylaxis against IE for dental procedures may lead to a greater number of deaths through fatal anaphylaxis than a strategy of no antibiotic prophylaxis, and is not cost effective.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 362;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antidepressant medication should not be used for the initial treatment of children and young people with mild depression.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 618;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Formula milk should not be given to breastfed babies in hospital unless medically indicated.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 874;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The EEG should not be used to exclude a diagnosis of epilepsy in a child, young person or adult in whom the clinical presentation supports a diagnosis of a non-epileptic event.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1130;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not refer people for intradiscal electrothermal therapy (IDET)";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 107;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotic prophylaxis against infective endocarditis is not recommended: For people undergoing dental procedures";"Antibiotic prophylaxis against infective endocarditis is not recommended: For people undergoing dental procedures: For people undergoing non-dental procedures at the following sites : Upper and lower gastrointestinal tract Genitourinary tract; this includes urological, gynaecological and obstetric procedures, and childbirth: Upper and lower respiratory tract; this includes ear, nose and throat procedures and bronchoscopy.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 363;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antidepressant medication should not be offered to a child or young person with moderate to severe depression except in combination with a concurrent psychological therapy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 619;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Breastfed babies with jaundice should not be routinely supplemented with formula, water or dextrose water.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 875;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The correction to normal levels of haemoglobin (Hb) with erythropoiesis-stimulating agents (ESAs) should not routinely be recommended in people with anaemia of chronic kidney disease (CKD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1131;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not refer people diagnosed with tension-type headache, migraine, cluster headache or medication overuse headache for neuroimaging solely for reassurance";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 108;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The Framingham 1991 risk equations should not be used for people with pre-existing: coronary heart disease (CHD) or angina: stroke or transient ischaemic attack: peripheral vascular disease.";.;2012;;;"Low value";.;"Link to the recommendation in the NICE website" 364;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Paroxetine and venlafaxine should not be used for the treatment of depression in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 620;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine assessment of proteinuria is not recommended in women with preclampsia or eclampsia.";-;2012;;;"Low value";-;"Link to the recommendation on website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 876;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The case for routine use of Ambulight PDT in achieving a more efficient service is not supported by the evidence submitted by the manufacturer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1132;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not refer adults, children or young people to a nephrologist or paediatric nephrologist when there is a clear cause for acute kidney injury.*";"*And the condition is responding promptly to medical management, unless they have a renal transplant.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 109;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The Framingham risk equation should not be used for people who are already considered at high risk of cardiovascular disease (CVD)";"The Framingham risk equation should not be used for people who are already considered at high risk of cardiovascular disease (CVD) because of: familial hypercholesterolaemia or other monogenic disorders of lipid metabolism - diabetes";2012;;;"Low value";.;"Link to the recommendation in the NICE website" 365;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tricyclic antidepressants should not be used for the treatment of depression in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 621;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use three-dimensional ultrasound scans to determine chorionicity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 877;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tests for vitamin B12 deficiency should not be carried out unless a full blood count and mean cell volume show a macrocytosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1133;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend complementary therapies for the treatment of urinary incontinence or overactive bladder syndrome.";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 110;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People should not routinely be recommended to take omega-3 fatty acid supplements for the primary prevention of cardiovascular disease (CVD).";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 366;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electroconvulsive Therapy (ECT) is not recommended in the treatment of depression in children (5-11 years).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 622;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Referrals to the enhanced team should not be made routinely for women with twin and triplet pregnancies but should be based on each woman's needs.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 878;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tests for serum ferritin in adults should not be carried out unless a full blood count and other haematological indices suggest iron deficiency.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1134;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not prescribe pancreatic enzyme supplements to people with chronic alcohol-related pancreatitis if pain is their only symptom.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2414;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Relapse prevention interventions for smoking cessation";"""NICE summary of review conclusions

Evidence shows that the majority of relapse prevention interventions for smoking cessation are not effective and should not be used. There is not enough evidence to recommend behavioural methods routinely to prevent smoking relapse in people who have achieved abstinence for circumstantial reasons; such as pregnancy, being an inpatient in hospital or recruited into the military; or decided to quit unaided. There is also little evidence that bupropion or nicotine replacement therapies are effective in preventing relapse. However, varenicline does seem to show benefit when given for a further 12 weeks after the quit date.

The Implications for practice section of the Cochrane review stated:

The available evidence does not support the use of any specific behavioural component or intervention for helping smokers who have successfully quit for a short time to avoid relapsing to smoking again. The conclusion of a lack of efficacy concerns specifically the traditional treatment focusing on identifying and resolving tempting situations, and minimal interventions using one-off sessions and written materials. There is hardly any evidence available on alternative approaches. Until new positive evidence becomes available, it may be more efficient to focus resources on supporting initial cessation attempts rather than on extended relapse prevention interventions. Regarding pharmacotherapies, extended treatment with varenicline may prevent relapse. Extended treatment with bupropion is unlikely to have a clinically important effect.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 111;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Higher intensity statins should not routinely be offered to people for the primary prevention of cardiovascular disease (CVD).";.;2012;;;"Low value";.;"Link to the recommendation in the NICE website" 367;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Drug treatments for post-traumatic stress disorder should not be used as a routine first-line treatment for adults* in preference to a trauma-focused psychological therapy.";"*In general use or by specialist mental health professionals";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 623;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use second trimester serum screening for Down's syndrome in triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 879;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tests for folate levels should not be carried out unless a full blood count and mean cell volume show a macrocytosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1135;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not prescribe fish oil preparations for the primary prevention of cardiovascular disease in people with type 2 diabetes.*";"*Unless the person has hypertriglyceridaemia and is receiving advice from a healthcare professional with special expertise in blood lipid management.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2415;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Cervical stitch (cerclage) for preventing pregnancy loss in women";"""NICE summary of review conclusions

Evidence shows that in some circumstances the harms of cervical stitch (cerclage) may outweigh the benefits. There seems to be limited benefit of cerclage in women at low to medium risk of second trimester miscarriage or preterm labour before 34 weeks? gestation. Prophylactic history-indicated cerclage may only be of benefit in women with three or more previous preterm births and/or second-trimester losses. Therapeutic ultrasound-indicated cerclage may be of benefit in women with a history of one or more spontaneous midtrimester losses or preterm births who have an ultrasound-measured cervix length of 25 mm or less before 24 weeks? gestation. Consider not routinely offering cerclage to women with two or fewer previous preterm births and/or second-trimester losses. Also consider not routinely offering cerclage to women who have an incidentally identified short cervix of 25 mm or less in the absence of a history of spontaneous preterm delivery or second-trimester loss. Since this Cochrane review was published, the Royal College of Obstetricians and Gynaecologists (RCOG) have published guidance that reinforce its conclusions. In particular, the RCOG recommends that history-indicated cerclage be offered to women with three or more previous preterm births and/or second-trimester losses. Women with a history of one or more spontaneous mid-trimester losses or preterm births who are undergoing transvaginal sonographic surveillance of cervical length should be offered an ultrasound-indicated cerclage if the cervix is 25 mm or less and before 24 weeks of gestation. The RCOG guidance is likely to have substantially reduced the use of cerclage outside of its guidelines, however there may be some women still receiving cerclage inappropriately and the Cochrane review reinforces that this practice in women at low- to medium-risk can be stopped.

The Implications for practice section of the Cochrane review stated:

Until more data become available cervical cerclage should not be offered to women considered at low or medium risk of second trimester miscarriage or extreme preterm labour. There may be a role for cervical cerclage for women considered ?at very high risk? of second trimester miscarriage due to a cervical factor for example, greater than two second trimester losses or progressive shortening of the cervix on ultrasound. However, predicting those women who will miscarry due to a cervical factor remains elusive and many women may be treated unnecessarily. The numbers involved in randomised studies are too few to draw firm conclusions.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 112;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fibrates should not routinely be offered for the primary prevention of cardiovascular disease (CVD). If statins are not tolerated, fibrates may be considered.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 368;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Non-trauma-focused interventions* that do not address traumatic memories, should not routinely be offered to people who present with post-traumatic stress disorder symptoms within 3m";"*Such as relaxation or nondirective therapy";2012;;;"Low value";PTSD;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 624;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not monitor for feto-fetal transfusion syndrome in the first trimester.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 880;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Systemic hormone replacement therapy is not recommended for the treatment of urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1136;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform rectal biopsy unless some of the clinical features of Hirschsprung's disease are or have been present.*";"*Delayed passage of meconium (more than 48 hours after birth in term babies); constipation since first few weeks of life; chronic abdominal distension plus vomiting; family history of Hirschsprung s disease; faltering growth in addition to any of the previous features.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2416;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Enemas during labour";"""NICE summary of review conclusions

Evidence shows that the use of enemas during labour is not effective. This confirms current clinical practice and reinforces that enemas should not be used routinely during labour. There were no significant differences in infection rates in puerperal women or neonates, no overall effect on length of labour and no clear improvement in maternal satisfaction between groups of mothers given or not given enemas. Consider not routinely using enemas during labour but instead base their use on patient preference alone.

The Implications for practice section of the Cochrane review stated:

This review found that enemas did not improve puerperal or neonatal infection rates, episiotomy dehiscence rates or maternal satisfaction. Therefore, their use is unlikely to benefit women or newborn children, and there is no reliable scientific basis to recommend their routine use. These findings should discourage the routine use of enemas during labour.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 113;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Nicotinic acid should not be offered for the primary prevention of cardiovascular disease (CVD).";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 369;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Non-trauma-focused interventions* which do not address traumatic memories, should not routinely be offered to people who present with chronic post-traumatic stress disorder (PTSD).";"*Such as relaxation or nondirective therapy";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 625;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use abdominal palpation or symphysis-fundal height measurements to predict intrauterine growth restriction in twin or triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 881;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Surgery cannot be recommended for the routine management of persistent gastro-oesophageal reflux disease (GORD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1137;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform multi-channel filling and voiding cystometry in the small group of women where pure stress urinary incontinence is diagnosed based on a detailed clinical history and examination.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 114;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Anion exchange resins should not routinely be offered for the primary prevention of cardiovascular disease (CVD). If statins are not tolerated, an anion exchange resin may be considered.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 370;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For individuals who have experienced a traumatic event, the systematic provision to that individual alone of brief, single-session interventions* should not be routine practice when delivering service";"*Often referred to as debriefing";2012;;;"Low value";debriefing;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 626;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use umbilical artery Doppler ultrasound to monitor for intrauterine growth restriction or birthweight differences in twin or triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 882;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Supplements of vitamin C should not be prescribed as adjuvants specifically for the treatment of anaemia of chronic kidney disease (CKD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1138;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform multi-channel cystometry, ambulatory urodynamics or videourodynamics before starting conservative management.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2418;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Bed rest during pregnancy for preventing miscarriage";"""NICE summary of review conclusions

Recommending bed rest to prevent miscarriage is not supported by sufficient good quality evidence. Consideration could be given to using it only in the context of a research or audit project. There is currently little evidence for bed rest in women at high risk of miscarriage or those who have had a threatened miscarriage improving the outcome of the pregnancy. In view of the potential negative consequences of bed rest in terms of increased risk of thromboembolic disease, muscle atrophy, depression and loss of productivity, bed rest cannot be currently recommended routinely.

The Implications for practice section of the Cochrane review stated:

There is not enough information to justify the recommendation of bed rest for women with threatened miscarriage or at high risk of miscarriage. There is currently no evidence to give reassurance that such a policy could not be harmful for women and their families since none of the studies assesses potential side-effects of bed rest (thromboembolic events, maternal stress, depression, costs). Until further evidence is available the policy of bed rest cannot be recommended for routine clinical practice for women with threatened miscarriage or at high risk of miscarriage.""";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 115;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The combination of an anion exchange resin, fibrate or nicotinic acid with a statin should not be offered for the primary prevention of cardiovascular disease (CVD).";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 371;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer an antipsychotic for the treatment of generalised anxiety disorder (GAD) in primary care.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 627;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use fetal fibronectin testing alone to predict the risk of spontaneous preterm birth in twin or triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 883;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Supplements of folic acid should not be prescribed as adjuvants specifically for the treatment of anaemia of chronic kidney disease (CKD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1139;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform manual evacuation of the bowel under anaesthesia unless optimum treatment with oral and rectal medications has failed.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 116;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The combination of a fish oil supplement with a statin should not be offered for the primary prevention of cardiovascular disease (CVD).";.;2012;;;"Low value";.;"Link to the recommendation in the NICE website" 372;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use blood tests routinely for the identification and diagnosis of alcohol use disorders.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 628;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use home uterine activity monitoring to predict the risk of spontaneous preterm birth in twin or triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 884;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Supplements of carnitine should not be prescribed as adjuvants specifically for the treatment of anaemia of chronic kidney disease (CKD).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1140;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer urodynamic investigations (such as filling cystometry and pressure-flow studies) routinely to people who are known to have a low risk of renal complications.*";"*For example, most people with multiple sclerosis.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 373;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer clomethiazole for community-based assisted withdrawal because of the risk of overdose and misuse.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 629;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use cervical length (with or without fetal fibronectin) routinely to predict the risk of spontaneous preterm birth in twin or triplet pregnancies";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 885;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Structural magnetic resonance imaging (MRI) should not be used in the differential diagnosis of Parkinson's disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1141;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer transcutaneous sacral nerve stimulation to treat overactive bladder syndrome in women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 118;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Anticoagulation treatment should not be used routinely for the treatment of acute stroke.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 374;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antidepressants (including selective serotonin reuptake inhibitors [SSRIs]) routinely for the treatment of alcohol misuse alone.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 630;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the following interventions (alone or in combination) routinely to prevent spontaneous preterm birth in twin or triplet pregnancies";"Bed rest at home or in hospital -intramuscular or vaginal progesterone -cervical cerclage -oral tocolytics.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 886;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Strategies for managing chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) should not include rest in response to a slight increase in symptoms.*";"*Prolonged or complete rest or extended periods of daytime rest.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1142;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer transcutaneous posterior tibial nerve stimulation for overactive bladder syndrome.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inciiativa " 119;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Immediate initiation of statin treatment is not recommended in people with acute stroke .";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 375;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use gammahydroxybutyrate (GHB) for the treatment of alcohol misuse.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 631;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use single or multiple untargeted (routine) courses of corticosteroids in twin or triplet pregnancies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 887;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Strategies for managing chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) should not include an imposed rigid schedule of activity and rest.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1143;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer transcutaneous electrical nerve simulation (TENS), as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 120;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People who have had a stroke should receive supplemental oxygen only if their oxygen saturation drops below 95%.";-;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 376;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Benzodiazepines should not be used as ongoing treatment for alcohol dependence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 632;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The effect of planned Caesarian section in improving outcome for the second twin remains uncertain and therefore Caesarian section should not routinely be offered outside a research context.";"In otherwise uncomplicated twin pregnancies at term where the presentation of the first twin is cephalic, perinatal morbidity and mortality is increased for the second twin. However, the effect of planned Caesarian section in improving outcome for the second twin remains uncertain and therefore Caesarian section should not routinely be offered outside a research context.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 888;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Steroid enemas should not be used for treating men with radiation proctopathy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1144;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer traction, as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 121;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Coronary heart disease risk estimation tools such as those based on the Framingham algorithm should not be used";"People with familial hypercholesterolaemia (FH) are already at a high risk of premature coronary heart disease.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 377;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use biological or physical tests in routine screening for substance misuse in adults and young people with psychosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 633;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The effect of planned Caesarian section in improving neonatal morbidity and mortality in 'small for gestational age' babies remains uncertain and should not routinely be offered";"The risk of neonatal morbidity and mortality is higher with 'small for gestational age' babies. However, the effect of planned Caesarian section (CS) in improving these outcomes remains uncertain and therefore CS should not routinely be offered outside a research context.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 889;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Specialist management programmes delivered by practitioners* should not be offered to people with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";"*Practitioners with no experience in the condition.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1145;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer therapeutic ultrasound, as a non-pharmacological therapy for low back pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 122;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The Simon Broome low-density lipoprotein cholesterol (LDL-C) criteria for index individuals should not be used because this will result in under diagnosis.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 378;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer antidepressants routinely for people with persistent subthreshold depressive symptoms or mild depression";"Consider them for, or refer for an assessment, people with: -initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or -subthreshold depressive symptoms or mild depression that persist(s) after other interventions or -a past history of moderate or severe depression or -mild depression that complicates the care of a physical health problem.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 634;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pelvimetry is not useful in predicting 'failure to progress' in labour and should not be used in decision making about mode of birth.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 890;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Soft-palate implants should not be used in the treatment of obstructive sleep apnoea (OSA).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1146;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer the combination of tumour necrosis factor-a (TNF-a) inhibitor therapy and anakinra for rheumatoid arthritis (RA).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 123;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People with familial hypercholesterolemia (FH) should not routinely be recommended to take omega-3 fatty acid supplements.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 379;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not rely on any autism-specific diagnostic tool alone to diagnose autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 635;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Shoe size, maternal height and estimations of fetal size* do not accurately predict cephalopelvic disproportion and should not be used to predict 'failure to progress' during labour.";"*Ultrasound or clinical examination";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 891;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Serological testing should not be carried out unless the history is indicative of an infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1147;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer systemic hormone replacement therapy for the treatment of urinary incontinence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 124;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Angiotensin-converting enzyme (ACE) inhibitors should not be used in people with familial hypercholesterolemia (FH) who are being treated with low-density lipoprotein cholesterol (LDL) apheresis";"Angiotensin-converting enzyme (ACE) inhibitors should not be used in people with familial hypercholesterolemia (FH) who are being treated with low-density lipoprotein cholesterol (LDL) apheresis. Instead, ACE inhibitors should be substituted with angiotensin-receptor blocking agents.";2012;;;"Low value";ACEI;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 380;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely perform any medical investigations as part of an autism diagnostic assessment";"Consider these circumstances: genetic tests, as recommended by your regional genetics centre, if there are specific dysmorphic features, congenital anomalies and/or evidence of intellectual disability -electroencephalography if there is suspicion of epilepsy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 636;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a Caesarian section on the grounds of HIV status to prevent mother-to-child transmission of HIV";"""Women on highly active anti-retroviral therapy (HAART) with a viral load of less than 400 copies per ml or Women on any anti-retroviral therapy with a viral load of less than 50 copies per ml. Inform women that in these circumstances the risk of HIV transmission is the same for a Caesarian section and a vaginal birth.""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 892;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Rubefacients are not recommended for the treatment of osteoarthritis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1148;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer stand-alone formal education programmes but include an educational component consistent with the guideline as part of other interventions.";-;2012;;;"Low value";-;"Link to the recommendation on the website if the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 125;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Serum cholesterol concentrations should not be measured routinely during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 381;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use risk assessment tools and scales to predict future suicide or repetition of self-harm.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 637;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women with hepatitis B should not be offered a planned Caesarian section because there is insufficient evidence that this reduces mother-to-child transmission of hepatitis B virus.";"Mother-to-child transmission of hepatitis B can be reduced if the baby receives immunoglobulin and vaccination.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 893;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine screening for elevated blood lipid levels and/or neurological function is not recommended for children and young people with type 1 diabetes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1149;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer selective serotonin reuptake inhibitors (SSRIs) for treating pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 126;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In asymptomatic children and young people with heterozygous familial hypercholesterolemia, evaluation of coronary heart disease is unlikely to detect clinically significant disease";"In asymptomatic children and young people with heterozygous (familial hypercholesterolemia) FH, evaluation of coronary heart disease is unlikely to detect clinically significant disease and referral should not be routinely offered.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 382;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use risk assessment tools and scales to determine who should and should not be offered treatment or who should be discharged.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 638;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who are infected with hepatitis C should not be offered a planned Caesarian section because this does not reduce mother-to-child transmission of the virus.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 894;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients with acute upper gastrointestinal bleeding during the resuscitation and initial management do not use recombinant factor Vlla except when all other methods have failed";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1150;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer platelet transfusion to patients who are not actively bleeding and are haemodynamically stable.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 127;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ultrasonography of the Achilles tendon is not recommended in the diagnosis of familial hypercholesterolemia (FH).";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 383;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When prescribing drugs for associated mental health conditions to people who self-harm, take into account the toxicity of the prescribed drugs in overdose.";"For example, when considering antidepressants, selective serotonin reuptake inhibitors (SSRIs) may be preferred because they are less toxic than other classes of antidepressants. In particular, do not use tricyclic antidepressants, such as dosulepin, because they are more toxic.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 639;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a body mass index (BMI) of over 50 alone as an indication for planned Caesarian section.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 895;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Repeated standard EEGs should not be used in preference to sleep or sleepdeprived EEGs.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1151;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer phytotherapy for treating lower urinary tract symptoms (LUTS) in men.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 128;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine monitoring of creatine kinase is not recommended in asymptomatic adults or children/young people with familial hypercholesterolemia (FH) who are receiving treatment with a statin.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 384;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use biological tests, genetic tests or neuroimaging for diagnostic purposes routinely as part of a comprehensive assessment";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 640;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The following aspects of intrapartum care have not been shown to influence the likelihood of Caesarian section for 'failure to progress' and should not be offered for this reason";"""Although they may affect other outcomes: -Active management of labour -Early amniotomy.""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 896;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Repeat cycles of treatment with docetaxel are not recommended if the disease recurs after completion of the planned course of chemotherapy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1152;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer pethidine for treating pain in an acute painful sickle cell episode.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 385;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not provide 'facilitated communication' for adults with autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 641;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Planned CS should not routinely be carried out before 39 weeks.";"The risk of respiratory morbidity is increased in babies born by Caesarian section (CS) before labour, but this risk decreases significantly after 39 weeks.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 897;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Regular blood test monitoring in children and young people is not recommended as routine, and should be done only if clinically indicated and recommended by the specialist. [2004]";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1153;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer percutaneous posterior tibial nerve stimulation for overactive bladder syndrome (OAB).*";"*Unless there has been a multidisciplinary team review; AND conservative management including OAB drug treatment has not worked adequately; AND the woman does not want botulinum toxin A7 or percutaneous sacral nerve stimulation.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 130;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mechanical venous thromboembolism (VTE) prophylaxis to patients with cancer having oncological treatment who are ambulant.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 386;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use anticonvulsants for the management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 642;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pregnant women who are healthy and who have otherwise uncomplicated pregnancies should not routinely be offered some tests before Caesarian section";"Grouping and saving of serum, cross-matching of blood, a clotting screen or preoperative ultrasound for localisation of the placenta, because this does not improve Caesarian section morbidity outcomes (such as blood loss of more than 1000 ml, injury of the infant, and injury to the cord or to other adjacent structures).";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 898;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Regular blood test monitoring in adults is not recommended as routine, and should be done only if clinically indicated. [2004]";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1154;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer people without left ventricular systolic dysfunction or heart failure, who have had an MI more than 12 months ago, treatment with a beta-blocker.*";"*Unless there is an additional clinical indication for a beta-blocker.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1410;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform UVB therapy for patients with vitiligo";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 131;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anti-embolism stockings for venous thromboembolism (VTE) prophylaxis to patients who are admitted for stroke.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 387;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use chelation for the management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 643;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of separate surgical knives to incise the skin and the deeper tissues at Caesarian section is not recommended because it does not decrease wound infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 899;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Referral for arthroscopic lavage and debridement should not be offered as part of treatment for osteoarthritis, unless the person has knee osteoarthritis with a clear history of mechanical locking.*";"*Not gelling, giving way or X-ray evidence of loose bodies.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1155;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer penile clamps to men with storage lower urinary tract symptoms (LUTS) (particularly urinary incontinence).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1411;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform aminoinfusion for the treatment of women with meconiumstained liquor";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 132;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anti-embolism stockings to patients with certain conditions*";"*Do not offer anti-embolism stockings to patients who have:suspected or proven peripheral arterial disease; peripheral arterial bypass grafting; any local conditions in which stockings may cause damage, for example fragile tissue paper skin dermatitis, gangrene or recent skin graft; known allergy to material of manufacture; cardiac failure; severe leg oedema or pulmonary oedema from congestive heart failure; unusual leg size or shape; major limb deformity preventing correct fit.";2012;;;"Low value";.;"Enlace a la recomendaci�n en la p�gina web de la NICE " 388;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the following interventions for the management of core symptoms of autism in adults: exclusion diets, vitamins, minerals or dietary supplements";"Exclusion diets such as gluten- or casein-free and ketogenic diets; vitamins, minerals and dietary supplements such as vitamin B6 or iron supplementation";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 644;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"At Caesarian section, the placenta should be removed using controlled cord traction and not manual removal as this reduces the risk of endometritis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 900;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Re-testing for H. pylori should be performed using a carbon-13 urea breath test.*";"*There is currently insufficient evidence to recommend the stool antigen test as a test of eradication.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1156;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer paracetamol, NSAIDS, opioids, ergots or oral triptans for the acute treatment of cluster headache";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1412;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use Electroconvulsive therapy as part of treatment for patients with moderate depression.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 133;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to patients with central venous catheters who are ambulant.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 389;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use drugs specifically designed to improve cognitive functioning for the management of core symptoms of autism or routinely for associated cognitive or behavioural problems in adults.";"Drugs specifically designed to improve cognitive functioning such as cholinesterase inhibitors";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 645;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Intraperitoneal repair of the uterus at Caesarian section should be undertaken. Exteriorisation of the uterus is not recommended";"Exteriorisation of the uterus is associated with more pain and does not improve operative outcomes such as haemorrhage and infection.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 901;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Raloxifene is not recommended as a treatment option for the primary prevention of osteoporotic fragility fractures in postmenopausal women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1157;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer oxybutynin (immediate release) to frail older women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1413;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to routinely offer cystoscopy to men with uncomplicated urinary tract syndromes";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 134;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mechanical venous thromboembolism (VTE) prophylaxis to patients with central venous catheters who are ambulant.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 390;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use oxytocin for the management of core symptoms of autism in adults";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 646;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine closure of the subcutaneous tissue space should not be used, unless the woman has more than 2 cm subcutaneous fat, because it does not reduce the incidence of wound infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 902;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Psychological therapies, such as cognitive behavioural therapy and psychotherapy, may reduce dyspeptic symptoms in the short term in individual patients.*";"*Given the intensive and relatively costly nature of such interventions, routine provision by primary care teams is not currently recommended.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inciaitiva " 1158;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer laparoscopic colposuspension as a routine procedure for the treatment of stress urinary incontinence (UI) in women.*";"*Only an experienced laparoscopic surgeon working in an multidisciplinary team with expertise in the assessment and treatment of UI should perform the procedure.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1414;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use indewelling catheters in comparison to suprapubic catheter";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 135;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to patients admitted for terminal care or those commenced on an end-of-life care pathway.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 391;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use secretin for the management of core symptoms of autism in adults";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 647;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Superficial wound drains should not be used at Caesarian section because they do not decrease the incidence of wound infection or wound haematoma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 903;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Proton pump inhibitors Do not offer acid-suppression drugs (proton pump inhibitors or H2-receptor antagonists) before endoscopy to patients with suspected non-variceal upper gastrointestinal bleeding.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1159;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t screen women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1415;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform PCNL in comparison to ESWLfor kidney stones";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 136;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mechanical venous thromboembolism (VTE) prophylaxis to patients admitted for terminal care or those commenced on an end-of-life care pathway.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 392;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use testosterone regulation for the management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 648;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use co-amoxiclav when giving antibiotics before skin incision.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 904;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Propantheline should not be used for the treatment of urinary incontinence (UI) or overactive bladder syndrome (OAB) in women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1160;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t screen women younger than 30 years of age for cervical cancer with HPV testing, alone or in combination with cytology.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1416;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform rubber band ligation in comparison to surgical excision of haemoroids";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 137;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to patients undergoing a surgical procedure with local anaesthesia by local infiltration with no limitation of mobility.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 393;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use hyperbaric oxygen therapy for the management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 649;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine respiratory physiotherapy does not need to be offered to women after a Caesarian section under general anaesthesia, because it does not improve respiratory outcomes such as coughing, phlegm, b";"It does not improve respiratory outcomes such as coughing, phlegm, body temperature, chest palpation and auscultatory changes";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 905;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Plain X-rays of the skull should not be used to diagnose significant brain injury without prior discussion with a neuroscience unit.However, they are sometimes useful.*";"*As part of the skeletal survey in children presenting with suspected non-accidental injury.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1161;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t prescribe antibiotics for otitis media in children aged 2?12 years with non-severe symptoms where the observation option is reasonable.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1417;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform rectal biopsy in children unless there are clinical features of Hirschsprung s disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 138;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mechanical venous thromboembolism (VTE) prophylaxis to patients undergoing a surgical procedure with local anaesthesia by local infiltration with no limitation of mobility.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 394;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antipsychotic medication for the management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 650;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For women with a pregnancy of unknown location, when using serial serum hCG measurements, do not use serum progesterone measurements as an adjunct to diagnose*";"*Either viable intrauterine pregnancy or ectopic pregnancy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 906;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pirfenidone is recommended for treating certain idiopathic pulmonary fibrosis.* This treatment should be discontinued if there is disease progression (decline in predicted FVC ?10% within 12 months).";"*When the person has a forced vital capacity (FVC) between 50% and 80% predicted and the manufacturer provides pirfenidone with the discount agreed in the patient access scheme.";2012;;;"Low value";-;"Link to the recommendation on the webstie of the initiative / Enlace a la recommendaci�n en la p�gina web de la iniciativa" 1162;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t perform voiding cystourethrogram (VCUG) routinely in first febrile urinary tract infection (UTI) in children aged 2?24 months.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1418;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform needling for encapsulated trabeculectomy filtering blebs";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 139;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer venous thromboembolism (VTE) prophylaxis to patients undergoing upper limb surgery.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 395;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antidepressant medication for the routine management of core symptoms of autism in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 907;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People undergoing anal sphincter repair should not routinely receive a temporary defunctioning stoma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1163;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t routinely screen for prostate cancer using a prostate-specific antigen (PSA) test or digital rectal exam.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"screening, prostate";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1419;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform occlusal adjustment in patients with temporomandibular joint dysfunction";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2955;2;"Choosing Wisely�";"American Society of Plastic Surgeons";English;"Avoid continuing prophylactic antibiotics for greater than 24 hours after a surgical procedure.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Prophylactic Antibiotics";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 140;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fondaparinux sodium is not recommended for use preoperatively for patients undergoing hip fracture surgery";-;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 396;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use anticonvulsants for the management of challenging behaviour in adults with autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 652;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anti-D rhesus prophylaxis to women in certain circumstances";"Women who receive solely medical management for an ectopic pregnancy or miscarriage or have a threatened miscarriage or have a complete miscarriage or have a pregnancy of unknown location.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 908;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"People undergoing anal sphincter repair should not receive constipating agents in the postoperative period and should be allowed to eat and drink as soon as they feel able to.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1164;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t screen adolescents for scoliosis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1420;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to do Porcelain dental crowns";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2956;2;"Choosing Wisely�";"American Society of Plastic Surgeons";English;"Avoid performing plain X-rays in instances of facial trauma.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Facial Trauma";"Link to the recommendation in the Choosing Wisely website" 141;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use people's response to glyceryl trinitrate (GTN) to make a diagnosis [of acute coronary syndrome (ACS)].";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 397;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer antipsychotic medication for psychotic symptoms or mental state changes that are not sufficient for a diagnosis of psychosis or schizophrenia, or to decreasing the risk of psychosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 653;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a Kleihauer test for quantifying feto-maternal haemorrhage.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 909;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pegloticase is not recommended within its marketing authorisation, that is, for treating severe debilitating chronic tophaceous gout in certain adults.*";"*Who may also have erosive joint involvement and in whom xanthine oxidase inhibitors at the maximum medically appropriate dose have failed to normalise serum uric acid, or for whom these medicines are contraindicated.";2012;;;"Low value";-;"Link to the recommendations on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1165;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t require a pelvic exam or other physical exam to prescribe oral contraceptive medications.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the wbesite of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1421;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to recommend liver function tests in patients taking statins";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 2957;2;"Choosing Wisely�";"American Society of Plastic Surgeons";English;"Avoid performing routine and follow-up mammograms of reconstructed breasts after mastectomies.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Reconstructed breasts";"Link to the recommendation in the Choosing Wisely website" 142;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission";"Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to people with oxygen saturation (SpO2) of less than 94% who are not at risk of hypercapnic respiratory failure, aiming for SpO2 of 94% - 98%.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 398;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antipsychotic medication in children and young people with a first presentation of sustained psychotic symptoms should not be started in primary care";"Unless it is done in consultation with a consultant psychiatrist with training in child and adolescent mental health.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 654;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Screening for antisperm antibodies should not be offered because there is no evidence of effective treatment to improve fertility.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 910;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pegaptanib is not recommended for the treatment of wet age-related macular degeneration";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1166;2;"Choosing Wisely�";"American Academy of Hospice and Palliative Medicine";English;"Don?t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1422;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure troponin tests in identifying patients with syncope due to acute myocardial infarction in the Emergency Department";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2958;2;"Choosing Wisely�";"American Society of Plastic Surgeons";English;"Avoid using drains in breast reduction mammaplasty.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Breast reduction";"Link to the recommendation in the Choosing Wisely website" 5774;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"The use of the Pediatric Logistic Organ Dysfunction (PELOD) score is recommended to assist with triage for mechanical ventilation in pediatric patients during a pandemic";"Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU), but these resources may become limited during a pandemic. Methods might be needed to triage patients to allocate access to these resources and this review examined these for pediatric patients. In this systematic review, the authors searched for studies evaluating critical care prognosis and multisystem organ failure scoring systems for children under 18 years of age. They restricted their searches to articles published in English and did these up to February 2010. They identified 22 reports of five independently derived scoring systems for use in a protocol for MV triage in a pandemic. The evidence in the review is that, of the possible scoring systems applicable for the generalized pediatric critical care population, the only score that fulfilled all criteria required for use as a ventilator triage tool for children during a respiratory pandemic is the Pediatric Logistic Organ Dysfunction (PELOD) score.";2012;;;"High value";Diagnosis;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 143;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission.";"Do not routinely administer oxygen, but monitor oxygen saturation using pulse oximetry as soon as possible, ideally before hospital admission. Only offer supplemental oxygen to people with chronic obstructive pulmonary disease who are at risk of hypercapnic respiratory failure, to achieve a target SpO2 of 88% - 92% until blood gas analysis is available.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 399;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a loading dose of antipsychotic medication (often referred to as 'rapid neuroleptisation')";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 655;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine use of post-coital testing of cervical mucus in the investigation of fertility problems is not recommended because it has no predictive value on pregnancy rate.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 911;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patients testing positive for H. pylori should be offered eradication therapy. Re-testing after eradication should not be offered routinely.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1167;2;"Choosing Wisely�";"American Academy of Hospice and Palliative Medicine";English;"Don?t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1423;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to do C-Reactive Protein Tests in patients with infections of the lower respiratory tract";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2959;2;"Choosing Wisely�";"American Society of Plastic Surgeons";English;"Avoid performing routine mammagrams before breast surgery.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Breast Surgery";"Link to the recommendation in the Choosing Wisely website" 144;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"No se recomienda usar marcadores bioqu�micos como el p�ptido natriur�tico y la prote�na C reactiva de alta sensibilidad para el diagn�stico de sindrome coronario agudo";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 400;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not initiate regular combined antipsychotic medication, except for short periods (for example, when changing medication) for pschosis or schizophrenia in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 656;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use any of the following tests individually to predict any outcome of fertility treatment: ovarian volume ovarian blood flow inhibin B oestradiol (E2)";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 912;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pad tests are not recommended in the routine assessment of women with urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1168;2;"Choosing Wisely�";"American Academy of Hospice and Palliative Medicine";English;"Don?t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1424;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine screening for preterm labour";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 145;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use biochemical markers of myocardial ischaemia (such as ischaemia-modified albumin) as opposed to markers of necrosis when assessing people with acute chest pain.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 401;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer counselling and supportive psychotherapy (as specific interventions) to children and young people with psychosis or schizophrenia.";"However, take the child or young person's and their parents' or carers' preferences.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 657;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of basal body temperature charts to confirm ovulation does not reliably predict ovulation and is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 913;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oxcarbazepine should not be recommended for the treatment of neuropathic pain in non-specialist settings.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1169;2;"Choosing Wisely�";"American Academy of Hospice and Palliative Medicine";English;"Don?t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (?ABH?) gel for nausea.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en le p�gina web de la iniciativa" 1425;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform biochemical tests of placental function";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 146;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use magnetic resonance (MR) coronary angiography for diagnosing stable angina.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 402;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adherence therapy (as a specific intervention) to children and young people with psychosis or schizophrenia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 658;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who are concerned about their fertility should not be offered a blood test to measure prolactin.";"This test should only be offered to women who have an ovulatory disorder, galactorrhoea or a pituitary tumour.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 914;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral antihistamines should not be used routinely in the management of atopic eczema in children.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1426;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine blood tests in children with fever";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 147;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use exercise electrocardiogram (ECG) to diagnose or exclude stable angina for people without known coronary artery disease (CAD).";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 403;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer social skills training (as a specific intervention) to children and young people with psychosis or schizophrenia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 659;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women with possible fertility problems are no more likely than the general population to have thyroid disease and the routine measurement of thyroid function should not be offered.";"Estimation of thyroid function should be confined to women with symptoms of thyroid disease";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 915;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In surgical intervention for otitis media with effusion (OME) in children, insertion of ventilation tubes is recommended. Adjuvant adenoidectomy is not recommended.*";"* In the absence of persistent and/or frequent upper respiratory tract symptoms.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1427;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Blood biochemical test is a potential low value intervention in children with dehydration";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 148;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Transmyocardial laser revascularisation (TMLR) for refractory angina pectoris should not be used.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 404;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Pharmacological interventions for psychosis and schizophrenia in children and young people: Do not use targeted, intermittent dosage maintenance strategies routinely.";"However, consider them for children and young people with psychosis or schizophrenia who are unwilling to accept a continuous maintenance regimen or if there is another contraindication to maintenance therapy, such as side-effect sensitivity.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 660;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should not be offered an endometrial biopsy to evaluate the luteal phase as part of the investigation of fertility problems.";"There is no evidence that medical treatment of luteal phase defect improves pregnancy rates";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 916;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"On the balance of its clinical benefits and cost effectiveness, anakinra is not recommended for the treatment of rheumatoid arthritis (RA).*";"*Except in the context of a controlled, long-term clinical study .";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1428;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to offer women the genetic testing for fragile X syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 149;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Percutaneous laser revascularisation (PLR) for refractory angina pectoris should not be used.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 405;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pharmacological interventions to treat social anxiety disorder in children and young people.";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 661;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who are not known to have comorbidities* should be offered hysterosalpingography (HSG) to screen for tubal occlusion because this is a reliable test for ruling out tubal occlusion";"""*Such as pelvic inflammatory disease, previous ectopic pregnancy or endometriosis It is less invasive and makes more efficient use of resources than laparoscopy.""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 917;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Office-based serological tests for H. pylori cannot be recommended because of their inadequate performance.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1429;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to test for thrombophilia genetic mutuations";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 150;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Coronary revascularisation should not be routinely considered in patients with heart failure due to systolic left ventricular impairment, unless they have refractory angina.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 406;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer anticonvulsants, tricyclic antidepressants, benzodiazepines or antipsychotic medication to treat social anxiety disorder in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 662;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women should not be offered hysteroscopy on its own as part of the initial investigation unless clinically indicated because";"The effectiveness of surgical treatment of uterine abnormalities on improving pregnancy rates has not been established.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 918;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ocriplasmin is not effective in patients with ERM.*";"*The use of ocriplasmin in people with vitreomacular traction with an epiretinal membrane, but without a stage II macular hole, is not a cost-effective use of NHS resources.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1430;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to test for diarrhea in children";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 151;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine monitoring of serum digoxin concentrations is not recommended. A measur within 8-12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 407;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer mindfulness-based interventions or supportive therapy to treat social anxiety disorder.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 663;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer sperm washing as part of fertility treatment for men with hepatitis B.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 919;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Occlusive medicated dressings and dry bandages should not be used to treat infected atopic eczema in children.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 152;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use nitric oxide donors to prevent hypertensive disorders during pregnancy.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link tot the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 408;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer St John's wort or other over-the-counter medications and preparations for anxiety to treat social anxiety disorder.";"Because the potential interactions with other prescribed and over-the-counter medications and the lack of evidence to support their safe use.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 664;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men with idiopathic semen abnormalities should not be offered antioestrogens, gonadotrophins, androgens, bromocriptine or kinin-enhancing drugs because they have not been shown to be effective.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 920;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Neuroimaging should not be routinely requested when a diagnosis of idiopathic generalised epilepsy has been made.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1432;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";Spanish;"It is a potential low value intervention to perform preimplantation genetic screening";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 5784;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Telephone follow-up of patients discharged from the hospital is recommended to improve contact with primary care";"The COVID-19 pandemic is placing a great strain on healthcare services. Telephone follow up after discharge from hospital might be used to try to reduce post-discharge emergency department visits and hospital readmissions, and to improve outcomes for patients. In this systematic review, the authors searched for research evaluating the impact of telephone follow-up by people based in primary care on hospital readmissions and emergency department visits after adult patients had been discharged from hospital. They did their search in December 2011. They included 3 randomized trials (1765 participants), all of whom had been discharged from general medicine inpatient units at academic teaching hospitals. Post discharge primary care contact was improved as a result of telephone follow up. None of the studies showed a significant reduction in hospital readmissions or emergency department visits following primary care-based telephone follow up. One study indicated that patients at higher risk of readmission would benefit more from telephone follow up. The core components of an ideal telephone follow-up intervention have not been standardized.";2012;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 153;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend magnesium solely with the aim of preventing hypertensive disorders during pregnancy.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 409;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer botulinum toxin to treat hyperhidrosis (excessive sweating) in people with social anxiety disorder.";"This is because there is no good-quality evidence showing benefit from botulinum toxin in the treatment of social anxiety disorder and it may be harmful.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 665;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men with leucocytes in their semen should not be offered antibiotic treatment unless there is an identified infection because there is no evidence that this improves pregnancy rates.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 921;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Monoamine oxidase inhibitors should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1433;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure mortality markers in patients with end stage renal disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 154;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer pregnant women with uncomplicated chronic hypertension treatment to lower diastolic blood pressure below 80 mmHg.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 410;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer endoscopic thoracic sympathectomy to treat hyperhidrosis or facial blushing in people with social anxiety disorder.";"This is because there is no good-quality evidence showing benefit from endoscopic thoracic sympathectomy in the treatment of social anxiety disorder and it may be harmful.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 666;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Men should not be offered surgery for varicoceles as a form of fertility treatment because it does not improve pregnancy rates.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 922;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Modified-release levodopa preparations should not be used to delay the onset of motor complications in people with early Parkinson's disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1434;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure calcium levels in people with stage 1, 2, 3A or 3B chronic kidney disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 155;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer birth to women with chronic hypertension whose blood pressure is lower than 160/110 mmHg, with or without antihypertensive treatment, before 37 weeks.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup, delivery";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 411;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer computerised cognitive behavioural therapy to treat specific phobias in adults.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 667;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women with polycystic ovary syndrome who are being treated with gonadotrophins should not be offered treatment with gonadotrophin-releasing hormone agonist concomitantly.";"It does not improve pregnancy rates, and it is associated with an increased risk of ovarian hyperstimulation.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 923;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Mineralocorticoids (such as fludrocortisone) should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1435;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure phosphate levels in people with stage 1 2, 3A or 3B chronic kidney disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 156;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer bed rest in hospital as a treatment for gestational hypertension.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 412;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antipsychotics for the management of core features of autism in children and young people.";"Please see paragraph 1.4.10 of this guidance for information relating to the use of anti-psychotics.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 668;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is not recommended the use of adjuvant growth hormone treatment* during ovulation induction in women with polycystic ovary syndrome who do not respond to clomifene citrate";"""*With gonadotrophin-releasing hormone agonist and/or human menopausal gonadotrophin *It is not recommended because it does not improve pregnancy rates.""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 924;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Methylphenidate should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1436;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure parathyroid hormone levels in patients with stage 1, 2, 3A or 3B chronic kidney";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 157;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer birth before 37 weeks to women with gestational hypertension whose blood pressure is lower than 160/110 mmHg, with or without antihypertensive treatment.";.;2012;;;"Low value";"hipertensi�n, hipertensivo, embarazo, preclampsia, eclampsia, parto";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 413;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use antidepressants for the management of core features of autism in children and young people";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 669;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The effectiveness of pulsatile gonadotrophin-releasing hormone in women with clomifene citrate-resistant polycystic ovary is uncertain and is therefore not recommended outside a research context";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 925;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Measurement of serum prolactin is not recommended for the diagnosis of epilepsy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1437;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure vitamin D levels in people with stage 1, 2, 3A or 3B chronic kidney disease.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 158;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women with pre-eclampsia who have given birth and have stepped down from critical care level 2, do not measure fluid balance if creatinine is within the normal range.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup, delivery";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 414;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use anticonvulsants for the management of core features of autism in children and young people";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 670;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Medical treatment (ovarian supression) of minimal and mild endometriosis diagnosed as the cause of infertility in women does not enhance fertility and should not be offered.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 926;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Massage is not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1438;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform chlamydia screening in under 25 yr olds";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

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" 159;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women with chronic hypertension, carry out ultrasound fetal growth and amniotic fluid volume assessment and umbilical artery doppler velocimetry between 28 and 30 weeks and between 32 and 34 weeks.";"In women with chronic hypertension, carry out ultrasound fetal growth and amniotic fluid volume assessment and umbilical artery doppler velocimetry between 28 and 30 weeks and between 32 and 34 weeks. If results are normal, do not repeat at more than 34 weeks, unless otherwise clinically indicated.";2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 415;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use exclusion diets for the management of core features of autism in children and young people";"Exclusion diets such as gluten- or casein-free diets";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 671;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If surgical ablation is used, post-operative medical treatment does not improve pregnancy rates in women with moderate to severe endometriosis and is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 927;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Management of bone metastases varies by primary cancer type.*";"*Prostate cancer: diagnosis and treatment (NICE clinical guideline 58) does not recommend the use of bisphosphonates to prevent or reduce complications of bone metastases in men with hormone refractory prostate cancer. In this patient group, bisphosphonates for pain relief may be considered when other treatments, including analgesics and palliative radiotherapy, have failed.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1439;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform chlamydia screening as a routine antenatal care";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 160;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women with mild or moderate gestational hypertension, carry out an ultrasound and umbilical artery doppler if diagnosis is confirmed at less than 34 weeks If results are normal, do not repeat them";"In women with mild or moderate gestational hypertension, carry out ultrasound fetal growth and amniotic fluid volume assessment and umbilical artery doppler velocimetry if diagnosis is confirmed at less than 34 weeks. If results are normal, do not repeat at more than 34 weeks, unless otherwise clinically indicated.";2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 416;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use neurofeedback to manage speech and language problems in children and young people with autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 672;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer oral ovarian stimulation agents (such as clomifene citrate, anastrozole or letrozole) to women with unexplained infertility.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 928;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance spectroscopy should not be used in the differential diagnosis of parkinsonian syndromes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1440;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform nucleic acid amplification tests diagnosis of Neisseria gonorrhea and Chlamydia trachomatis in patients with rectal infections";"For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"

Enlace a la p�gina web de la iniciativa

" 161;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the results of all fetal monitoring are normal in women with severe gestational hypertension or pre-eclampsia, do not routinely repeat cardiotocography more than weekly.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 417;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use auditory integration training to manage speech and language problems in children and young people with autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 673;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For people with unexplained infertility, mild endometriosis or 'mild male factor infertility', who are having regular unprotected sexual intercourse: do not routinely offer intrauterine insemination";"""Either with or without ovarian stimulation* *Exceptional circumstances include, for example, when people have social, cultural or religious objections to IVF""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 929;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic devices are not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1441;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform urinary protein measurement for complications of preeclampsia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 162;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women with severe gestational hypertension or pre-eclampsia, do not routinely repeat ultrasound or umbilical artery doppler velocimetry more than every 2 weeks.";"In women with severe gestational hypertension or pre-eclampsia, do not routinely repeat ultrasound fetal growth and amniotic fluid volume assessment or umbilical artery doppler velocimetry more than every 2 weeks.";2012;;;"High value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia, followup";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 418;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use omega-3 fatty acids to manage sleep problems in children and young people with autism.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 674;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When using gonadotrophins for ovarian stimulation in in vitro fertilisation treatment: do not use a dosage of follicle-stimulating hormone of more than 450 IU/day.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 930;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Low-grade laser treatment should not be used routinely for musculoskeletal pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1442;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure inflamatory markers to predict stroke";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 163;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not preload women who have severe pre-eclampsia with intravenous fluids before establishing low-dose epidural analgesia and combined spinal epidural analgesia.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 419;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use secretin to manage autism in any context in children and young people";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 675;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer women 'natural cycle' In vitro fertilisation (IVF) treatment";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 931;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Loperamide hydrochloride should not be offered to people with hard or infrequent stools, acute diarrhoea without a diagnosed cause, or an acute flare-up of ulcerative colitis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1443;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure alfa fetoprotein in gastric cancer as a diagnostic tool";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 5795;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Social distancing, general population antiviral prophylaxis plus closure of schools, and antiviral prophylaxis for household contacts plus closure of schools are cost effective for influenza pandemics";"Public health interventions and preparedness strategies are necessary to limit the effect of pandemics such as COVID-19. It is important to know the economic impact of these interventions and the evidence from influenza pandemics might be informative. In this systematic review, the authors searched for research evaluating the cost-effectiveness of interventions to control or prevent the 2009 H1N1 human influenza pandemic or other potential human influenza pandemics. They restricted the search to publications in English, Spanish, German, Thai and Dutch and did the search in September 2011. They included a variety of types of economic evaluation: cost effectiveness analyses (14 studies); cost utility analyses (16); cost benefit analyses (6); combined cost effectiveness and cost benefit analyses (2); combined cost effectiveness and cost utility analysis (1) and partial economic evaluations (5). All but two of the studies were model based, and most (34/44) focused only on pharmaceutical interventions such as using vaccines and antiviral drugs. The combination of pharmaceutical and non-pharmaceutical interventions is relatively cost effective for influenza pandemics, compared to providing vaccines or antiviral drugs. Quarantine of household contacts is unlikely to be cost effective, even for low- and middle-income countries during influenza pandemics. The cost effectiveness of interventions aimed at the general population or targeting specific groups is uncertain for influenza pandemics. None of the included studies evaluated the cost-effectiveness of public hygiene and disinfection measures.";2012;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 164;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use diazepam, phenytoin or lytic cocktail as an alternative to magnesium sulphate in women with eclampsia.";.;2012;;;"Low value";"pregnancy, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 420;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use chelation to manage autism in any context in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 676;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use growth hormone or dehydroepiandrosterone (DHEA) as adjuvant treatment in IVF protocols.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 932;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Long-term, frequent dose, continuous prescription of antacid therapy is inappropriate and only relieves symptoms in the short term rather than preventing them.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1444;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure serum ferritin in women with heavy menstural bleedings";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 165;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use dexamethasone for the treatment of haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome.";.;2012;;;"Low value";"glucocordicoids, gestational hypertension, pre-eclampsia, eclampsia";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 421;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use hyperbaric oxygen therapy to manage autism in any context in children and young people.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 677;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Women who have developed at least 3 follicles before oocyte retrieval should not be offered follicle flushing";"This procedure does not increase the numbers of oocytes retrieved or pregnancy rates, and it increases the duration of oocyte retrieval and associated pain.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 933;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Liraglutide 1.8 mg daily is not recommended for the treatment of people with type 2 diabetes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1445;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure serum ferritin in adults with chronic fatigue syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 166;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not repeat quantification of proteinuria for the for the management of pregnancy with pre-eclampsia";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 422;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a pharmacological intervention to aid sleep unless sleep problems persist despite following the sleep plan";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 678;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Assisted hatching is not recommended because it has not been shown to improve pregnancy rates.";-;2012;;;"Low value";-;"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 934;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Levetiracetam is not cost effective at June 2011 unit costs. Offer levetiracetam, oxcarbazepine or sodium valproate if carbamazepine and lamotrigine are unsuitable or not tolerated.*";"*Provided the acquisition cost of levetiracetam falls to at least 50% of June 2011 value documented in the National Health Service Drug Tariff for England and Wales.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1446;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure female hormone in women with heavy menstural bleeding";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 167;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women who have pre-eclampsia with mild or moderate hypertension, or after step-down from critical care do not repeat liver and renal function test if results are normal at 48-72 hours.";"In women who have pre-eclampsia with mild or moderate hypertension, or after step-down from critical care do not repeat platelet count, transaminases or serum creatinine measurements if results are normal at 48-72 hours.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 423;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use a pharmacological intervention to aid sleep unless sleep problems are having a negative impact on the child or young person and their family or carers.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 679;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Replacement of embryos into a uterine cavity with an endometrium of less than 5 mm thickness is unlikely to result in a pregnancy and is therefore not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 935;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"It is recommended that scleral expansion surgery for presbyopia should not be used.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1447;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform saline infusion sonography in premenopausal women with abnormal uterin bleeding";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 168;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In women with mild or moderate gestational hypertension, do not carry an ultrasound if diagnosis is confirmed after 34 weeks, unless otherwise clinically indicated.";"In women with mild or moderate gestational hypertension, do not carry out ultrasound fetal growth and amniotic fluid volume assessment and umbilical artery doppler velocimetry if diagnosis is confirmed after 34 weeks, unless otherwise clinically indicated.";2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 424;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"High-intensity focused ultrasound and cryotherapy are not recommended for men with locally advanced prostate cancer other than in the context of trials comparing with established interventions";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 680;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"There is insufficient evidence to recommend the use of gamete intrafallopian transfer or zygote intrafallopian transfer* in couples with unexplained fertility problems or male factor fertility problem";"* In preference to IVF";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 936;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In view of the limited evidence available, the use of topical lidocaine as first-line or second-line treatment is not recommended across all neuropathic pain conditions in non-specialist settings.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1448;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to test vitamin B12 for chronique fatigue syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 169;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use progesterone to prevent hypertensive disorders during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 681;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Testing for Y chromosome microdeletions should not be regarded as a routine investigation before intracytoplasmic sperm injection.";"However, it is likely that a significant proportion of male infertility results from abnormalities of genes on the Y chromosome involved in the regulation of spermatogenesis, and couples should be informed of this.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 937;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In view of the limited evidence available, the use of topical capsaicin is not recommended across all neuropathic pain conditions in non-specialist settings.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1449;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform test folate levels for chronique fatigue syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 170;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use diuretics to prevent hypertensive disorders during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 426;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Combined androgen blockade is not recommended as a first-line treatment for men with metastatic prostate cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 938;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In the absence of risk factors [such as diabetes and hypertension], do not use age, gender or ethnicity as risk markers to test people for chronic kidney disease (CKD).*";"*In the absence of metabolic syndrome, diabetes or hypertension, do not use obesity alone as a risk marker to test people for CKD.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1450;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Fasting plasma glucose, random blood glucose, glucose challenge test and urinalysis for glucose are potential low value interventions for screening gestational diabetes";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 171;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use low molecular weight heparin to prevent hypertensive disorders during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 427;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In prostate cancer, repeat cycles of treatment with docetaxel are not recommended if the disease recurs after completion of the planned course of chemotherapy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 683;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform arthroscopic surgery in patients with osteoarthritis";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"artroscopic surgery for knee osteoarthritis";"

Enlace a la p�gina web de la iniciativa

" 939;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In people with anaemia of chronic kidney disease (CKD), androgens should not be used to treat the anaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1451;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure serum cholesterol concentrations in pregnancy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 172;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend folic acid solely with the aim of preventing hypertensive disorders during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 428;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine use of spinal magnetic resonance imaging (MRI) for all men with hormone-refractory prostate cancer and known bone metastases is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 684;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Tension free repair is a potential low value intervention in patients with asymptomatic inguinal hernia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 940;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In otherwise uncomplicated twin pregnancies at term where the presentation of the first twin is cephalic, perinatal morbidity and mortality is increased for the second twin.*";"*However, the effect of planned Caesarian section in improving outcome for the second twin remains uncertain and therefore Caesarian section should not routinely be offered outside a research context.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1452;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform screening for hepatitis C virus in pregnancy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 173;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommendantioxidants (vitamins C and E) solely with the aim of preventing hypertensive disorders during pregnancy.";-;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 429;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The use of bisphosphonates to prevent or reduce the complications of bone metastases in men with hormone-refractory prostate cancer is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 685;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Vertebroplasty is a potential low value intervention to reduce pain in osteoporotic vertebral fractures";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"painful osteoporetic vertebral fractures";"

Enlace a la p�gina web de la iniciativa

" 941;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In asymptomatic women whose urine tests positive for both leucocytes and nitrites, do not offer antibiotics without the results of midstream urine culture.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1453;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform microscopic urine analysis to test for hematuria";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 174;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend fish oils or algal oils solely with the aim of preventing hypertensive disorders during pregnancy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inicaitiva " 686;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a Diskectomy/discectomy in patients with sciatica or lumbar disc herniation";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 942;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Immunostimulants are not recommended for the management of Otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1454;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform IgG) anti-gliadin antibody (AGA) test for Caeliac disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 175;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not recommend garlic solely with the aim of preventing hypertensive disorders during pregnancy.";.;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 687;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is of low value to do Radiofrequency facet joint denervation in patients with low back pain";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 943;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Immediate initiation of statin treatment is not recommended in people with acute stroke .";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1455;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform HLA DQ2/DQ8 testing for Caeliac disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 176;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use betamethasone for the treatment of haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome.";-;2012;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 432;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Imaging is not routinely recommended for men with prostate cancer in whom no radical treatment is intended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 688;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Spinal surgery for preventing metastatic spinal cord compression is a potential low value intervention in patients with spinal metastases without pain or instability.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 944;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Imipramine should not be used for the treatment of urinary (UI) or overactive bladder syndrome (OAB) in women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1456;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to measure bilirubin levels in babies without visible jaundice";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 177;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"An antiarrhythmic drug is not required to maintain sinus rhythm in patients with persistent atrial fibrillation when a precipitant has been corrected and cardioversion has been performed successfully";"An antiarrhythmic drug is not required to maintain sinus rhythm in patients with persistent atrial fibrillation (AF) in whom a precipitant (such as chest infection or fever) has been corrected and cardioversion has been performed successfully, providing there are no risk factors for recurrence.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 433;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Isotope bone scans are not routinely recommended for men with low-risk localised prostate cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 689;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a posterior decompression alone, compared with posterior decompression combineed with stabilisation (usually with posterior pedicle screws) in patients with metastatic spinal cord compression";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 945;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If there are absence or myoclonic seizures, or if JME is suspected, do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1457;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform umbilical cord blood direct antiglobulin test (DAT) (Coombs test)";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 178;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients with atrial fibrilation (AF) of confirmed duration of less than 48 hours undergoing cardioversion, anticoagulation following successful restoration of sinus rhythm is not required.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 434;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Immediate post-operative radiotherapy after radical prostatectomy is not routinely recommended, even in men with margin-positive disease, other than in the context of a clinical trial .";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 690;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform an extrapleural pneumonectomy in patients with untreated malignant pleural mesothelioma";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 946;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If the clinical suspicion of prostate cancer is high*, prostate biopsy for histological confirmation should not be performed, unless this is required as part of a clinical trial.";"*Because of a high prostate-specific antigen (PSA) value and evidence of bone metastases (identified by a positive isotope bone scan or sclerotic metastases on plain radiographs)";2012;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1458;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform urine testing for UTI in children";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 179;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"it is not recommended to use atrioventricular node-blocking agents in people with Wolff-Parkinson-White Syndrome, with non-life-threatening haemodynamic instability, following an atrial fibrilation";"In patients with non-life-threatening haemodynamic instability following the onset of atrial fibrilation (AF), it is recommended that atrioventricular node-blocking agents (for example, diltiazem, verapamil and digoxin) should not be used in people with known Wolff-Parkinson-White syndrome.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 435;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bisphosphonates should not be used to treat spinal pain in patients with vertebral involvement from tumour types other than myeloma, breast cancer or prostate cancer*";"*If conventional analgesia fails or with the intention of preventing metastatic spinal cord compression (MSCC), except as part of a randomised controlled trial.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 691;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform radical prostatectomy comparing with minimally invasive radical prostatectomy in men with prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 947;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If offering surgery for managing voiding lower urinary tract symptoms (LUTS) presumed secondary to benign prostate enlargement (BPE), do not offer minimally invasive treatments as an alternative to ot";"*Minimally invasive treatments (such as transurethral needle ablation [TUNA], transurethral microwave thermotherapy [TUMT], high-intensity focused ultrasound [HIFU], transurethral ethanol ablation of the prostate [TEAP] and laser coagulation) as an alternative to transurethral resection of the prostate (TURP), transurethral vaporisation of the prostate (TUVP) or holmium laser enucleation of the prostate (HoLEP).";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1459;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform frequent monitoring HbA1C levels in diabetic patients";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 180;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients undergoing cardiothoracic surgery, digoxin is not effective in preventing postoperative atrial fibrialtion (AF) and is therefore not recommended for this use.";-;2012;;;"Low value";-;"Link to the recommendation on the website of NICE / Enlace a la recomendaci�n en la p�gina web de la NICE " 436;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patients with asymptomatic spinal metastases should not be offered radiotherapy with the intention of preventing metastatic spinal cord compression (MSCC)*";"*Except as part of a randomised controlled trial.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 692;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform Transurethral resection of the prostate comparing with laser prostatectomy for benign prostatic obstruction";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 948;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Homeopathy is not recommended for the management of otitis media with effusion (OME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1460;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform Chest X-ray for diagnosis of acute coronary syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 181;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Verapamil, diltiazem or short-acting dihydropyridine agents should be avoided for the treatment of co-morbid hypertension and/or angina in patients with heart failure";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 437;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Patients with spinal metastases without pain or instability should not be offered surgery with the intention of preventing metastatic spinal cord compression (MSCC)";"*Except as part of a randomised controlled trial.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 693;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform radical prostatectomy and external beam radiation therapy compared with prostate brachytherapy in selected patients with prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 949;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hand held urinals should not be considered as a routine treatment for urinary incontinence (UI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1461;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform Chest X-ray for preoperative parients";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 182;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cultured human dermis (or equivalent) should not be used in the treatment of foot ulcers because there is a lack of trial evidence on its use.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 438;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Posterior decompression alone should not be performed in patients with metastatic spinal cord compression (MSCC) except in the rare circumstances of isolated epidural tumour or neural arch metastases";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 694;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform radical prostatectomy in patients with early stage prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 950;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Glucocorticoids (such as hydrocortisone) should not be used for the treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1462;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform Chest X-ray for acute respiratory infections";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 183;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Hyperbaric oxygen therapy should not be used in the treatment of foot ulcers because there is a lack of trial evidence on its use.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 439;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"En bloc excisional surgery with the objective of curing the cancer should not be attempted, except in very rare circumstances*";"*For example, confirmed solitary renal or thyroid metastasis following complete staging";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 695;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to do an active surveillance (PSA testing and prostate biopsy) in men with high-risk localised prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 951;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Formal debriefing of the birth experience is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1463;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform Chest X-ray for children with symptoms and signs suggesting pneumonia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 184;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Topical ketanserin or growth factors should not be used in the treatment of foot ulcers because there is a lack of trial evidence on its use.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 440;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Preoperative radiotherapy should not be carried out on patients with metastatic spinal cord compression (MSCC) if surgery is planned.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 696;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform adenoidectomy in children with otitis media with effusion";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 952;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For the small group of women with a clearly defined clinical diagnosis of pure stress urinary incontinence (UI), the use of multi-channel cystometry is not routinely recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1464;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine chest X-rays in children with fever and no features of serious illness";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 441;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform plain radiographs of the spine either to make or to exclude the diagnosis of spinal metastases or metastatic spinal cord compression (MSCC).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 697;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"The Saphenous vein loop graft is a potential low value intervention in haemodialysis patients comparing to femoral vein transposition grafts";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 953;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance imaging (MRI) scanning is not currently indicated as the primary investigation for clinically important brain injury in patients who have sustained a head injury.*";"*For safety, logistic and resource reasons; although it is recognised that additional information of importance to the patient's prognosis can sometimes be detected using MRI.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1465;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform ultrasound in the diagnosis of appendicitis in children";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 186;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer vitamin or fish oil supplements to treat stable angina. Inform people that there is no evidence that they help stable angina.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 442;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients with a previous diagnosis of malignancy, routine imaging of the spine is not recommended if they are asymptomatic.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 698;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a pelvic lymphadenectomy in women with endometrial cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 954;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine magnetic resonance imaging (MRI) scanning should not be performed prior to salvage radiotherapy in men with prostate cancer.*";"*For men with evidence of biochemical relapse following radical treatment and who are considering radical salvage therapy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1466;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine monitoring of bone mineral density within the first 3 years of biphosphonate treatment";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 187;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer anti-anginal drugs other than beta blockers or calcium channel blockers as first-line treatment for stable angina.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 443;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not perform sentinel lymph node biopsy (SLNB) routinely in patients with a preoperative diagnosis of ductal carcinoma in situ (DCIS) who are having breast conserving surgery*";"*Unless they are considered to be at a high risk of invasive disease .";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 699;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform an endovascular repair in patients with infrarenal abdominal aortic aneurysms";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 955;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Following the introduction or dose increase of angiotensin-converting enzyme (ACE) inhibitor/angiotensin-II receptor blockers (ARB), do not modify the dose.*";"*If either the glomerular filtration rate (GFR) decrease from pretreatment baseline is less than 25% or the plasma creatinine increase from baseline is less than 30%.";2012;;;"Low value";"ACE inhibitor, ACEI, ARB";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1467;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform MRI in all men with hormone reftractory prostate cancer and unknown bone metastases";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"magnetic resonance";"

Enlace a la p�gina web de la iniciativa

" 188;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a third anti-anginal drug to people whose stable angina is controlled with two anti-anginal drugs.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 444;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer further axillary treatment to patients found to have only isolated tumour cells in their sentinel lymph nodes. These patients should be regarded as lymph node-negative.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 700;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to insert medial pin in patients with supracondylar humeral fractures";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 956;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fluocinolone acetonide intravitreal implant is not recommended for the treatment of chronic diabetic macular oedema considered insufficiently responsive to available therapies.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1468;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";Spanish;"Mammography of the ipsilateral soft tissues is a potential low value intervention after mastectomy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 189;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer the following interventions to manage stable angina: -transcutaneous electrical nerve stimulation (TENS) -enhanced external counterpulsation (EECP) -acupuncture.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 445;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely assess progesterone receptor status of tumours in patients with invasive breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 701;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use conservative treatment for dorsally displaced fractures of the distal radius in adults";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 957;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Flavoxate should not be used for the treatment of urinary (UI) or overactive bladder syndrome (OAB) in women.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1469;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Intravenous Urography is of low value in comparison to Computed Tomography Urography in detecting urothelial tumors in haematuria patients with urothelial tumors";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 190;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer drugs for the secondary prevention of cardiovascular disease to people with suspected cardiac syndrome X.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 446;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant ovarian ablation/suppression to premenopausal women with estrogen receptor-positive early invasive breast cancer who are being treated with tamoxifen*";"*And, if indicated, chemotherapy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 702;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a very early (within 72 hours after birth) surgical ligation of patent ductus arteriosus in preterm infants";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 958;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Choice treatment in young people with benign epilepsy centrotemporal spikes, Panayiotopoulos syndrome or Gastaut childhood occipital epilepsy Levetiracetam is not cost-effective.*";"*Offer levetiracetam, oxcarbazepine or sodium valproate if carbamazepine and lamotrigine are unsuitable or not tolerated. Provided the acquisition cost of levetiracetam falls to at least 50% of June 2011 value documented in the National Health Service Drug Tariff for England and Wales.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1470;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Formal angiography in patients with lower limb vascular injury may cause an increased amputation rate as a result of delay in treatment. Early recognition of vascular injury is vital for limb salvage. ";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 191;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Relaxation therapies can reduce blood pressure and people may wish to pursue these as part of their treatment. However, routine provision by primary care teams is not currently recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la initiative" 447;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant tamoxifen after breast conserving surgery to patients with ductal carcinoma in situ (DCIS).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 703;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform an endoscopic retrograde cholangiopancreatiography in patients with acute gallstone pancreatitis without cholangitis";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 959;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Exenatide is not recommended for routine use in Type 2 diabetes.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1471;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"CT or MRI are potential low value interventions in primary aldosteronism";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 5567;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - Cuidados Cr�ticos";Spanish;"There are not evidence on Chinese herbs combined with Western medicines reduce the mortality in severe acute respiratory syndrome ";"We did not find evidence of the effectiveness using Chinese herbs compared to Western medicines alone. It is possible that Chinese herbs combined with Western medicines may improve symptoms, quality of life and absorption of pulmonary infiltration, and decrease the corticosteroid dosage for SARS patients. The evidence is weak because of the poor quality of the included trials. Long?term follow?up of these included trials is needed.";2012;;;"Low value";"Treatment Covid-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 192;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer calcium, magnesium or potassium supplements as a method for reducing blood pressure.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 448;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer paclitaxel as an adjuvant treatment for lymph node-positive breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 704;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a total fundoplication in patients with gastroesophageal reflux disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 960;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Escalation of dose of the TNF-a inhibitors above their licensed starting dose is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1472;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine ultrasound in infants and children with uncomplicated UTI";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 193;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Beta-blockers are not a preferred initial therapy for hypertension. However, beta-blockers may be considered in younger people";"Beta-blockers are not a preferred initial therapy for hypertension. However, beta-blockers may be considered in younger people, particularly: -those with an intolerance or contraindication to ACE inhibitors and angiotensin II receptor antagonists or -women of child-bearing potential or -people with evidence of increased sympathetic drive.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 449;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a dual energy x-ray absorptiometry (DEXA) scan to patients with early invasive breast cancer who are receiving tamoxifen alone, regardless of pretreatment menopausal status.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 705;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform an upper airway surgery in patients with obstructive sleep apnoea syndrome";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 961;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Endoscopic treatment Do not use adrenaline as monotherapy for the endoscopic treatment of nonvariceal upper gastrointestinal bleeding.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1473;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform CT or MRI in patients with first episodes of psychosis";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 194;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer intensive insulin therapy to manage hyperglycaemia in patients admitted to hospital for an ACS unless clinically indicated.";"Defining insulin therapy as an intravenous infusion of insulin and glucose with or without potassium and hyperglycaemia as blood glucose above 11.0 mmol/litre";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 450;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer radiotherapy following mastectomy to patients with early invasive breast cancer who are at low risk of local recurrence (for example, most patients who are lymph node-negative).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 706;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform emergency pulpectomy without planning endodontic treatment completion";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 962;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Elucigene FH20 and LIPOchip are not recommended for the confirmation of a clinical diagnosis in people with familial hypercholesterolaemia.*";"*Because greater health benefits can be achieved cost-effectively through the use of comprehensive genetic analysis.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1474;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use soft markers on ultrasonography (at 18 weeks 0 days to 20 weeks 6 days) in Down syndrome screening";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 195;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer oral glucose tolerance tests to patients with hyperglycaemia after ACS and without known diabetes if HbA1c and fasting blood glucose levels are within the normal range.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 451;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant radiotherapy to the axilla or supraclavicular fossa to patients with early breast cancer who have been shown to be histologically lymph node-negative.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 707;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform hysterectomy in patients with heavy menstural bleeding in comparison with pharmaceutical treatments";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 963;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Elucigene FH20 and LIPOchip are not recommended for cascade testing relatives of people with confirmed familial hypercholesterolaemia.*";"*Because targeted sequencing is less expensive and can be used for all relatives with no loss in health benefits.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1475;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to routinely screen cardiac anomalies using nuchal translucency";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 196;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer transdermal patch formulations as first-line maintenance treatment to patients in whom oral opioids are suitable.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 452;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant radiotherapy to the axilla after axillary lymph node dissection (ALND) for early breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 708;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform abdominal hysterectomy for benign gynaecological disease, in comparison to vaginal hysterectomy or laparoscopic hysterectomy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 964;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Eltrombopag is not recommended within its marketing authorisation for the treatment of chronic immune (idiopathic) thrombocytopenic purpura in certain cases.*";"*In splenectomised adults whose condition is refractory to other treatments (for example, corticosteroids, immunoglobulins) or as second-line treatment in non-splenectomised adults where surgery is contraindicated.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1476;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform plain radiographs of the spine for diagnosis of spinal metastases or cord compression";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 197;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer fast-acting fentanyl as first-line rescue medication.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 453;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant radiotherapy to the internal mammary chain to patients with early breast cancer who have had breast surgery.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 709;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a caesarean section without a medical indication";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 965;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electrodermal conductivity should not be done routinely to aid diagnosis.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1477;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine imaging of the spine patients with a previous diagnosis of malignancy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 198;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer pharmacological systemic thrombolytic therapy to patients with Pulmonary Embolism and haemodynamic stability";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 454;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer hormone replacement therapy (HRT) (including oestrogen/progestogen combination) routinely to women with menopausal symptoms and a history of breast cancer*";"*HRT may, in exceptional cases, be offered to women with severe menopausal symptoms and with whom the associated risks have been discussed.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 710;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform a temporary defunctioning stoma in patients requiring anal sphincter repair";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 966;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electro-acupuncture should not be used to treat people with osteoarthritis .";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1478;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform imaging of the upper urinary tract for men with uncomplicated lower urinary tract symptoms";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 199;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer self-management or self-monitoring of INR to patients who have had Deep Vein Thrombosis or Pulmonary Embolism and are having treatment with a vitamin K antagonist (VKA).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 455;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer mammography of the ipsilateral soft tissues after mastectomy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 711;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Intracavity lavage is a potential low value intervention to reduce the risk of surgical site infection";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 967;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electrical stimulation should not routinely be used in the treatment of women with overactive bladder syndrome (OAB).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1223;2;"Choosing Wisely�";"American College of Rheumatology";English;"Don?t prescribe biologics for rheumatoid arthritis before a trial of methotrexate (or other conventional non-biologic DMARDs).";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1479;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform plain abdominal radiograph for idiopathic constipation in children and young people";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 200;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer thrombophilia testing to patients who are continuing anticoagulation treatment.";"Recommendation included in the clinical practice guideline ""Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing"" (NICE CG144)
Review decision date: August 2014
Next review date: June 2016
";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 456;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer ultrasound for routine post-treatment surveillance in patients who have been treated for early invasive breast cancer or ductal carcinoma in situ (DCIS).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 712;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform routine episiotomy in spontaneous vaginal birth";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 968;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electrical stimulation should not routinely be used in combination with pelvic floor muscle training.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1480;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform abdominal ultrasound for the study of idiopathic constipation";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 201;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer thrombophilia testing to patients who have had provoked* Deep Vein Thrombosis or Pulmonary Embolism.";"*""Provoked DVT or PE in a patient with an antecedent (within 3 months) and transient major clinical risk factor for VTE ? for example surgery, trauma, significant immobility (bedbound, unable to walk unaided or likely to spend a substantial proportion of the day in bed or in a chair), pregnancy or puerperium ? or in a patient who is having hormonal therapy (oral contraceptive or hormone replacement therapy).""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 457;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer magnetic resonance imaging (MRI) for routine post-treatment surveillance in patients who have been treated for early invasive breast cancer or ductal carcinoma in situ (DCIS).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 713;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform open total mesorectal excision in patients with primary resectable rectal cancer compared to laparoscopic mesorectal excision";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 969;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"During exchange transfusion do not use albumin priming.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1481;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform exercise electrocardiogram for angina";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 202;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer thrombophilia testing to first-degree relatives of people with a history of Deep Vein Thrombosis or Pulmonary Embolism and thrombophilia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 458;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine use of magnetic resonance imaging (MRI) of the breast is not recommended in the preoperative assessment of patients with biopsy-proven invasive breast cancer or ductal carcinoma in situ (D";-;2012;;;"Low value";DCIS;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 714;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Anal fistula surgery is a potential low value intervention in patients with inflammatory bowel disease";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 970;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"During exchange transfusion do not routinely administer intravenous calcium.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1482;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform PSA testing for screening of prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"screening, prostate";"

Enlace a la p�gina web de la iniciativa

" 459;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tibolone is not recommended for women with menopausal symptoms who have breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 715;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Laparoscopic colposuspension is a potential low value intervention in comparison with open colposuspension in woman with urinary incontinence";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 971;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"During exchange transfusion do not perform a single-volume exchange.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1483;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Holter monitoring (24 hour ECG) is an intervention of low value in young patients with palpitations & history indicating ectopic beats";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 204;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer primary stent placement for treating people with intermittent claudication caused by aorto-iliac disease (except complete occlusion) or femoro-popliteal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inciativa" 460;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Progestogens are not recommended for women with menopausal symptoms who have breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 716;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use scalpel approach to vasectomy in comparison with no scalpel";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 972;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"During conventional blue light phototherapy do not give additional fluids or feeds routinely.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1228;2;"Choosing Wisely�";"American Gastroenterological Association";English;"The follow-up surveillance examination in patients with Barrett?s esophagus with absence of dysplasia on a second endoscopy and biopsy, should not be performed in less than 3 years.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1484;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform cardiac stress testing low risk patients before major surgery";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 205;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer primary stent placement for treating people with critical limb ischaemia caused by aorto-iliac disease (except complete occlusion) or femoro-popliteal disease.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 461;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Soy (isoflavone) is not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 717;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Performing trocar technique thoracostomy solely is a potential low value intervention in comparison to the combination method (surgery and trocar technique)";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 973;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Duloxetine is not recommended as a first-line treatment for women with predominant stress UI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1485;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform cardiotocography Antepartum fetal assessment/Antenatal";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 206;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer chemical sympathectomy to people with critical limb ischaemic pain.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 462;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Red clover is not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 718;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform femoral central vein catheterization in patients requiring long-term intravenous therapy comparing to subclavian access";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 974;2;"Choosing Wisely�";"American Urological Association";English;"A routine bone scan is unnecessary in men with low-risk prostate cancer.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1230;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";"Nutrici�n, alimentaci�n, Alzheimer, feeding, nutrition";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1486;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to diagnosis the primary tumor site in metastatic cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 207;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer wrist and hand splints to people with upper limb weakness after stroke.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 463;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Black cohosh is not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 719;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to use landmark SC approach for central venous cannulation in comparison to use Ultrasound-guided internal jugular technique";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 975;2;"Choosing Wisely�";"American Urological Association";English;"Don?t prescribe testosterone to men with erectile dysfunction who have normal testosterone levels.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la inciativa" 1231;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1487;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform tissue biopsy for patients with advanced breast cancer (ER status)";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 208;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer people with stroke electrical stimulation for their hand and arm.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 464;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Vitamin E is not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 720;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"The use of prophylactic implantable cardioverter defibrillators is a potential low value intervention";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 976;2;"Choosing Wisely�";"American Urological Association";English;"Don?t order creatinine or upper-tract imaging for patients with benign prostatic hyperplasia (BPH).";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1232;2;"Choosing Wisely�";"American Geriatrics Society";English;"Avoid using medications to achieve hemoglobin A1c <7.5% in most adults age 65 and older; moderate control is generally better.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1488;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform tissue biopsy in patients with advanced breast cancer (reassess HER2 status)";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 209;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to determine whether a person is eligible for coronary angiography (with follow-on primary PCI if indicated).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 465;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic devices are not recommended for the treatment of menopausal symptoms in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 721;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"Coronary stenting (angioplasty) is a potential low value intervention in patients with stable angina and in diabetic patients with multivessel disease in comparison to use contemporary medications";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 977;2;"Choosing Wisely�";"American Urological Association";English;"Don?t treat an elevated PSA with antibiotics for patients not experiencing other symptoms.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1233;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1489;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to assess progesterone receptor status of tumors in patients with invasive breast cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 210;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer routine glycoprotein IIb/IIIa inhibitors or fibrinolytic drugs before arrival at the catheter laboratory to people with acute STEMI for whom primary PCI is planned.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 466;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use bone scintigraphy to monitor the response of bone metastases to treatment in women with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 722;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform off-pump bypass";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 978;2;"Choosing Wisely�";"American Urological Association";English;"Don?t perform ultrasound on boys with cryptorchidism.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1234;2;"Choosing Wisely�";"American Geriatrics Society";English;"Don?t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1490;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform rhinomanometry and acoustic rhinometry for evaluation of the nasal airway";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 211;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely use mechanical thrombus extraction during primary PCI for people with acute STEMI.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 467;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use positron emission tomography - computed tomography (PET-CT) to monitor advanced breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 723;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t order sinus computed tomography (CT) or indiscriminately prescribe antibiotics for uncomplicated acute rhinosinusitis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 979;2;"Choosing Wisely�";"Society of Hospital Medicine ? Adult Hospital Medicine";English;"Don?t place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for non-critically ill patients*";"*Acceptable indications: critical illness, obstruction, hospice, perioperatively for <2 days for urologic procedures; use weights instead to monitor diuresis.

For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1491;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";Spanish;"It is a potential low value intervention to perform fluorimetry or endoscopy for assessing dysphagia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 212;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not repeat fibrinolytic therapy for those who have residual ST-segment elevation (suggesting failed coronary reperfusion) on ECG 60-90 mins after administration of fibrinolytic therapy";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 468;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For patients who are receiving treatment with trastuzumab For advanced breast cancer. Do not discontinue trastuzumab if disease progression is within the central nervous system alone*";"*For advanced breast cancer, discontinue treatment with trastuzumab at the time of disease progression outside the central nervous system.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 724;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t routinely do diagnostic testing in patients with chronic urticaria.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 980;2;"Choosing Wisely�";"Society of Hospital Medicine ? Adult Hospital Medicine";English;"""Don?t prescribe medications for stress ulcer prophylaxis to medical inpatients unless at high risk for GI complications.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1492;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform upper endoscopy or endoscopy for assessing dysphagia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 213;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use compression bandaging or hosiery for more than 7 days after interventional treatment.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 469;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with 5-fluorouracil plus folinic acid, with or without irinotecan, is not recommended for the first-line treatment of metastatic colorectal cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 725;2;"Choosing Wisely�";"American Academy of Allergy, Asthma & Immunology";English;"Don?t recommend replacement immunoglobulin therapy for recurrent infections unless impaired antibody responses to vaccines are demonstrated.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"http://www.choosingwisely.org/doctor-patient-lists/" 981;2;"Choosing Wisely�";"Society of Hospital Medicine ? Adult Hospital Medicine";English;"""Avoid transfusions of red blood cells for arbitrary hemoglobin or hematocrit thresholds and in the absence of symptoms of active coronary disease, heart failure or stroke.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1493;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform auditory brainstem responses for diagnosing Chronic fatigue syndrome/myalgic encephalomyelitis";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 214;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer compression hosiery to treat varicose veins unless interventional treatment is unsuitable. Note that advice differs in pregnancy";-;2012;;;"Low value";-;"Link to the recommendation of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 470;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fludarabine monotherapy, within its licensed indication, is not recommended for the first-line treatment of chronic lymphocytic leukaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 726;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t routinely prescribe antibiotics for acute mild-to-moderate sinusitis unless symptoms last for seven or more days, or symptoms worsen after initial clinical improvement.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"http://www.choosingwisely.org/doctor-patient-lists/" 982;2;"Choosing Wisely�";"Society of Hospital Medicine ? Adult Hospital Medicine";English;"Don?t order continuous telemetry monitoring outside of the ICU without using a protocol that governs continuation.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1494;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to test fetal blood samples as intrapartum care of healthy women and their babies";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 215;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not carry out interventional treatment for varicose veins during pregnancy other than in exceptional circumstances.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 471;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cetuximab in combination with platinum-based chemotherapy is not recommended for the treatment of recurrent and/or metastatic squamous cell cancer of the head and neck.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 727;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 983;2;"Choosing Wisely�";"Society of Hospital Medicine ? Adult Hospital Medicine";English;"Don?t perform repetitive complete blood count and chemistry testing in the face of clinical and lab stability.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1495;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is of low value to perform measure umbilical cord blood bilirubin level to predict significant hyperbilirubinaemia.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 216;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform stress cardiac imaging or advanced non-invasive imaging in the initial evaluation of patients without cardiac symptoms unless high-risk markers are present.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 472;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab, sorafenib and temsirolimus are not recommended as first-line treatment options for people with advanced and/or metastatic renal cell carcinoma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 728;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1496;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform CT in men with low or intermediate risk of prostate cancer";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 217;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform annual stress cardiac imaging or advanced non-invasive imaging as part of routine follow-up in asymptomatic patients.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 473;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sorafenib and sunitinib are not recommended as second-line treatment options for people with advanced and/or metastatic renal cell carcinoma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 729;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Don?t schedule elective, non-medically indicated inductions of labor or Cesarean deliveries before 39 weeks, 0 days gestational age.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 985;2;"Choosing Wisely�";"Society of Hospital Medicine. Pediatric Hospital Medicine";English;"Don?t routinely use bronchodilators in children with bronchiolitis.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1497;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform sentinel lymph node biopsy as a part of preoperative diagnosis of ductal carcinoma in situ";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 218;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform stress cardiac imaging or advanced non-invasive imaging as a pre-operative assessment in patients scheduled to undergo low-risk non-cardiac surgery.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 474;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Sorafenib is not recommended for the treatment of advanced hepatocellular carcinoma in patients for whom surgical or locoregional therapies have failed or are not suitable.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 730;2;"Choosing Wisely�";"American Academy of Family Physicians";English;"Avoid elective, non-medically indicated inductions of labor between 39 weeks, 0 days and 41 weeks, 0 days unless the cervix is deemed favorable.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 986;2;"Choosing Wisely�";"Society of Hospital Medicine. Pediatric Hospital Medicine";English;"Don?t use systemic corticosteroids in children under 2 years of age with an uncomplicated lower respiratory tract infection.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1498;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform urinary flow-rate measurement for men with urinary tract symptoms";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 219;2;"Choosing Wisely�";"American College of Cardiology";English;"Don?t perform stenting of non-culprit lesions during percutaneous coronary intervention (PCI) for uncomplicated hemodynamically stable ST-segment elevation myocardial infarction (STEMI).";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"http://www.choosingwisely.org/wp-content/uploads/2013/02/Choosing-Wisely-Master-List.pdf" 475;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not carry out upper or lower gastrointestinal (GI) endoscopy in patients with malignancy of undefined primary origin (MUO) unless the symptoms, histology or radiology suggest a GI primary tumour.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 987;2;"Choosing Wisely�";"Society of Hospital Medicine. Pediatric Hospital Medicine";English;"Don?t treat gastroesophageal reflux in infants routinely with acid suppression therapy.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1499;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform fecal occult blood screening in comparison to Fecal DNA screening";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 476;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer mammography routinely to women presenting with malignancy of undefined primary origin (MUO), unless clinical or pathological features are compatible with breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 988;2;"Choosing Wisely�";"Society of Hospital Medicine. Pediatric Hospital Medicine";English;"Don?t use continuous pulse oximetry routinely in children with acute respiratory illness unless they are on supplemental oxygen.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1500;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform transit studies for idiopathic constipation";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 477;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use gene-expression-based profiling to identify primary tumours in patients with provisional carcinoma of unknown primary origin (CUP).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 989;2;"Choosing Wisely�";"Society of Nuclear Medicine and Molecular Imaging";English;"Don?t use PET/CT for cancer screening in healthy individuals.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 478;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer further investigations to identify the primary site of origin of the malignancy to patients who are unfit for treatment.";-;2012;;;"Low value";"cancer, neoplasia, neoplasms";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 990;2;"Choosing Wisely�";"Society of Nuclear Medicine and Molecular Imaging";English;"""Don?t perform routine annual stress testing after coronary artery revascularization.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 479;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use gene-expression-based profiling when deciding which treatment to offer patients with confirmed carcinoma of unknown primary origin (CUP).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 991;2;"Choosing Wisely�";"Society of Nuclear Medicine and Molecular Imaging";English;"""Don?t use nuclear medicine thyroid scans to evaluate thyroid nodules in patients with normal thyroid gland function.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 480;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer chemotherapy to patients with brain metastases of unknown primary origin except as part of a controlled clinical trial.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the inititiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 992;2;"Choosing Wisely�";"Society of Nuclear Medicine and Molecular Imaging";English;"""Avoid using a computed tomography angiogram to diagnose pulmonary embolism in young women with a normal chest radiograph; consider a radionuclide lung study (?V/Q study?) instead.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 481;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Imatinib is not recommended for the adjuvant treatment of gastrointestinal stromal tumours (GISTs) after surgery.";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 993;2;"Choosing Wisely�";"Society of Nuclear Medicine and Molecular Imaging";English;"Don?t use PET imaging in the evaluation of patients with dementia unless the patient has been assessed by a specialist in this field.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 482;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Ofatumumab is not recommended for the treatment of chronic lymphocytic leukaemia that is refractory to fludarabine and alemtuzumab.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 994;2;"Choosing Wisely�";"The Society of Thoracic Surgeons";English;"""Patients who have no cardiac history and good functional status do not require preoperative stress testing prior to non-cardiac thoracic surgery.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 483;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Imatinib at 600 or 800 mg/day is not recommended for people with unresectable and/or metastatic gastrointestinal stromal tumours whose disease has progressed after treatment with 400 mg/day imatinib.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 995;2;"Choosing Wisely�";"The Society of Thoracic Surgeons";English;"""Don?t initiate routine evaluation of carotid artery disease prior to cardiac surgery in the absence of symptoms or other high-risk criteria.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 228;2;"Choosing Wisely�";"American Society of Nuclear Cardiology";English;"Don?t perform cardiac imaging as a pre-operative assessment in patients scheduled to undergo low- or intermediate-risk non-cardiac surgery.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 484;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine is not recommended for the treatment of metastatic colorectal cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 996;2;"Choosing Wisely�";"The Society of Thoracic Surgeons";English;"""Don?t perform a routine pre-discharge echocardiogram after cardiac valve replacement surgery.""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 485;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with a taxane is not recommended for the first-line treatment of metastatic breast cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 997;2;"Choosing Wisely�";"American Society of Nephrology";English;"Don?t perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 486;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Everolimus is not recommended for the second-line treatment of advanced renal cell carcinoma.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 998;2;"Choosing Wisely�";"American Society of Nephrology";English;"Don?t administer erythropoiesis-stimulating agents to chronic kidney disease patients with hemoglobin levels greater than or equal to 10 g/dL without symptoms of anemia.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 487;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Trabectedin in combination with pegylated liposomal doxorubicin hydrochloride (PLDH) is not recommended for the treatment of women with relapsed platinum-sensitive ovarian cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 999;2;"Choosing Wisely�";"American Society of Nephrology";English;"Avoid nonsteroidal anti-in?ammatory drugs (NSAIDS) in individuals with hypertension or heart failure or CKD of all causes, including diabetes.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 488;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use Magnetic Resonance Imaging (MRI) routinely for assessing women with suspected ovarian cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1000;2;"Choosing Wisely�";"American Society of Nephrology";English;"Don?t place peripherally inserted central catheters (PICC) in stage III?V CKD patients without consulting nephrology.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 489;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not include systematic retroperitoneal lymphadenectomy* as part of standard surgical treatment in women with suspected ovarian cancer whose disease appears to be confined to the ovaries (1).";"""*Block dissection of lymph nodes from the pelvic side walls to the level of the renal veins (1) That is, who appear to have stage I disease""";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1001;2;"Choosing Wisely�";"American Society of Nephrology";English;"Don?t initiate chronic dialysis without ensuring a shared decision making process between patients, their families, and their physicians.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 490;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer adjuvant chemotherapy to women with ovarian cancer who have had optimal surgical staging and have low-risk stage I disease (grade 1 or 2, stage Ia or Ib).";-;2012;;;"Low value";-;"Link tot he recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1002;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer anterior colporrhaphy, needle suspensions, paravaginal defect repair or the Marshall Marchetti Krantz procedure for the treatment of stress urinary incontinence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1514;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform spirometry for COPD screening";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 491;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer preoperative chemoradiotherapy solely to facilitate sphincter-sparing surgery to patients with rectal cancer.";-;2012;;;"Low value";"Chemotherapy, Radiotherapy, Cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de iniciativa" 1003;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Based on limited clinical evidence, combination testing with IgA tTGA and IgA EMA does not appear to substantially to improve accuracy in the diagnostic process.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1515;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to recommend social skills training to patients with schizophrenia";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 492;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not place self-expanding metallic stents: in low rectal lesions or to relieve right-sided colonic obstruction or if there is clinical or radiological evidence of colonic perforation or peritonitis.";-;2012;;;"Low value";-;"Link to the recommendation in the Do not Do NICE website" 1004;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with juvenile myoclonic epilepsy (JME) Do not offer carbamazepine, gabapentin, oxcarbazepine, phenytoin, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1516;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to recommend hospitalization for patients who have had multiple pregancies.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 493;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not dilate the tumour before inserting the self-expanding metallic stent in patients with colorectal cancer.";-;2012;;;"Low value";"Stent, Cancer";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1005;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjunctive treatment in children, young people and adults with Lennox Gastaut syndrome Do not offer carbamazepine, gabapentin, oxcarbazepine, pregabalin, tiagabine or vigabatrin.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1517;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is of low value to perform a routine daily chest radiographs in intensive care";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 494;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"If intracranial disease is suspected, offer contrast-enhanced MRI of the brain. Do not offer imaging of the head, neck and limbs unless involvement of these sites is suspected clinically.";-;2012;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1006;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"[Do not use] deamidated gliadin tests and point-of-care tests or self tests [until supported by further evidence].";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 495;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Fulvestrant is not recommended*, as an alternative to aromatase inhibitors for the treatment of oestrogen-receptorpositive, locally advanced or metastatic breast cancer in postmenopausal women(1)";"*Within its licensed indication. (1)Women whose cancer has relapsed on or after adjuvant anti-oestrogen therapy, or who have disease progression on anti-oestrogen therapy.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1007;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Oxycodone should not be started in non-specialist settings without an assessment by a specialist pain service or a condition-specific service.*";"*Clinicians in non-specialist settings have very different levels of experience in prescribing and managing the long-term use of oxycodone.";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 240;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Infants and children with an alternative site of infection should not have a urine sample tested.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 496;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"In patients with non-melanoma skin cancer, the case for routine use of Ambulight PDT in achieving a more efficient service is not supported by the evidence submitted by the manufacturer.";-;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1008;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Morphine should not be started in non-specialist settings without an assessment by a specialist pain service or a condition-specific service.*";"*Clinicians in non-specialist settings have very different levels of experience in prescribing and managing the long-term use of morphine. Therefore";2012;;;"Low value";-;"Link to the recommendation in the NICE website" 5616;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - cuidados cr�ticos (tratamiento farmacol�gico)";Spanish;"No survival benefit or clinical efficacy was demonstrated in empirical coverage of atypical pathogens in hospitalized patients with community-acquired pneumonia.";"No survival or clinical efficacy benefit was demonstrated in empirical coverage of atypical pathogens in hospitalized patients with CAP. This conclusion mainly refers to the comparison of quinolone monotherapy versus beta-lactams. More trials should be conducted comparing beta-lactam monotherapy with the same monotherapy combined with a macrolide.";2012;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 241;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"C-reactive protein alone should not be used to differentiate acute pyelonephritis/upper urinary tract infection from cystitis/lower urinary tract infection in infants and children";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 497;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cetuximab monotherapy or combination chemotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has progressed after first-line chemotherapy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1009;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer a conventional glucocorticosteroid or budesonide to maintain remission.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 242;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Asymptomatic bacteriuria in infants and children should not be treated with antibiotics.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 498;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with non-oxaliplatin* chemotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has progressed after first-line chemotherapy.";*fluoropyrimidine-based;2012;;;"Low value";-;"Link to the recommendation in the NICE website" 1010;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer botulinum toxin B to women with proven detrusor overactivity.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2034;6;"Less Is More Collection - JAMA Network";"Leach R, et al. Arch Intern Med. 2012;172(11):835-836.";English;"Don't forget that, there is not a consensus approach to the potential use of PSA testing. Solution to the problems encountered with PSA testing is not yet insight.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 243;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotic prophylaxis should not be routinely recommended in infants and children following first-time urinary tract infection (UTI).";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 499;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Panitumumab monotherapy is not recommended for the treatment of people with metastatic colorectal cancer that has progressed after first-line chemotherapy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1011;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use volume expansion in women with severe pre-eclampsia unless hydralazine is the antenatal antihypertensive.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2035;6;"Less Is More Collection - JAMA Network";"Harb S, et al. Arch Intern Med. 2012;172(11):854-861.";English;"Appropriateness of exercise echocardiography after coronary revascularization in asymptomatic patients must be carefully reviewed and depends on the timing relative intervention.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 244;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Asymptomatic bacteriuria in infants and children should not be treated with prophylactic antibiotics.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 500;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dasatinib is not recommended for the treatment of chronic, accelerated or blast-crisis phase chronic myeloid leukaemia in adults with imatinib intolerance or resistance to standard-dose of imatinib.";-;2012;;;"Low value";CML;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1012;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use venlafaxine to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2036;6;"Less Is More Collection - JAMA Network";"Prasad V, et al. Arch Intern Med. 2012;172(12):955-958.";English;"The Diagnosis and Treatment of Pulmonary Embolism: A Metaphor for Medicine in the Evidence-Based Medicine Era";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 245;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Infants and children who do not undergo imaging investigations should not routinely be followed up";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 501;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"High-dose imatinib is not recommended for the treatment of chronic, accelerated or blast-crisis phase Philadelphia-chromosome-positive chronic myeloid leukaemia that is resistant to standard-dose";-;2012;;;"Low value";CML;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1013;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use umbilical cord blood direct antiglobulin test (DAT) (Coombs test) to predict significant hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2037;6;"Less Is More Collection - JAMA Network";"Benjamin M, et al. Arch Intern Med. 2012;172(12):906";English;"What the Surgeon Should Have Said to My Patient With Thin Malignant Melanoma";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3061;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend blood pressure measurement at all appropriate primary care visits*. (Strong recommendation; moderate quality evidence)";"*?Appropriate? visits may include new patient visits, periodic health exams; urgent office visits for neurological or cardiovascular related issues, medication renewal visits, and other visits where the Primary Care Practitioner deems it an appropriate opportunity to monitor blood pressure. It is not necessary to measure blood pressure on every patient at every office visit if not clinically indicated.

**The frequency and timing of blood pressure screening may vary between patients. The risk of high blood pressure and the risk of stroke or heart disease change over a person?s natural lifespan and increases with age, comorbidities, and the presence of other risk factors. Therefore appropriate screening frequency may increase accordingly, especially in patients with more than one vascular risk factor. Adults identified as belonging to a high-risk ethnic group (South Asian, Aboriginal, African ancestry) may benefit from more frequent monitoring. Having recent consistently normal blood pressure measurements may decrease the need for monitoring, whereas a tendency toward high-normal blood pressure could indicate that more frequent monitoring is needed.

For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 246;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Infants and children who are asymptomatic following an episode of urinary tract infection (UTI) should not routinely have their urine re-tested for infection.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 502;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Eribulin is not recommended* for the treatment of locally advanced or metastatic breast cancer that has progressed after at least two chemotherapy regimens for advanced disease.";"*Within its licensed indication";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1014;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use umbilical cord blood bilirubin level to predict significant hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2038;6;"Less Is More Collection - JAMA Network";"Goldberger Z, et al. Arch Intern Med. 2012;172(14):1106-1107.";English;"ICDs?Increasingly Complex Decisions: Comment on ?Patient Preference in the Decision to Place Implantable Cardioverter-Defibrillators""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3062;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"We recommend that blood pressure be measured according to the current techniques described in the Canadian Hypertension Education Program CHEP recommendations for office and out-of-office (ambulatory) blood pressure measurement. (Strong recommendation; mo";"For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 247;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Urine-testing strategies for children 3 years or older: If leukocyte esterase is positive and nitrite is negative, a urine sample should be sent for microscopy and culture.";"Antibiotic treatment for urinary tract infection (UTI) should not be started unless there is good clinical evidence of UTI (for example, obvious urinary symptoms). Leukocyte esterase may be indicative of an infection outside the urinary tract which may need to be managed differently.";2012;;;"High value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 503;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Dasatinib is not recommended for the first-line treatment of chronic phase Philadelphia-chromosome-positive CML.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1015;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use ultrasound for the routine assessment of women with urinary incontinence other than for the assessment of residual urine volume.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2039;6;"Less Is More Collection - JAMA Network";"Kirch R, et al. Arch Intern Med. 2012;172(15):1170-1172";English;"Palliative Care and Quality of Life: Patient-Centered Care Case Study";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3063;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For people who are found to have an elevated blood pressure during screening, the CHEP criteria for assessment and diagnosis of hypertension should be applied to determine whether the patient meets diagnostic criteria for hypertension. (Strong recommendat";"For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 248;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Infants and children with a minor, unilateral renal parenchymal defect do not need long-term follow-up unless they have recurrent urinary tract infection or family history or lifestyle risk factors fo";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 504;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Cabazitaxel in combination with prednisone or prednisolone is not recommended for the treatment of hormone-refractory metastatic prostate cancer previously treated with a docetaxel-containing regimen.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1016;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use transit studies to make a diagnosis of idiopathic constipation.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2040;6;"Less Is More Collection - JAMA Network";"Meier D, et al. Arch Intern Med. 2012;172(15):1130.";English;"Pain as a Cause of Agitated Delirium";"For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3064;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults at low to moderate risk of diabetes (determined with a validated risk calculator*), we recommend not routinely screening for type 2 diabetes. (Weak recommendation; low-quality evidence)";"*Risk calculation for 10-year risk for diabetes:

Low Risk
1 � 100 to 1 � 25 = 1% to 4%

Moderate Risk
1 � 6 = 17%

High Risk
1 � 3 = 33%

Very High Risk
1 � 2 = 50%

For adults ? 18 years of age, we suggest risk calculation at least every 3?5 years (when risk factors exist (e.g., obesity & hypertension).

FINDRISC (the Finnish Diabetes Risk Score) has been selected as the preferred validated risk calculator, but CANRISK (the Canadian Diabetes Risk Questionnaire) is an acceptable alternative. Factors considered in FINDRISC and CANRISK are age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables. The CANRISK questionnaire can be found on the CTFPHC website or on the PHAC website.

For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 249;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The routine use of imaging in the localisation of a urinary tract infection (UTI) is not recommended.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 505;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer transdermal patch formulations as first-line maintenance treatment to patients in whom oral opioids are suitable.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1017;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use tramadol to treat neuropathic pain for long-term use in non-specialist settings, unless advised by a specialist to do so. For short-term use, see recommendation 1.1.10.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2041;6;"Less Is More Collection - JAMA Network";"Rickert J, et al. Arch Intern Med. 2012;172(15):1129";English;"Overtreatment situations. ""Quiet Caring""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3065;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults at high risk of diabetes (determined with a validated risk calculator*), we recommend routinely screening every 3?5 years with A1C** (Weak recommendation; low-quality evidence)";"*Risk calculation for 10-year risk for diabetes:

Low Risk
1 � 100 to 1 � 25 = 1% to 4%

Moderate Risk
1 � 6 = 17%

High Risk
1 � 3 = 33%

Very High Risk
1 � 2 = 50%

For adults ? 18 years of age, we suggest risk calculation at least every 3?5 years (when risk factors exist (e.g., obesity & hypertension).

FINDRISC (the Finnish Diabetes Risk Score) has been selected as the preferred validated risk calculator, but CANRISK (the Canadian Diabetes Risk Questionnaire) is an acceptable alternative. Factors considered in FINDRISC and CANRISK are age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables. The CANRISK questionnaire can be found on the CTFPHC website or on the PHAC website.

**A1C has been selected as the preferred blood test, but fasting glucose measurement and the oral glucose tolerance test are acceptable alternatives. An A1C level of 6.5% or greater is recommended as the threshold for diagnosing diabetes, but values less than 6.5% do not exclude diabetes diagnosed using glucose tests. A1C should be measured using a standardized, validated assay.

For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 250;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For infants and children aged 6m and older with first-time urinary tract infection that responds to treatment, routine ultrasound is not recommended unless the infant or child has atypical infection";"Atypical UTI (seriously ill; poor urine flow; abdominal or bladder mass; raised creatinine; septicaemia; fails to respond to treatment with suitable antibiotics within 48 hours; infection with non-E. coli organisms).";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 506;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer fast-acting fentanyl as first-line rescue medication.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1018;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use traditional Chinese medicine to treat hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2042;6;"Less Is More Collection - JAMA Network";"Wielawski I, et al. Arch Intern Med. 2012;172(15):1131.";English;"Overdiagnosis and overtreatment situations: ""My Mother the Gardener""";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3066;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For adults at very high risk of diabetes (determined with a validated risk calculator*), we recommend routine screening annually with A1C** (Weak recommendation; low-quality evidence)";"*Risk calculation for 10-year risk for diabetes:

Low Risk
1 � 100 to 1 � 25 = 1% to 4%

Moderate Risk
1 � 6 = 17%

High Risk
1 � 3 = 33%

Very High Risk
1 � 2 = 50%

For adults ? 18 years of age, we suggest risk calculation at least every 3?5 years (when risk factors exist (e.g., obesity & hypertension).

FINDRISC (the Finnish Diabetes Risk Score) has been selected as the preferred validated risk calculator, but CANRISK (the Canadian Diabetes Risk Questionnaire) is an acceptable alternative. Factors considered in FINDRISC and CANRISK are age, obesity, history of elevated glucose levels, history of hypertension, family history of diabetes, limited activity levels, and diet with limited intake of fruits and vegetables. The CANRISK questionnaire can be found on the CTFPHC website or on the PHAC website.

**A1C has been selected as the preferred blood test, but fasting glucose measurement and the oral glucose tolerance test are acceptable alternatives. An A1C level of 6.5% or greater is recommended as the threshold for diagnosing diabetes, but values less than 6.5% do not exclude diabetes diagnosed using glucose tests. A1C should be measured using a standardized, validated assay.

For further information please visit the website of the initiative (link below)";2012;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 251;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine imaging to identify vesicoureteric reflux (VUR) is not recommended for infants and children who have had a urinary tract infection (UTI), except in specific circumstances.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 507;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Lapatinib in combination with an aromatase inhibitor is not recommended for first-line treatment in postmenopausal women with metastatic hormonereceptor- positive breast cancer that overexpresses HER2";-;2012;;;"Low value";"human epidermal growth factor receptor 2";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1019;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use topiramate to treat neuropathic pain in non-specialist settings, unless advised by a specialist to do so.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2043;6;"Less Is More Collection - JAMA Network";"Larson E, et al. Arch Intern Med. 2012;172(15):1132.";English;"Overtreatment situations: ?My Mother Was 67 . . . ?";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 252;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Surgical management of vesicoureteric reflux (VUR) is not routinely recommended";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 508;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Trastuzumab in combination with aromatase inhibitors is not recommended for first-line treatment in postmenopausal women with metastatic hormonereceptor positive breast cancer that overexpresses HER2";-;2012;;;"Low value";"Human epidermal growth factor receptor 2";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1020;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the vega test in the diagnosis of food allergy.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 2044;6;"Less Is More Collection - JAMA Network";"Howard D, et al. Arch Intern Med. 2012;172(16):1267-1268.";English;"Don't perform prostate cancer screening for men 75 years and older with PSA test.";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 253;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"When results are normal, a follow-up outpatient appointment is not routinely required.";"Parents or carers should be informed of the results of all the investigations in writing.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 509;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bevacizumab in combination with capecitabine is not recommended within its marketing authorisation for 'first-line treatment of patients with metastatic breast cancer (1)";"(1) In whom treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate, or when taxanes or anthracyclines have been used as part of adjuvant treatment within the past 12 months'.";2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1021;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the Q-tip, Bonney, Marshall and Fluid-Bridge tests in the assessment of women with urinary incontenence.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1277;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform dilation and curettage for missed abortion";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 2045;6;"Less Is More Collection - JAMA Network";"Pogach L, et al. Arch Intern Med. 2012;172(19):1510-1512";English;"The Other Side of Quality Improvement in Diabetes for Seniors: A Proposal for an Overtreatment Glycemic Measure";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 254;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use topical antimicrobial agents for surgical wounds that are healing by primary intention to reduce the risk of surgical site infection.";-;2012;;;"Low value";-;"Link to the recommendation oon the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 510;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"For further assessment of neutropenic sepsis, after completing the initial clinical assessment try to identify the underlying cause. Do not perform a chest X-ray unless clinically indicated";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1022;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use the albumin/bilirubin ratio when making decisions about the management of hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1278;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";English;"It is a potential low value intervention to perform dilatation and curettage as a diagnostic tool OR therapeutic treatment";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 255;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use Eusol and gauze to manage surgical wounds that are healing by secondary intention.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 511;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Denosumab is not recommended for preventing skeletal-related events in adults with bone metastases from prostate cancer.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1023;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use sunlight as treatment for hyperbilirubinaemia.";-;2012;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 1279;7;"Elshaug, et al. article: Over 150 potentially low-value health care practices: an Australian study. ";"Comprehensive Management Framework (CMF) for the Australia's Medicare Benefits Schedule (MBS)";Spanish;"In patients with patients with early invasive breast cancer at low risk of local recurrence it is a potential low value intervention to offer radiotherapy";"For further information please visit the website of the initiative (link below)";2012;;;"Low value";-;"

Enlace a la p�gina web de la iniciativa

" 10;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended to switch the administration of paracetamol/acetaminophen to orally from intravenously as soon as possible in inpatients, in order to reduce the time of intravenous administration.";"It is recommend to use oral instead of intravenous administration of paracetamol/acetaminophen as soon as the patient starts eating or taking medications, unless there is a contraindication, which should be stated explicitly in the respective medical record.";2011;;;"High value";"Acetaminophen, analgesia, analgesic, painkiller, intravenous, oral, pain, administratio";"http://www.dianasalud.com/docs/ResumenPARACETAMOL.pdf" 11;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is not recommended to use more than three lines of treatment in patients with advanced colorectal cancer.";"In the treatment of patients with advanced colorectal cancer, it is not recommended to use more than two combinations of chemotherapy and two biological agents, distributed between one and three lines of treatment. A fourth line should be administered exceptionally. The oncologist should evaluate the clinical circumstances and preferences of each patient when establishing the best therapeutic sequence.";2011;;;"Low value";"cancer, colorectal, advanced cancer, chemotherapy, line, biological, biological";"http://www.dianasalud.com/docs/ResumenCANCERCOLORECTAL.pdf" 13;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommend using only one to three lines of treatment in patients with advanced multiple myeloma.";"In patients with advanced multiple myeloma, it is recommended first-line chemotherapy (Vincristine, Carmustine, Melphalan, Cyclophosphamide and prednisone alternating with Vincristine, Carmustine, Doxorubicin, Dexamethasone, VBCMP / VBAD) and two cycles of bortezomib. In the second-line treatment after first relapse, it is recommended again bortezomib, and the next relapse, in third-line therapy, administered lenalidomide.";2011;;;"High value";"multiple myeloma, Vincristine, Carmustine, Melphalan, Cyclophosphamide, Doxorubicin, Bortezomib";"http://www.dianasalud.com/docs/ResumenMIELOMAAFAVOR.pdf" 14;4;"Iniciativa MAPAC (Mejorar la Adecuaci�n de la Pr�ctica Asistencial y Cl�nica)";"Hospital de Sant Pau";Spanish;"It is recommended not to use lenalidomide until the third line in the treatment of patients with advanced multiple myeloma.";"In patients with advanced multiple myeloma, it is recommended first-line chemotherapy (Vincristine, Carmustine, Melphalan, Cyclophosphamide and prednisone alternating with Vincristine, Carmustine, Doxorubicin, Dexamethasone, VBCMP / VBAD) and two cycles of bortezomib, and the second-line treatment after first relapse, it is recommended again bortezomib. The Lenalidomide only manage third line after the second relapse. It also states that in responding patients after 12 cycles of lenalidomide treatment stop, instead of continuing to progression of the disease.";2011;;;"Low value";"multiple myeloma, lenalidomide, Vincristine, Carmustine, Melphalan, Cyclophosphamide, Bortezomib";"http://www.dianasalud.com/docs/ResumenMIELOMAENCONTRA.pdf" 795;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Analgesia: Non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended as pain relief for patients with hip fracture.";-;2011;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 3116;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antenatal interventions for fetomaternal alloimmune thrombocytopenia";-;2011;;;"Low value";-;"Link to the NICE website" 2630;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Don't do imaging for low back pain within the first 6 weeks unless red flags are present.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2631;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Family Medicine: Don't routinely prescribe antibiotics for acute mild to moderate sinusitis unless symptoms last for 7 or more days OR symptoms worsen after initial clinical improvement.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the recommendation on the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2632;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Family Medicine: Don't order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2633;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Family Medicine: Don't perform Pap tests on patients younger than 21 years or in women status post hysterectomy for benign disease";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2634;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Family Medicine: Don't use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2635;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Don't do imaging for low back pain within the first 6 weeks unless red flags are present";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 5707;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"There is uncertainty about the impact of electronic medical records or electronic health records on primary care on health outcomes and health care costs";"The COVID-19 pandemic is placing a strain on healthcare services. Existing research on the use of electronic medical records (EMR) or electronic health records (EHR) might provide information to help policy makers with this. In this systematic review, the authors searched for research evaluating EMR/EHR in primary care. They restricted their search to articles published in English between January 1998 and January 2010. They identified 30 studies (mostly observational and qualitative studies), which assessed the impact of EMR/EHR on healthcare structure (5 studies), process (21) and outcomes (4).";2011;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2636;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Internal Medicine: Don't obtain blood chemistry panels (eg, basic metabolic panel) or urinalyses for screening in asymptomatic, healthy adults.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2637;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Internal Medicine: Don't order annual ECGs or any other cardiac screening for asymptomatic, low-risk patients.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2638;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Internal Medicine: Use only generic statins when initiating lipid-lowering drug therapy";"For further information please visit the website of the initiative (link below)";2011;;;"High value";-;"Link to the article in the JAMA website" 2639;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Internal Medicine: Don't use DEXA screening for osteoporosis in women under age 65 years or men under 70 years with no risk factors";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2640;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Pediatrics: Don't prescribe antibiotics for pharyngitis unless the patient tests positive for streptococcus.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2641;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Pediatrics: Don't obtain diagnostic images for minor head injuries without loss of consciousness or other risk factors";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the website of JAMA / Enlace a la publicaci�n en la p�gina web de JAMA" 2642;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Pediatrics: Don't refer otitis media with effusion early in the course of the problem";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace a la publicaci�n en la p�gina web de JAMA" 2643;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Pediatrics: Advise patients not to use cough and cold medications";"For further information please visit the website of the initiative (link below)";2011;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ?Less is More?" 2644;6;"Less Is More Collection - JAMA Network";"The Good Stewardship Working Group - Arch Intern Med. 2011;171(15):1385-90)";English;"Top 5 List in Pediatrics: Use inhaled corticosteroids to control asthma appropriately";"For further information please visit the website of the initiative (link below)";2011;;;"High value";-;"Link to the article in the JAMA website" 6751;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"It is not recommended use medicines like aspirin, heparin or progesterone in a bid to maintaining a pregnancy in a woman who has had unexplained and recurrent miscarriages.";"Aspirin alone or in combination with heparin is being prescribed for women with unexplained recurrent miscarriage, with the aim of improving pregnancy outcome.Two recent randomised controlled trials reported that neither of these interventions improves the live birth rate among women with unexplained recurrent miscarriage. There is insufficient evidence to evaluate the effect of progesterone supplementation in pregnancy to prevent a miscarriage in women with recurrent miscarriage.";2011;;;"Low value";Treatment;"Link to the recommendation on the website of the initiative" 1378;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Gonorrhea prophylactic medication: newborns";"The USPSTF recommends prophylactic ocular topical medication for all newborns for the prevention of gonococcal ophthalmia neonatorum. Recommendation Grade A";2011;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 2404;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children";"""NICE summary of review conclusions

Evidence shows that anti-leukotrienes are safe but slightly less effective than a low dose of inhaled corticosteroids, and therefore should not replace inhaled corticosteroids as the first line regular monotherapy for persistent asthma. More research is needed to determine the relative efficacy of anti-leukotrienes in children.

To maintain clinical quality and prevent expenditure on a less effective intervention, leukotriene antagonists for mild to moderate asthma should only be added into a treatment regime after inhaled corticosteroids have been started. The Implications for practice section of the Cochrane review stated: In symptomatic adult asthmatics with mild to moderate asthma, anti-leukotrienes are less effective than inhaled corticosteroids in maintaining asthma control. The use of anti-leukotrienes is associated with a 65% increased risk of experiencing an exacerbationrequiring systemic steroids. The superiority of inhaled corticosteroids is observed within 4 to 8 weeks of treatment. Antileukotrienes are also less effective than inhaled corticosteroids in improving lung function and quality of life, and in reducing symptoms, nocturnal awakenings, and use of rescue beta 2-agonists.

The observed disadvantage persists at 12-16 weeks of treatment. The higher rate of withdrawals due to poor asthma control in the anti-leukotriene group supports the above findings. Although anti-leukotrienes have a similar safety profile than that of inhaled steroids, one must take note that adverse effects typically associated with inhaled steroids such as growth suppression (in children), osteopenia and adrenal suppression have not been measured in these trials. The evidence does not support the use of anti-leukotrienes as a substitute for inhaled steroids that should remain the firstline therapy for asthma.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2405;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Intra-amniotic surfactant for women at risk of preterm birth for preventing respiratory distress in newborns";"""NICE summary of review conclusions

Intraamniotic instillation of surfactant for women at risk of preterm birth is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project.

Reducing or stopping intraamniotic instillation of surfactant for women at risk of preterm birth is likely to improve the quality of patient care in the NHS by avoiding unnecessary procedures. It may be of value in terms of releasing productivity savings but the amount cannot be quantified.

The Implications for practice section of the Cochrane review stated:

We found no randomised trials that evaluated the effect of intraamniotic instillation of surfactant for women at risk of preterm birth. The use of intra-amniotic surfactant should be limited to randomised controlled trials.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2406;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Pulmonary artery catheters for adult patients in intensive care";"""NICE summary of review conclusions

The use of pulmonary artery catheters for adult patients in intensive care is not supported by sufficient good quality evidence. Consideration could be given to using it only in the context of a research or audit project.

The limited evidence does not support the use of pulmonary artery catheters in patients undergoing major surgery or critically ill patients admitted to intensive care units.

Reducing or stopping the use of pulmonary artery catheters in patients undergoing major surgery or critically ill patients admitted to intensive care units, does not appear to have an impact on patient care, although this review did not look at morbidity as an end point. Pulmonary artery catheters do not confer a survival advantage, and they do not reduce hospital length of stay or costs of care. Switching to less invasive monitoring techniques is likely to produce productivity savings.

The Implications for practice section of the Cochrane review stated:

To date, there has only been one large, adequately powered, multicentre randomised control trial (RCT) of the clinical effectiveness of managing general intensive care patients with a pulmonary artery catheter. The results do, however, agree with the findings of previous smaller studies, namely that pulmonary artery catheters do not appear to confer the survival advantage expected of them, nor do they reduce hospital length of stay or costs of care. Equally, the suggestion from one study that pulmonary artery catheters cause excess mortality is not confirmed. None of the studies reviewed were equivalency studies, so pulmonary artery catheters may have a beneficial or harmful effect sufficiently small that it was not detected in the primary studies or the meta-analyses. Clinicians will need to decide if the actual and opportunity costs of placing a pulmonary artery catheter to manage general intensive care patients can be justified given the lack of evidence of benefit, or whether these resources might better be employed on other interventions of proven benefit. The declining use of pulmonary artery catheters in general intensive care units in Scotland suggests that many clinicians are already choosing the latter option. This review concentrated specifically on patients admitted to intensive care units. The use of pulmonary artery catheters in 'preoptimisation' of high-risk surgical patients is not covered in this review, but is the subject of another Cochrane review.""";2011;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2407;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine chest physiotherapy for pneumonia in adults";"""NICE summary of review conclusions

Chest physiotherapy should not be recommended as a routine adjunctive treatment for pneumonia in adults as it is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project.

The effect of reducing or stopping routine chest physiotherapy for pneumonia in adults is difficult to ascertain but is not likely to be detrimental to the quality of patient care. It is likely to result in productivity savings by allowing physiotherapists to focus on those patients more likely to benefit.

The Implications for practice section of the Cochrane review stated:

There is limited evidence indicating that osteopathic manipulative treatment and positive expiratory pressure may reduce the mean duration of hospital stay. Osteopathic manipulative treatment could also reduce the duration of antibiotic treatment, while positive expiratory pressure could reduce the duration of fever. However, based on current evidence, chest physiotherapy should not be recommended as a conventional adjunctive treatment for pneumonia in adults.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2408;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Single dose oral codeine, as a single agent, for acute postoperative pain in adults";"""NICE summary of review conclusions

Evidence shows that single doses of codeine 60 mg for acute postoperative dental pain are not effective and should not be used as a first line analgesic agent. Reducing or stopping the use of single doses of codeine 60 mg for acute postoperative dental pain is likely to improve the quality of patient care in the NHS and to result in productivity savings.

The Implications for practice section of the Cochrane review stated:

Single doses of codeine 60 mg provide poor levels of analgesia in acute post-operative dental pain compared with other commonly used analgesics, such as ibuprofen, as measured by both numbers of participants achieving clinically useful levels of pain relief and duration of analgesia; better results are obtained for other types of postoperative pain, though these results are still relatively poor compared with other analgesics. In situations where a non-steroidal anti-inflammatory drug (NSAID) is contraindicated, paracetamol 1000 mg is likely to be a more effective option, and particularly the combination of paracetamol 1000 mg plus codeine 60 mg.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2409;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Calcium antagonists for aneurysmal subarachnoid haemorrhage";"""NICE summary of review conclusions

Limited evidence suggests that oral nimodipine demonstrates increased benefits by reducing the risks of poor outcome and secondary ischaemia, with only modest risks. Evidence shows that the harms of intravenous calcium antagonists for aneurysmal subarachnoid haemorrhage may outweigh the benefits. The intravenous administration of calcium antagonists should not be offered for routine use, given the limited evidence to support its use, higher costs and potentially higher risk of hypotensive effects. Consider replacing intravenous calcium antagonists with oral nimodipine for routine use in the management of aneurysmal subarachnoid haemorrhages, which may lead to improved patient outcomes and patient safety through reduced adverse events

The Implications for practice section of the Cochrane review stated:

Based on our conclusions, we recommend oral nimodipine (60 mg every 4 hours, to be continued for 3 weeks) as standard treatment in patients with aneurysmal subarachnoid haemorrhage. Although the evidence about the beneficial effect of nimodipine is not beyond all doubt, and is mainly based on one large study where aneurysms were treated with surgical clipping, we recommend oral nimodipine given the potential benefits and modest risks associated with it. Intravenous administration of calcium antagonists is more expensive and potentially hazardous in view of hypotensive effects, and is therefore not recommended.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2410;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Colloids versus crystalloids for fluid resuscitation in critically ill patients";"""NICE summary of review conclusions

Evidence shows that the use of colloids rather than crystalloids for intravascular volume resuscitation in critically ill patients is not cost effective and colloids should not be used routinely. The evidence does not support the routine use of colloids compared with crystalloids as a treatment for intravascular volume resuscitation in critically ill patients following trauma, burns or surgery, outside the context of randomised controlled trials (RCTs). Stopping or reducing the use of colloids over crystalloids for intravascular volume resuscitation in critically ill patients outside the context of research may reduce the risk of adverse events experienced by patients, and provide productivity savings to the health service.

The Implications for practice section of the Cochrane review stated:

There is no evidence from RCTs that resuscitation with colloids, instead of crystalloids, reduces the risk of death in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and further, colloids are considerably more expensive than crystalloids, it is hard to see how their continued use outside the context of RCTs in subsets of patients of particular concern, can be justified""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2411;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin";"""NICE summary of review conclusions

Evidence shows that the harms of using low or medium intensity anticoagulation for the prevention of further vascular events after a transient ischaemic attack (TIA) or minor stroke of presumed arterial origin (excluding cervical artery dissection) may outweigh the benefits. There was no benefit seen by using low intensity anticoagulation, unclear benefit with medium intensity anticoagulation and a higher risk associated with using higher intensity oral anticoagulation compared with aspirin in the secondary prevention of further events after limited ischaemic stroke or TIA of arterial origin that are not as a result of dissection. When a transient ischaemic attack or minor stroke is of arterial origin rather than atrial fibrillation or artery dissection, reducing or stopping the use of anticoagulation for secondary prevention may lead to an improvement in patient outcomes and patient safety through reduced adverse events.

The Implications for practice section of the Cochrane review stated:

There is no evidence to support the routine use of low intensity oral anticoagulation in the secondary prevention of further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin. This review showed that the balance of risk and benefit with medium intensity oral anticoagulation (international normalised ratio [INR] 2.0 to 3.0) was unclear. Higher intensity oral anticoagulation (INR 3.0 to 4.5) is unsafe and hence there is no evidence to support its use for the secondary prevention of further vascular events after transient ischaemic attack or minor ischaemic stroke of presumed arterial origin.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2412;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine 72-96 hour replacement of peripheral venous catheters";"""NICE summary of review conclusions

Evidence shows that routine 72? 96 hour catheter changes are not effective. Reducing or stopping routine replacement of peripheral venous catheters is likely to improve the quality of patients? care in the NHS and to result in productivity savings by reducing unnecessary venous catheter replacement.

The Implications for practice section of the Cochrane review stated:

The review found no conclusive evidence of benefit for 72 to 96 hour catheter changes. Consequently, health care organisations may consider changing to a policy whereby catheters are changed only if clinically indicated. This would provide significant cost savings and would also be welcomed by patients, who would be spared the unnecessary pain of routine re-sites in the absence of clinical indications. Busy clinical staff would also reduce time spent on this intervention.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 6764;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"Parental karyotyping is not routinely recommended for recurrent miscarriages. ";"Karyotyping of peripheral blood from both parents should be performed in couples with recurrent miscarriages where testing of the products of conception reports an unbalanced structural chromosomal abnormality. Knowledge of the karyotype of the products of conception allows an informed prognosis of the outcome of a future pregnancy. While a sporadic fetal chromosomal abnormality is the most common cause of any miscarriage, knowledge of the karyotype of the products of conception allows an informed prognosis of future pregnancy outcome. A sporadic fetal chromosomal abnormality is the most common cause of miscarriage, the risk of miscarriage as a result of fetal aneuploidy decreases. If the karyotype of the aborted pregnancy is abnormal, there is a better prognosis for the next pregnancy. Information should be given to the patient, questions should be answered, and her individual circumstances and preferences should be discussed.";2011;;;"Low value";Diagnostic;"Link to the recommendation on the website of the initiative" 2413;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Repeat digital cervical assessment in pregnancy for identifying women at risk of preterm labour";"""NICE summary of review conclusions

Evidence shows that routine digital cervical assessment in the absence of clinical indication in pregnant women is not effective at identifying women at risk of preterm labour and should not be used. Stopping the practice of routine digital examination of the cervix to screen women at risk of pre-term labour, in absence of clinical indication, is likely to improve quality of patient care and result in productivity savings by reducing ineffective clinical practice.

The Implications for practice section of the Cochrane review stated:

The results from this systematic review show that routine digital cervical assessment in the absence of clinical indication is not useful. We have found insufficient evidence to assess adverse effects. Clinicians who are not performing routine digital cervical assessment should not change their practice, whereas those who perform it may consider modifying their practice.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2417;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Lactulose versus polyethylene glycol for chronic constipation";"""NICE summary of review conclusions

Polyethylene glycol should be used in preference to lactulose in the treatment of chronic constipation. Using polyethylene glycol in preference to lactulose in the treatment of chronic constipation is likely to improve the quality of patient care by reducing the use of a less effective treatment.

The Implications for practice section of the Cochrane review stated:

Polyethylene glycol should be used in preference to lactulose in the treatment of chronic constipation.""";2011;;;"High value";-;"Link to the recommendation in the NICE website" 2419;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Bariatric surgery for non-alcoholic steatohepatitis in obese patients";"""NICE summary of review conclusions

Bariatric surgery for non-alcoholic steatohepatitis in obese patients is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project. Reducing or stopping bariatric surgery for non-alcoholic steatohepatitis in obese patients is likely to improve quality of patient care and result in productivity savings by avoiding unnecessary operations.

The Implications for practice section of the Cochrane review stated:

The lack of randomised clinical trials to demonstrate the beneficial or harmful effects of bariatric surgery procedures for treatment of NASH could not enable us to reach any scientifically sustained conclusion.Despite positive results observed in cohort studies, due to their high risk of bias and the potential risk for worsening in fibrosis scores, bariatric surgery needs to be assessed in randomised clinical trials.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2420;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Restricting oral fluid and food intake during labour";"""NICE summary of review conclusions

Evidence shows that restricting oral fluid and food intake during labour labour in women at low risk of needing anaesthesia is not necessary. Reducing or stopping the practice of restricting oral fluid and food intake during labour in women at low risk of needing anaesthesia is likely to improve the quality of patient care with minimal impact on productivity.

The Implications for practice section of the Cochrane review stated:

The evidence identified no benefits or harms associated with restricting women?s access to fluids and foods during labour for women at low risk of potentially requiring a general anaesthetic, although the studies did not assess women?s views or feelings of control. Hence, women should have the autonomy and freedom to choose whether to eat or drink in labour, or not. Women should be able to consume what they desire and in doing so experience no adverse impact on labour, maternal or fetal outcomes. Most women seem to naturally reduce their intake as labour progresses and becomes more intense. There were no studies identified that looked at restricting fluids and food during labour for women at increased risk of requiring general anaesthesia, so restricting fluid and food intake for these women remains an unproven intervention.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2421;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"High dose rate versus low dose rate intracavity brachytherapy for locally advanced uterine cervix cancer";"""NICE summary of review conclusions

The evidence from the systematic review of clinical trials suggests that high dose rate intracavity brachytherapy is comparable with low dose rate brachytherapy in improving tumour control and survival rates for women with cervical carcinoma. The incidence of small bowel complications was slightly higher with high dose rate intracavity brachytherapy but the disadvantage of this complication may be outweighed by the advantages of high dose rate brachytherapy, which include outpatient treatment, patient convenience, accuracy of treatment, individualised treatment and complete radiation protection for personnel. Replacing the use of low dose rate intracavity brachytherapy with high dose rate treatment in patients with cervical cancer will improve patient care by reducing use of a less convenient and frequently uncomfortable therapy and replacing it with an equally efficacious and more acceptable alternative for the patient.

The Implications for practice section of the Cochrane review stated:

Due to some potential advantages of high dose rate intracavity brachytherapy, such as rigid immobilisation, outpatient treatment, patient convenience, accuracy of source and applicator positioning, individualised treatment with source optimisation and complete radiation protection for personnel, high dose rate intracavity brachytherapy should be considered a standard treatment strategy for patients with cervical cancer instead of low dose rate intracavity brachytherapy, especially in developing countries. This review included the current available evidence and showed that high dose rate intracavity brachytherapy was comparable with low dose rate intracavity brachytherapy. In the subgroup analysis there was no significant difference between high dose rate and low dose rate when considering overall survival, disease specific survival, relapse-free survival, local control rate, recurrence and metastasis and treatment related to complications for patients with clinical stages I, II and III. Therefore, we recommend the use of high dose rate intracavity brachytherapy for all clinical stages of uterine cervix cancer.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 5749;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Comparative effectiveness of integration effects of primary health care services in low- and middle-income countries is uncertain";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research on strategies to increase efficiency and access, such as the integration of different primary healthcare services, might provide useful information for policy makers. In this Cochrane systematic review, the authors searched for comparative effectiveness studies of the effects of the integration of primary healthcare services in low- and middle-income countries. They did not restrict their searches by date or language of publication and did the search in September 2010. They included 5 randomized trials and 4 controlled before-and-after studies. The studies assessed adding an additional specialized service (e.g. family planning or HIV counselling and testing) to existing routine services (5 studies) or the comparison of an integrated program of services versus a single, specialized service (4). The addition of a specialized component to existing services probably increases service use but without affecting patient outcomes. Integrating specialized services may decrease service use, client knowledge and satisfaction with services, without affecting health outcomes, compared to a specialized service. The economic impacts, and patients? views, preferences and experiences, of integrating primary care services are uncertain.";2011;;;Uncertain;Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2422;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants";"""NICE summary of review conclusions

Tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project. Reducing or stopping tracheal gas insufflation for the prevention of morbidity and mortality in mechanically ventilated newborn infants, outside of a research context, is currently likely to improve the quality of patient care in the NHS and result in productivity savings by reducing the use of unproven therapies.

The Implications for practice section of the Cochrane review stated:

There is evidence from a single small randomised controlled trial that tracheal gas insufflation may reduce the duration of mechanical ventilation in preterm infants ? although the data from this single small study does not give sufficient evidence to support the introduction of tracheal gas insufflation into clinical practice. The technical requirements for performing tracheal gas insufflation (as performed in the single included study) are great, and there is no statistically significant reduction in the total duration of respiratory support or hospital stay. Tracheal gas insufflation cannot be recommended for general use at this time.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2423;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Miniport versus standard ports for laparoscopic cholecystectomy";"""NICE summary of review conclusions

Use of miniport as opposed to standard ports for laparoscopic cholecystectomy is not currently supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project. Reducing or stopping the use of miniports instead of standard ports for laparoscopic cholecystectomy is likely to have an impact on both quality of patient care and productivity.

The Implications for practice? section of the Cochrane review stated:

Miniport laparoscopic cholecystectomy can be completed successfully in more than 85% of patients. Patients in whom elective miniport laparoscopic cholecystectomy is completed successfully have less pain than those who underwent standard ports laparoscopic cholecystectomy. However, because of the lack of information on its safety, clinical and economic benefits, it cannot be recommended routinely outside a well-designed clinical trial.""";2011;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2424;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Pharmacological interventions for the prevention of allergic and febrile non-haemolytic transfusion reactions";"""NICE summary of review conclusions

Pre-transfusion medication with paracetamol or hydrocortisone combined with diphenhydramine (not currently used as an antihistamine in the UK) is not supported by sufficient good quality evidence. Consideration could be given to using pre-transfusion medications only within the context of a research or audit project.

The Implications for practice section of the Cochrane review stated:

We found no evidence that pre-transfusion medication prevents non-haemolytic transfusion reactions (NHTR). This applies regardless of the patient?s history of non-haemolytic transfusion reactions and whether or not they were transfused with leukodepleted blood products. This conclusion is based on three trials with moderate risk of bias. Practically, this implies the prescription of pre-transfusion medication is not justified, unless new evidence from a large high quality trial modifies this conclusion.""";2011;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2425;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Single dose oral gabapentin for established acute postoperative pain in adults";"""NICE summary of review conclusions

Evidence shows that gabapentin used alone for individuals with acute nociceptive pain is not as effective as other available drugs, and should not be used as a first-line treatment. Reducing or stopping the use of gabapentin as a single first-line agent in the treatment of acute postoperative pain is likely to improve the quality of patient care and increase productivity by ensuring that more effective and less expensive first-line analgesic agents are used.

The Implications for practice section of the Cochrane review stated:

Somewhat unexpectedly, gabapentin demonstrated an analgesic effect in a limited number of individuals with acute nociceptive pain. As a single agent, in the doses investigated, it is inferior to a number of other drugs that can be used in this setting, and would not be recommended as a first line therapy.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2426;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Continuous passive motion following total knee arthroplasty in people with arthritis";"""NICE summary of review conclusions

Evidence shows that continuous passive motion following total knee arthroplasty in people with arthritis is not effective and should not be used.

Reducing or stopping continuous passive motion following total knee arthroplasty in people with arthritis is likely to improve the quality of patient care in the NHS by reducing the use of ineffective treatments and may be of value in terms of productivity savings although this is difficult to quantify.

The Implications for practice section of the Cochrane review stated:

The effects of continuous passive motion (CPM) on range of motion (ROM) are too small to justify its use. There is evidence that CPM reduces the need for subsequent manipulation under anaesthesia, however, the quality of the evidence is low and this possible benefit needs to be carefully weighed against the inconvenience and expense of CPM.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2427;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Neoadjuvant chemotherapy for cervical cancer";"""NICE summary of review conclusions

The addition of neoadjuvant chemotherapy to surgery is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project.

Reducing or stopping the addition of neoadjuvant chemotherapy to surgery for early-stage or locally advanced cervical cancer is likely to improve the quality of patient care. It is also likely to result in productivity savings by avoiding unnecessary treatment and associated side effects.

The Implications for practice section of the Cochrane review stated:

Although there is a trend towards improved overall survival in cervical cancer patients with early-stage or locally advanced disease, it still remains unclear whether neoadjuvant chemotherapy consistently offers a benefit over surgery alone. Therefore adding neoadjuvant chemotherapy to surgery cannot be recommended outside the context of clinical trials.""";2011;;;"Low value";-;"Enlace a la recomendaci�n en la p�gina web de la NICE" 2428;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Minocycline for acne vulgaris: efficacy and safety.";"""NICE summary of review conclusions

Minocycline is an effective treatment for moderate acne vulgaris, but this review found no reliable randomised control trial evidence to justify its continued first-line use, especially given the price differential and the concerns that still remain about its safety. Its efficacy relative to other acne therapies could not be reliably determined because of the poor methodological quality of the trials and lack of consistent outcome measures. Similarly the relative risk of adverse drug reactions could not be ascertained reliably and no recommendations can be made concerning the appropriate dose that should be used. It is hoped that this review will highlight the inadequacy of acne trials in general and encourage improvements in methodological quality and standards of reporting.

Stopping the use of minocycline as the first-line systemic antibiotic for management of acne vulgaris, outside of well designed clinical trials, is likely to improve the quality of patient care and savings of approximately �2.2m may be generated by replacing its use with a safe, effective and less costly alternative.

The Implications for practice section of the Cochrane review stated:

The 27 studies included in this review do not provide any clear and unbiased evidence to support the first-line use of minocycline in the treatment of acne. Although it has been shown to be an effective treatment for moderate acne vulgaris at a dose of 100 mg per day, no study has conclusively shown any important clinical difference between the tetracycline antibiotics or other commonly used therapies. Given that it is 2.9 to 4.8 times more expensive than (oxy)tetracycline in the UK (Drug Tariff Jan 2000) depending on the formulation, the additional cost of minocycline is not justified on the basis of clinical efficacy alone.

Similarly, there is no evidence that it is more effective in acne resistant to other therapies or that it has a faster onset of action or a more prolonged effect. Insufficient information was located to make any recommendations concerning the appropriate dose that should be used. The relative safeties of the tetracyclines have still not been adequately determined and little further information could be derived from the studies due to their inherent inability to detect rare events. Recent reviews of case reports and case series suggest that minocycline therapy for acne may be associated with a broader spectrum and a higher incidence of severe adverse drug reactions that other tetracyclines.

The lack of a denominator in nearly all of the studies means that the risks for minocycline compared to other tetracyclines cannot be compared. Only in the case of lupus-like syndrome has it been conclusively shown that acne patients treated with minocycline are at a significantly greater risk than those given tetracycline or no treatment. Doctors should be aware that the risk of lupus-like syndrome and pigmentation increases with cumulative dose. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2429;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antenatal interventions for fetomaternal alloimmune thrombocytopenia";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2430;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Symptomatic treatment of the cough in whooping cough";"""NICE summary of review conclusions

Symptomatic treatment of the cough in whooping cough is not supported by sufficient good quality evidence. Consideration could be given to using it only within the context of a research or audit project.

Reducing or stopping symptomatic treatment of the cough in whooping cough using the interventions included in the review is likely to improve quality of patient care by avoiding side-effects associated with treatment and to result in productivity savings.

The Implications for practice section of the Cochrane review stated:

Given the uncertain effectiveness and potential side effects of interventions for the cough in whooping cough, there appears to be no justification for their use.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2431;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Light physical conditioning programmes for workers with back pain";"""NICE summary of review conclusions

Evidence shows that light physical conditioning programs are not effective and should not be used

Reducing or stopping light physical conditioning programs for workers with back pain is likely to have miminal impact on the quality of patient care in the NHS but is likely to result in productivity savings.

The Implications for practice section of the Cochrane review stated:

For workers with acute back pain a physical conditioning program is not effective in reducing sickness absence duration. Light physical conditioning programs do not reduce sickness absence in workers with subacute nor with chronic back pain. There is conflicting evidence regarding the effectiveness of intense physical conditioning program versus usual care for workers with subacute back pain. It might be that including workplace visits or execution of the intervention at the workplace is the component that renders a physical conditioning programme effective. For workers with chronic back pain, there is moderate quality evidence that intense physical conditioning programs have a small but significant effect on sickness absence compared to care as usual. There is conflicting evidence on the effect of intense physical conditioning programs versus exercise therapy for workers with chronic back pain. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website
" 2432;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus";"""NICE summary of review conclusions

Our analysis of the currently available long-term trials comparing long acting insulin analogues with NPH (human isophane) insulin showed that insulin glargine and insulin detemir were almost identically effective compared with NPH insulin in long-term metabolic control (as measured by glycated haemoglobin). Fewer people experienced symptomatic or nocturnal hypoglycaemic episodes with either of the two analogues. No conclusive information on late complications or on possible differences in the number of fatalities exists.

One study found a higher rate of progression of diabetic retinopathy in patients treated with insulin glargine, while in another investigation the opposite result was found. It was thus not possible to conclude for certain whether insulin glargine treatment is safe or not. From the retrieved trials it was also not possible to draw firm conclusions on the effects of these new insulins on quality of life or their cost effectiveness. Until long-term data on benefit and risk are available, we suggest a cautious approach to treatment with insulin glargine or insulin detemir.

In the absence of evidence to suggest the superiority of insulin analogues glargine and detemir over NPH insulin in terms of improved safety, glycaemic control or reduction of long-term diabetic complications, a cautious approach to prescription of these two insulins is advised. There are clear productivity savings to be generated by reducing prescription of these insulins. Practitioners should consider the individual features of the patient and the NICE recommendations before prescribing these insulins.

The Implications for practice section of the Cochrane review stated:

Our analysis suggests, if at all, only a minor clinical benefit of treatment with long-acting insulin analogues for patients with type 2 diabetes mellitus treated with ?basal? insulin regarding symptomatic nocturnal hypoglycaemic events. Until long-term efficacy and safety data are available, we suggest a cautious approach to therapy with insulin glargine or detemir. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2433;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Fetal and umbilical doppler ultrasound in normal pregnancy";"""NICE summary of review conclusions

The review of trials of routine doppler ultrasound of the baby?s vessels in pregnancy identified five studies involving more than 14,000 women and babies. The studies were not of high quality and were all undertaken in the 1990s. They showed that the use of routine umbilical artery doppler ultrasound, or a combination of umbilical and uterine artery doppler ultrasound in low-risk or unselected populations benefits neither mother nor baby and should not be used.

Stopping or reducing the use of routine umbilical artery doppler ultrasound, or combination of umbilical and uterine artery doppler ultrasound in low-risk or unselected populations is likely to lead to improved quality of patient care and improved patient experience through the reduced use of unproven and unnecessary investigations. This is in line with the recommendation in NICE clinical guideline 62, Antenatal care: routine care for the healthy pregnant woman. More research is needed to clarify whether this will also lead to improvements in patients? safety.

The Implications for practice section of the Cochrane review stated:

Existing data do not provide conclusive evidence that the use of routine umbilical artery doppler ultrasound, or combination of umbilical and uterine artery doppler ultrasound in low-risk or unselected populations benefits either mother or baby. At present, doppler ultrasound examination should be reserved for use in high-risk pregnancies. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website
" 2435;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury";"""NICE summary of review conclusions

Evidence shows that the harms of hyperbaric oxygen therapy on ankle sprain or acute knee ligament injury, or on experimentally induced delayed-onset muscle soreness may outweigh the benefits.

Reducing or stopping the use of hyperbaric oxygen therapy in delayed-onset muscle soreness, ankle sprain and acute knee ligament injury is likely to improve the quality of patient care and result in productivity savings by reducing exposure to unproven therapies for conditions for which less costly alternative interventions exist.

The Implications for practice section of the Cochrane review stated:

There was insufficient evidence from comparisons tested within randomised controlled trials to establish the effects of hyperbaric oxygen therapy on ankle sprain or acute knee ligament injury, or on experimentally induced delayed-onset muscle soreness. There was some evidence that hyperbaric oxygen therapy may increase pain in delayed-onset muscle soreness. Thus, the use of hyperbaric oxygen therapy in these patients cannot be justified by this review. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2437;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Elective caesarean delivery for the prevention of anal incontinence";"""NICE summary of review conclusions

Evidence shows that elective caesarean delivery for the prevention of anal incontinence does not have the anticipated benefits and therefore should not be undertaken.

Reducing or stopping elective caesarean delivery for the prevention of anal incontinence is likely to improve the quality of patient care and result in productivity savings by reducing unnecessary operations.

The Implications for practice section of the Cochrane review stated:

No benefit for Caesarian delivery (CD) over vaginal delivery (VD) can be demonstrated in this review of 21 non-randomized studies. Elective primary CD in average risk women when done for the preservation of anal continence cannot be recommended. Average risk is the key factor. No doubt there are women who, due to previous trauma or pelvic reconstruction, cannot risk further trauma to the sphincter and for whom CD is appropriate. There is no evidence in included studies that such women constituted a significant number of women having CD, which could lead to a bias in favor of VD, and this situation would have been excluded in most of the best studies. In any case the results of this review state that based upon current evidence, a pregnant woman cannot be told that by having a CD she can reliably avoid anal incontinence. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2438;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Joint lavage for osteoarthritis of the knee";"""NICE summary of review conclusions

Evidence shows that joint lavage, used alone, without debridement, for patients with knee osteoarthritis is not effective and should not be used.

Stopping joint lavage alone in patients with osteoarthritis of the knee is likely to improve quality of patient care and result in productivity savings by avoiding an intervention with no proven benefit and unknown potential for serious side effects.

The Implications for practice section of the Cochrane review stated:

Joint lavage does not result in a relevant benefit for patients with knee osteoarthritis in terms of pain relief or improvement of function. Insufficient numbers of patients have been studied to exclude the potential for serious adverse events such as joint infection, effusion, haemarthrosis, or deep vein thrombosis. Joint lavage [alone] should be discouraged in patients with osteoarthritis. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2439;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases";"""NICE summary of review conclusions

Breathing training, walking aids, neuroelectrical muscle stimulation and chest wall vibration appear to be effective non-pharmacological interventions for relieving breathlessness in the advanced stages of some diseases.

The routine use of acupuncture or acupressure; distractive auditory stimuli (music); relaxation; fans; counselling and support programmes with or without relaxation and breathing training; case management; and psychotherapy to relieve breathlessness in the advanced stages of disease are not supported by sufficient good quality evidence. Consideration could be given to using it only in the context of a research or audit project.

Reducing the use of therapies for which there is no proven benefit and promoting those that do provide benefit may improve patient care and provide productivity savings.

The Implications for practice section of the Cochrane review stated:

Giving recommendations for the clinical setting is limited by the fact that most interventions were only tested in one patient group. Weighing up the findings of this review the following can be summarised:

?The studies testing neuroelectrical muscle stimulation indicate strong evidence that this intervention is helpful to relieve breathlessness in COPD [chronic obstructive pulmonary disease] patients.

?The studies evaluating chest wall vibration show that there is strong evidence that this intervention can relieve breathlessness in COPD patients. However, the practical implication of this intervention is unclear as the studies were only conducted in the respiratory laboratory.
?The studies testing the use of walking aids (rollators) indicate moderate strength of evidence that there is some benefit for COPD patients with breathlessness.
?The studies testing breathing training suggest that there is moderate strength of evidence that patients with breathlessness benefit from it.
?There is not enough evidence to recommend the routine use of acupuncture/acupressure, distractive auditory stimuli (music), relaxation, fan, counselling and support programmes, counselling and support programmes in combination with relaxation and breathing training, case management, and psychotherapy. These interventions need further testing before they can be routinely used in clinical practice.

This review showed the big gap of evidence outside COPD. Many studies have been conducted either in the respiratory laboratory or in respiratory settings with little connection to palliative and end-of-life care. This review contributes to the need to view such interventions offered to participants with COPD or chronic heart failure from a palliative care perspective and will hopefully foster the cooperation between the different specialties to further improve the management of breathlessness in participants with advanced diseases. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2440;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Corticosteroids for treating severe sepsis and septic shock";"""NICE summary of review conclusions

Evidence shows that a course of low-dose corticosteroids lasting for 5 day or longer leads to better outcomes for patients with septic shock. However, shorter courses of high-dose corticosteroids are not effective and should not be used for treating severe sepsis and septic shock.

Although overall corticosteroids did not change 28-day mortality, there was significant heterogeneity between trials. Treatment with a long course (5 days or more) of low-dose corticosteroids significantly reduces 28-day mortality, increases the proportion of shock reversal by days seven and 28, reduces the sepsis-related organ failure assessment score by day seven and reduces the survivors? length of stay in the intensive care unit. There was no evidence of increased gastroduodenal bleeding, superinfection or neuromuscular weakness. Corticosteroid use does increase the risk of hyperglycaemia and hypernatraemia.

Reducing or stopping the use of a short course of high-dose corticosteroids in adult patients with severe sepsis or septic shock and instead using a longer course of low-dose (physiological dose) corticosteroids may reduce 28-day mortality without inducing major complications. This may result in better outcomes for patients and produce productivity savings.

""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2441;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Beta-lactam antibiotic monotherapy versus beta-lactam?aminoglycoside antibiotic combination therapy for sepsis";"""NICE summary of review conclusions

Evidence shows that the harms of using a combination of aminoglycoside antibiotic together with narrow-spectrum beta-lactam antibiotic for the empirical treatment of sepsis may outweigh the benefits of using a broad-spectrum beta-lactam alone.

For the empirical treatment of sepsis, broad-spectrum beta-lactam monotherapy should be used; beta-lactam?aminoglycoside combination therapy does not offer an advantage over beta-lactam monotherapy, and it is associated with an increased rate of adverse events.

Stopping or reducing the use of beta-lactam aminoglycoside combination therapy in patients hospitalised with sepsis is cost effective and may improve clinical outcomes and patient safety.

The Implications for practice section of the Cochrane review stated:

Clinicians usually face the dilemma of selecting an antibiotic treatment on two occasions during an uncomplicated infectious episode. On the initial encounter with a patient the clinician must prescribe empirical antibiotic treatment, since the causative pathogen and its susceptibilities are generally unknown. Most studies addressed this situation, and the results show that there is no difference in overall mortality whether monotherapy or combination therapy is used. Adverse effects, most significantly nephrotoxicity, will occur more frequently with combination therapy. If the choice is between a narrower-spectrum beta-lactam combined with an aminoglycoside versus a broad-spectrum beta-lactam, our results show that treatment will ultimately have to be modified more frequently if the combination is chosen. We have not identified a specific site of infection, or disease severity, where combination treatment has an advantage.

The second decision point occurs when the causative pathogen is identified. Here, the choice of the antibiotic treatment is dictated by known susceptibility results. However, the question remains, whether for specific bacteria beta-lactam?aminoglycoside combination treatment offers an advantage over single beta-lactam treatment. We addressed this question by subgroup analyses of patients with documented infections caused by specific pathogens (gram-negatives, Pseudomonas aeruginosa, Staphylococcus aureus). In addition, several semi-empirical studies addressed this question specifically. We have not identified a specific pathogen, or pathogen group, where combination therapy is advantageous.

Overall, appropriate beta-lactam monotherapy should be used. Beta-lactam-aminoglycoside combination therapy does not offer an advantage, and is associated with an increased rate of adverse events. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 6538;1;"NICE ";NICE;English;"It is recommended the use of colonoscopy to check for signs of bowel cancer in people aged 18 and over with ulcerative colitis or Crohn?s disease or adenomas. ";"There is no evidence from RCTs on the effectiveness of colonoscopic surveillance programmes in improving survival in people at increased risk of colorectal cancer. Although there is some observational evidence in people with IBD, there is no evidence in people after adenoma removal. RCTs should be undertaken to determine the comparative effect of different surveillance programmes on survival (preferably with a follow-up of 5 years and longer) and quality of life in people at increased risk of colorectal cancer because of IBD or adenomas. Such trials should also assess any differential effects associated with risk category (as defined in this guideline).";2011;;;Uncertain;Diagnosis;"Link to the recommendation on the website of the initiative" 2443;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antihistamines and/or decongestants for otitis media with effusion (OME) in children";"""NICE summary of review conclusions

The use of antihistamines, decongestants or a combination of both in otitis media with effusion (OME) was not found to be of benefit for any short or long-term outcomes including resolution of the fluid, hearing problems, or the necessity of additional referral to specialists. Further, using these medications causes side effects, such as gastrointestinal upset, irritability, drowsiness or dizziness in approximately 10% of patients. Therefore, antihistamines, decongestants or antihistamine and decongestant combinations are not recommended treatments for OME.

Not using antihistamines, decongestants or a combination of both in otitis media with effusion is likely to improve the quality of patient care by reducing side effects and will result in productivity savings by avoiding unnecessary treatment.

The Implications for practice section of the Cochrane review stated:

Because we found no benefit for any of the studied interventions for any of the outcomes measured and we found harm from the side effects of the interventions, we recommend that practitioners not use antihistamines, decongestants or antihistamine/decongestant combinations to treat otitis media with effusion in children. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2444;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotics for acute laryngitis in adults";"""NICE summary of review conclusions

The use of antibiotics in acute laryngitis has not been shown objectively to have any significant clinical benefit that can justify this use in clinical practice. Despite an overall paucity of evidence, treating acute laryngitis with conservative measures in the first instance is appropriate because antibiotics are associated with side effects and an increased incidence of antimicrobial resistance, which is costly and harmful to the population as a whole.

Not using antibiotics for acute laryngitis is likely to lead to productivity savings and reduce the risk of antimicrobial resistance without compromising the clinical care of individual patients.

The Implications for practice section of the Cochrane review stated:

Definitive recommendations cannot be made since evidence is only available from two randomised controlled trials. Antibiotics appear to have no benefit in the treatment of acute laryngitis. Even if erythromycin could reduce voice disturbance at 1 week and cough at 2 weeks, measured subjectively, we consider these outcomes are not relevant in clinical practice. The implications for practice are that prescription of antibiotics should not be given in the first instance, as they will not objectively improve symptoms. Unnecessary antibiotic prescribing may contribute to increasing rates of antibiotic resistance. Antibiotics may not outweigh their costs or adverse effects. Currently, antibiotics are widely prescribed for patients with upper respiratory tract infections. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2445;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Azathioprine and 6-mercaptopurine for maintenance of remission in ulcerative colitis";"""NICE summary of review conclusions

Given the established effectiveness and safety of aminosalicylates (that is, mesalazine or sulfasalazine) for the maintenance of remission in ulcerative colitis, azathioprine and [6-] mercaptopurine cannot be recommended as first-line treatment to prevent the disease from coming back. However, azathioprine may be an effective maintenance treatment for patients who have failed or cannot tolerate mesalazine or sulfasalazine and for patients who need repeated courses of steroids.

There is a lack of evidence to support the effectiveness of azathioprine or mercaptopurine alone as first-line therapy to retain remission in non-active ulcerative colitis. Stopping their use as first-line agents and using proven safer alternatives such as the aminosalicylate drugs sulphasalazine and mesalazine may lead to improved quality of patient care and patient safety through reduced adverse events.

The Implications for practice section of the Cochrane review stated:

Azathioprine may be an effective treatment for patients who have failed or can not tolerate standard maintenance therapy with mesalazine or sulfasalazine or for patients who require repeated courses of corticosteroids to induce remission. There is insufficient evidence to assess superiority of azathioprine alone, or azathioprine in addition to standard maintenance, as compared to standard maintenance with mesalazine or sulfasalazine only. Given the potential for serious adverse events, azathioprine cannot be recommended as first line therapy in quiescent ulcerative colitis. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2446;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Surgery for obstructive sleep apnoea in adults";"""NICE summary of review conclusions

A small number of trials have compared different surgical techniques with inactive and active control treatments for patients with obstructive sleep apnoea/hypopnoea syndrome. The studies do not provide evidence to support the use of surgery because overall significant benefit was not demonstrated. The participants recruited to the studies had mixed levels of apnoea hypopnoea, but tended to have moderate daytime sleepiness, if this was measured.

Short-term outcomes are unlikely to consistently identify suitable candidates for surgery. Long-term follow-up of patients who undergo surgical correction of upper airway obstruction is needed. This would help to determine whether surgery is a curative intervention, or whether there is a tendency for the signs and symptoms of sleep apnoea to recur, prompting patients to seek further treatment for sleep apnoea.

Stopping or reducing the use of surgical interventions as first-line treatment for obstructive sleep apnoea is likely to lead to improved quality of patient care, improved patient safety and productivity savings.

The Implications for practice section of the Cochrane review stated:

The available evidence does not currently support the widespread use of surgical interventions in the management of unselected patients with obstructive sleep apnoea. Given the proven efficacy of continuous positive airways pressure (CPAP) in patients with moderate and severe symptoms and significant sleep disordered breathing, surgery cannot be recommended as a front line therapy, ahead of positive airways pressure in these patients. Long-term follow-up comparing surgery with oral appliances suggests that the initial effect of surgery on airway obstruction lessened over time. This observation requires confirmation.

The appeal of an apparently curative intervention for sleep apnoea should be balanced against the uncertainty surrounding its safety, continued effectiveness and inconsistent impact on subjective and objective markers of disease in patients with obstructive sleep apnoea/hypopnoea syndrome. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2447;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antiplatelet agents and anticoagulants for hypertension";"""NICE summary of review conclusions

Aspirin cannot be recommended for the primary prevention of cardiovascular events in patients with hypertension because the benefit does not outweigh the harm. The size of the benefit is much greater for secondary prevention, so aspirin is recommended for this indication. Warfarin, glycoprotein IIb/IIIa inhibitors, ticlopidine, and clopidogrel are not recommended for primary prevention of cardiovascular events in patients with hypertension. Further trials are needed to investigate the benefits and harms of antithrombotic therapy in people with high blood pressure.

Stopping or reducing the use of antiplatelets or anticoagulants for the primary prevention of occlusive vascular disease in patients with hypertension is likely to lead to improved patient safety and productivity savings through reduced prescribing costs and adverse events.

The Implications for practice section of the Cochrane review stated:

For primary prevention in patients with elevated blood pressure antiplatelet therapy with acetylsalicyclic acid (aspirin) cannot be recommended since the magnitude of the benefit, reduced myocardial infarctions, is similar to the magnitude of harm, increased major haemorrhagic events.

For secondary prevention in patients with elevated blood pressure, antiplatelet therapy with aspirin is recommended, as the magnitude of the absolute benefit, reduced major vascular events is much greater than in primary prevention and appears to be greater than for secondary prevention in patients with normal blood pressure.

Antithrombotic therapy with warfarin alone or in combination with aspirin in patients with elevated blood pressure is not recommended because of lack of effectiveness in reducing cardiovascular events as well as a trend towards increased haemorrhagic events. Glycoprotein IIb/IIIa inhibitors as well as ticlopidine and clopidogrel have not been sufficiently evaluated in order to recommend their use in patients with elevated blood pressure. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2448;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotics for treating salmonella gut infections";"""NICE summary of review conclusions

Evidence shows that the use of antibiotic therapy in otherwise healthy children and adults with non-severe salmonella diarrhoea is not effective, is associated with increased adverse events and prolongs the period in which salmonella is microbiologically detected. They should therefore not be offered to otherwise healthy children and adults with non-severe infection.

Not using antibiotic therapy in otherwise healthy children (older than 6 months) and adults with non-severe salmonella diarrhoea is likely to improve the quality of patient care, reduce the incidence of antimicrobial resistance and result in productivity savings. There is no current evidence on the effectiveness of antibiotic therapy for salmonella infection in immunocompromised patients and further research in this group is recommended.

The Implications for practice section of the Cochrane review stated:

Antibiotic therapy has no positive clinical effect on the treatment of salmonella diarrhoea in healthy children and adults with non-severe diarrhoea. Adverse drug reactions, although minimal, do occur with antibiotic treatment. Antibiotic administration therefore should not be routinely recommended for this disease in children and adults. For patients with some underlying immunosuppressive disorder, current data are insufficient to guide management: this suggests that they are not indicated outside the context of a randomised, placebo controlled trial.

Antibiotic therapy has an apparent effect on stool cultures only in the early stages, but clinical impact and public impact has not been demonstrated. Antibiotic regimens of 1-14 days do not decrease the positive rates of intestinal salmonella after 2-3 weeks, but prolong salmonella excretion. Antibiotic-resistant organisms can occur during treatment and selective pressure will occur especially with frequent use. They are not useful for intestinal salmonella eradication and should not be recommended.

""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 5776;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"In the available research, which was at high risk of bias, interventions aimed at changing organizational culture had positive effects on work-related (improved employee spirit), personal (appreciating self and others), and clinical outcomes (decreased nosocomial infections).";"The COVID-19 pandemic is placing a strain on healthcare systems. Existing research on ways to improve healthcare outcomes by changing organizational cultures might provide information for policy makers to help with this. In this systematic review, the authors searched for comparative effectiveness studies of strategies to change organisational culture in order to improve healthcare performance. They did their search in October 2009. They included two controlled before-and-after studies (both judged to be at high risk of bias) assessing the impact of educational interventions targeting handwashing practice and improving employee spirit at work. The studies were from Canada (1 study) and the USA (1). At the time of this review, current available evidence did not identify any generalizable strategies to change organizational culture that were effective at improving healthcare outcomes. In the available research, which was at high risk of bias, interventions aimed at changing organizational culture had positive effects on work-related (improved employee spirit), personal (appreciating self and others), and clinical outcomes (decreased nosocomial infections).";2011;;;"Low value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2449;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Antibiotics for the common cold and acute purulent rhinitis";"""NICE summary of review conclusions

Antibiotics for initial treatment of acute upper respiratory tract infections or purulent rhinitis in patients without co-morbid conditions or signs of systemic illness have not been shown to provide any symptomatic benefit or reduce the length of illness. They are associated with side effects in adults and should not be offered for initial treatment.

Not using antibiotics in the initial treatment of acute upper respiratory tract infections and purulent rhinitis in patients who are systemically well, is likely to improve patient care, reduce the incidence of side effects and lead to productivity savings through both reduced prescriptions and reduced antimicrobial resistance.

The Implications for practice section of the Cochrane review stated:

Antibiotics appear to have no benefit in the initial treatment of acute upper respiratory tract infections. The implications for practice are that prescription of antibiotics should not be given in the first instance as they will not improve the symptoms and adult participants will get adverse effects. For acute purulent rhinitis there may be no benefit from antibiotics while there is an increase in adverse effects. However, if the symptoms persist for longer than 10 days then antibiotic therapy may be beneficial and clinicians may wish to negotiate the use of them with patients, taking into account the resistance issues. """;2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2450;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Mechanical bowel preparation for elective colorectal surgery";"""NICE summary of review conclusions

Evidence shows that mechanical bowel preparation is not effective for improving outcomes in patients undergoing elective colorectal surgery and should not be used routinely. It should be reserved for procedures in which intraoperative colonoscopy might be performed or close visualisation of the bowel mucosa is needed.

Stopping or reducing the routine use of mechanical bowel preparation in patients undergoing elective colorectal surgery is likely to lead to improved quality of patient care, improved patient experience and productivity savings. Mechanical bowel preparation should still be used at the surgeon?s discretion during procedures to identify pathology or when intra-operative colonoscopy might be performed.

The Implications for practice section of the Cochrane review stated:

Prophylactic mechanical bowel preparation prior to colorectal surgery has not been proven to be valuable for patients. This review suggested this should be abandoned. Bowel cleansing should be considered when a surgeon needs to identify pathology ? for example, a small tumour ? or when an intraoperative colonoscopy might be performed. In rectal surgery, prior to construction of an anastomosis, one of the surgical team can wash out possible bowel contents at the anal site of the anastomosis.""";2011;;;"Low value";-;"Link to the recommendation in the NICE website" 2019;6;"Less Is More Collection - JAMA Network";"Khera A, et al. Arch Intern Med. 2011;171(4):281-283.";English;"There is not sufficient evidence to support the population screening of coronary disease based on coronary artery calcium imaging or on carotid ultrasonography.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2020;6;"Less Is More Collection - JAMA Network";"Rotjanapan P, et al. Arch Intern Med. 2011;171(5):438-443.";English;"Potentially Inappropriate Treatment of Urinary Tract Infections in Two Rhode Island Nursing Homes";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";"urinary tract infections, UTIs, Antibiotic, elderly, old people";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2021;6;"Less Is More Collection - JAMA Network";"Shehab N, et al. Arch Intern Med. 2011;171(5):473-474 & Arch Intern Med. 2011;171(6):487-488.";English;"Time to Change the Paradigm?From ?Potentially Inappropriate? to Real Patient Harms";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""

Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""

" 2022;6;"Less Is More Collection - JAMA Network";"Volk M, et al. Arch Intern Med. 2011;171(6):487-488.";English;"Clinical Care should be improved by Limiting Physician Access to Unsolicited Diagnostic Information.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2023;6;"Less Is More Collection - JAMA Network";"Schwartz L, et al. Arch Intern Med. 2011;171(6):489-490.";English;"Don't neglect to consider that CT scanning as a part of health clinically programs is associated with incidental findings. Since many incidentally found lesions may never cause disease, there is a risk of overdiagnosis.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2024;6;"Less Is More Collection - JAMA Network";"Glaser A, et al. Arch Intern Med. 2011;171(6):594-595.";English;"Free PSA for the screening of prostate cancer at appropriate age is recommended, since is likely to have more discriminatory power than total PSA.";"For PSA values from 2.0 to 3.9 ng/mL, the cancer rate is more than 30% when the free PSA value is less than 10% of the total, compared with a cancer rate of less than 10% when the free PSA value is more than 30% of the total.";2011;;;"High value";"screening, prostate";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2025;6;"Less Is More Collection - JAMA Network";"Singh P, et al. Arch Intern Med. 2011;171(6):595.";English;"The overdiagnosis and overtreatment burden from screening is in part due to the low sensitivity and specificity of PSA and problems with the histological diagnostic test*";"*Transrectal ultrasound (TRUS)-guided prostate biopsy

For further information please visit the website of the initiative (link below)";2011;;;"Low value";"screening, prostate";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2026;6;"Less Is More Collection - JAMA Network";"Gomes T, et al. Arch Intern Med. 2011;171(7):686-691.";English;"Opioid Dose and Drug-Related Mortality in Patients With Nonmalignant Pain";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2027;6;"Less Is More Collection - JAMA Network";"Soylemez R, et al. Arch Intern Med. 2011;171(9):831-837";English;"Computed tomographic pulmonary angiography (CTPA) should be ordered with caution since there is a potential risk of overdiagnosis with CTPA throughout finding clinically unimportant embolism and exposing patients to harms from unnecessary treatment.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2028;6;"Less Is More Collection - JAMA Network";"Stephenson A, et al. Arch Intern Med. 2011;171(10):914-920.";English;"Inhaled Anticholinergic Drug Therapy and the Risk of Acute Urinary Retention in Chronic Obstructive Pulmonary Disease: A Population-Based Study";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2029;6;"Less Is More Collection - JAMA Network";"Atroshi I, et al. Arch Intern Med. 2011;171(10):941-954.";English;"Incidence of Physician-Diagnosed Carpal Tunnel Syndrome in the General Population";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2030;6;"Less Is More Collection - JAMA Network";"Hamilton H, et al. Arch Intern Med. 2011;171(11):1013-1019.";English;"Potentially Inappropriate Medications Defined by STOPP Criteria and the Risk of Adverse Drug Events in Older Hospitalized Patients";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2031;6;"Less Is More Collection - JAMA Network";"Morandi A, et al. Arch Intern Med. 2011;171(11):1032-1034.";English;"Inappropriate Medications in Elderly ICU Survivors: Where to Intervene?";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2032;6;"Less Is More Collection - JAMA Network";"Armstrong E, et al. Arch Intern Med. 2011;171(12):1109.";English;"Don't neglect to consider the complications from use of pulmonary artery catheter due to their clinical severity, which can cause high morbidity and mortality.";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2033;6;"Less Is More Collection - JAMA Network";"Armstrong E, et al. Arch Intern Med. 2011;171(12):1110-1111";English;"Pulmonary Artery Catheterization in the Intensive Care Unit: Just Numbers Floating By?";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 3058;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 40 to 49 we recommend not routinely screening with mammography. (Weak recommendation; moderate quality evidence)";"For further information please visit the website of the initiative (link below)";2011;;;"Low value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3059;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 50 to 69 years we recommend routinely screening with mammography every 2 to 3 years. (Weak recommendation; moderate quality evidence)";"For further information please visit the website of the initiative (link below)";2011;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 3060;22;"The Canadian Task Force for Preventive Health Care Guidelines";"Public Health Agency of Canada, PHAC";English;"For women aged 70 to 74 we recommend routinely screening with mammography every 2 to 3 years. (Weak recommendation; low quality evidence)";"For further information please visit the website of the initiative (link below)";2011;;;"High value";-;"Link to the recommendation on the website of the Canadian Task Force for Preventive Health Care / Enlace a la recomendaci�n en la p�gina web de la Canadian Task Force for Preventive Health Care" 1082;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use biochemical markers such as natriuretic peptides and high sensitivity C-reactive protein to diagnose an acute coronary syndrome (ACS).";-;2010;;;"Low value";-;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 6738;36;"Choosing Wisely UK";"Royal College of Emergency Medicine";English;"There is no evidence to suggest that splint immobilization is inferior to cast immobilization for functional recovery without increasing complications of pediatric buckle wrist fractures in children of 0-18 years old";"Children with small fractures on one side of the wrist, ?buckle fractures? do not usually need a plaster cast. They can be treated with a removable splint and written information. There is usually no need to put a plaster cast on, or follow these children up in fracture clinic as they will get better just as quickly without this. No good trials but all trials have no refracture complications. No evidence to suggest that futura splint is inferior to plaster cast immobilisation it is superior in terms of patient satisfaction. Wool and crepe/bandage/ no treatment no evidence. ";2010;;;"Low value";-;"Link to the recommendation on the website of the initiative " 129;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to patients with cancer having oncological treatment who are ambulant.";.;2010;;;"Low value";.;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2434;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Stavudine or zidovudine in three-drug combination therapy for initial treatment of HIV infection in antiretroviral-naive individuals";"""NICE summary of review conclusions

Overall the systematic review showed no critical difference between stavudine and zidovudine as part of first-line therapy for patients with HIV. Other existing literature reports a more significant side-effect profile with stavudine than zidovudine, and thus stavudine is not recommended as first-line treatment. Future studies and recommendations should focus on specific toxicities and tolerability when comparing these drugs.

Patients with HIV should be given zidovudine as a first-line agent rather than stavudine. This is In accordance with WHO guidelines. This will improve the quality of clinical care by using a drug with similar efficacy but a lower side-effect profile.

The Implications for practice section of the Cochrane review stated:

While stavudine and zidovudine appear to be clinically equivalent in the trial literature, there is a large literature about severe metabolic side effects with stavudine, and for this reason WHO has recently recommended against using stavudine for first-line antiretroviral therapy. Its use may evolve to be restricted to patients with severe anaemia who cannot tolerate zidovudine, or in second-line therapy. Clinical and public health judgment will be needed to weigh the risks and benefits of stavidine compared to zidovudine. """;2010;;;"Low value";-;"Link to the recommendation in the NICE website" 2436;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders";"""NICE summary of review conclusions

Selective serotonin reuptake inhibitors show no evidence of benefit in children with autistic spectrum disorders, but evidence of harm is emerging. Evidence of the effectiveness of selective serotonin reuptake inhibitors for autism in adults is also limited.

Reducing or stopping the use of selective serotonin reuptake inhibitors to manage autism in children outside of research or on a specific case-by-case basis may improve clinical quality through the reduced use of an unproven intervention and increase patient safety through potential reduction of side effects. Further research is needed to ascertain the role of SSRIs in the management of adults with autism spectrum disorders.

The Implications for practice section of the Cochrane review stated:

There is no evidence that selective serotonin reuptake inhibitors (SSRIs) are effective as a treatment for children with autism. In fact, there is emerging evidence that they are not effective and can cause harm. As such, selective serotonin reuptake inhibitors cannot be recommended as a treatment for children with autism at this time.

For adults, small positive effects have been seen with fewer side effects reported, but the possible risk of bias and small sample size of the trials make clear recommendations impossible at this time. Decisions about the use of SSRIs for established clinical indications that may co-occur with autism, such as obsessive-compulsive disorder and depression, and anxiety (in the case of adults), should be made on a case by case basis.

Not all the selective serotonin reuptake inhibitors currently in use have been subjected to controlled trials for autism spectrum disorder. As autisim spectrum disorder causes substantial impairment, parents of children with the condition are motivated to try treatments regardless of the evidence. Nevertheless, it is important that prescribing clinicians are explicit to parents and patients about the limited evidence, discuss the risks of treatment, and discuss other pharmacological and non-pharmacological interventions.

""";2010;;;"Low value";-;"Link to the recommendation in the NICE website" 2442;23;"Cochrane Quality and Productivity topics";"National Institute for Health and Clinical Excellence (NICE)";English;"Statins for the treatment of dementia";"""NICE summary of review conclusions

At present, evidence to recommend statins for the treatment of dementia is insufficient. Analysis from the studies available, including one large randomised control trial indicate that statins have no clear benefit on cognitive performance as measured by the ADAS-Cog or MMSE cognitive assessment scales.

Stopping or reducing the use of stains solely for the treatment of dementia outside of clinical trials is likely to lead to improved quality of patient care through reduced use of unproven interventions.

The Implications for practice section of the Cochrane review stated:

There is insufficient evidence to recommend statins for the treatment of Alzheimer?s disease or dementia. In LEADe 2010, the first large-scale randomised control trial evaluating statins as a treatment for mild-to-moderate Alzheimer's disease, the regimen of atorvastatin plus donepezil was not associated with significant benefit in clinical outcome measures over 72 weeks. When data from this trial were pooled with two smaller scale studies there was no benefit from statins seen with the primary outcome measure Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-Cog) or in Mini Mental State Examination (MMSE).

From ADCLT 2005 there was some evidence that atorvastatin treatment was more beneficial at six months in Alzheimer's disease patients with higher MMSE at baseline, those with an apolipoprotein E4 allele and higher cholesterol levels at baseline. This would need to be confirmed in larger scale studies. """;2010;;;"Low value";-;"Link to the recommendation in the NICE website" 1995;6;"Less Is More Collection - JAMA Network";"Katz M, et al. Arch Intern Med. 2010;170(9):747-748";English;"Failing the Acid Test: Benefits of Proton Pump Inhibitors May Not Justify the Risks for Many Users";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1996;6;"Less Is More Collection - JAMA Network";"Grady D, et al. Arch Intern Med. 2010;170(9):749-750";English;"Less Is More: How Less Health Care Can Result in Better Health";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1997;6;"Less Is More Collection - JAMA Network";"Gray S, et al. Arch Intern Med. 2010;170(9):765-771";English;"Proton Pump Inhibitor Use, Hip Fracture, and Change in Bone Mineral Density in Postmenopausal Women: Results From the Women's Health Initiative.";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1998;6;"Less Is More Collection - JAMA Network";"Howell MD, et al. Arch Intern Med. 2010;170(9):784-790";English;"Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 1999;6;"Less Is More Collection - JAMA Network";"Linsky A, et al. Arch Intern Med. 2010;170(9):772-778";English;"Proton Pump Inhibitors and Risk for Recurrent Clostridium difficile Infection";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2000;6;"Less Is More Collection - JAMA Network";"Wang CH, et al. Arch Intern Med. 2010;170(9):751-758";English;"High-Dose vs Non?High-Dose Proton Pump Inhibitors After Endoscopic Treatment in Patients With Bleeding Peptic Ulcer: A Systematic Review and Meta-analysis of Randomized Controlled Trials";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2001;6;"Less Is More Collection - JAMA Network";"Yachimski P, et al. Arch Intern Med. 2010;170(9):779-783";English;"Proton Pump Inhibitors for Prophylaxis of Nosocomial Upper Gastrointestinal Tract Bleeding: Effect of Standardized Guidelines on Prescribing Practice";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2002;6;"Less Is More Collection - JAMA Network";"Sawaya G, et al. Arch Intern Med. 2010;170(11):985-986.";English;"Rightsizing Cervical Cancer Screening: Comment on ?Cervical Cancer Screening With Both Human Papillomavirus and Papanicolaou Testing vs Papanicolaou Testing Alone";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2003;6;"Less Is More Collection - JAMA Network";"Saraiya M, et al. Arch Intern Med. 2010;170(11):977-986";English;"Cervical Cancer Screening With Both Human Papillomavirus and Papanicolaou Testing vs Papanicolaou Testing Alone: What Screening Intervals Are Physicians Recommending?";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2004;6;"Less Is More Collection - JAMA Network";"Avins A, et al. Arch Intern Med. 2010;170(12):1013-1014";English;"It is recommended to adapt clinical recommendations from guidelines to the each patient baseline risk. ""When Clinical Practice Guidelines Meet the Black Box""";"For further information please visit the website of the initiative (link below)";2010;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2005;6;"Less Is More Collection - JAMA Network";"Timbie J, et al. Arch Intern Med. 2010;170(12):1037-1044.";English;"Variation in the Net Benefit of Aggressive Cardiovascular Risk Factor Control Across the US Population of Patients With Diabetes Mellitus";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2006;6;"Less Is More Collection - JAMA Network";"Onder G, et al. Arch Intern Med. 2010;170(13):1142-1148.";English;"Development and Validation of a Score to Assess Risk of Adverse Drug Reactions Among In-Hospital Patients 65 Years or Older: The GerontoNet ADR Risk Score";"For further information please visit the website of the initiative (link below)";2010;;;"High value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2007;6;"Less Is More Collection - JAMA Network";"Shao YH, et al. Arch Intern Med. 2010;170(14):1256-1261.";English;"Lowering the biopsy threshold for PSA but retaining our inability to distinguish indolent from aggressive prostate cancers might increase the risk of overdiagnosis and overtreatment";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";"screening, prostate";"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2008;6;"Less Is More Collection - JAMA Network";"Patel M, et al. Arch Intern Med. 2010;170(14):1218-1225";English;"Geographic Variation in Carotid Revascularization Among Medicare Beneficiaries, 2003-2006. [Study concluding ""Significant geographic variation exists for carotid endarterectomy and carotid stenting"" in the Unites States]";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2009;6;"Less Is More Collection - JAMA Network";"Daskivich T, et al. Arch Intern Med. 2010;170(15):1396-1397.";English;"Severity of Comorbidity and Non?Prostate Cancer Mortality in Men With Early-Stage Prostate Cancer";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2010;6;"Less Is More Collection - JAMA Network";"Ablin R, et al. Arch Intern Med. 2010;170(15):1397-1399";English;"Invited Commentary?Prostate Cancer: Doing Less Might Be More: Comment on ""Severity of Comorbidity and Non?Prostate Cancer Mortality in Men With Early-Stage Prostate Cancer""";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2011;6;"Less Is More Collection - JAMA Network";"Zhang Y, et al. Arch Intern Med. 2010;170(15):1308-1314.";English;"Ambulatory Antibiotic Use and Prescription Drug Coverage in Older Adults";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2012;6;"Less Is More Collection - JAMA Network";"Mattison M, et al. Arch Intern Med. 2010;170(15):1331-1336.";English;"Preventing Potentially Inappropriate Medication Use in Hospitalized Older Patients With a Computerized Provider Order Entry Warning System";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2013;6;"Less Is More Collection - JAMA Network";"Wijeysundera D, et al. Arch Intern Med. 2010;170(15):1365-1374.";English;"Outcomes and Processes of Care Related to Preoperative Medical Consultation";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2014;6;"Less Is More Collection - JAMA Network";"Hansen M, et al. Arch Intern Med. 2010;170(16):1433-1441.";English;"Risk of Bleeding With Single, Dual, or Triple Therapy With Warfarin, Aspirin, and Clopidogrel in Patients With Atrial Fibrillation";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2015;6;"Less Is More Collection - JAMA Network";"Bell JS, et al. Arch Intern Med. 2010;170(17):1604-1605.";English;"Use of Proton Pump Inhibitors and Mortality Among Institutionalized Older People";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2016;6;"Less Is More Collection - JAMA Network";"Garfinkel D, et al. Arch Intern Med. 2010;170(18):1648-1654.";English;"Feasibility Study of a Systematic Approach for Discontinuation of Multiple Medications in Older Adults: Addressing Polypharmacy";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2017;6;"Less Is More Collection - JAMA Network";"Clarke R, et al. Arch Intern Med. 2010;170(18):1622-1631.";English;"Effects of Lowering Homocysteine Levels With B Vitamins on Cardiovascular Disease, Cancer, and Cause-Specific Mortality: Meta-analysis of 8 Randomized Trials Involving 37 485 Individuals";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 2018;6;"Less Is More Collection - JAMA Network";"Licurse A, et al. Arch Intern Med. 2010;170(21):1900-1907";English;"Don't routinely order renal Ultrasonography in the Evaluation of the patients with Acute Kidney Injury and low risk of obstruction.";"For further information please visit the website of the initiative (link below)";2010;;;"Low value";-;"Link to the article in the collection ""Less is More"" / Enlace al art�culo de la serie ""Less is More""
" 20;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.";-;2009;;;"Low value";"Back pain, low back pain, lumbar, radiography, X-ray, computed tomography, CT, magnetic resonance, MRI, radiation, pain, imaging, image";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 6710;36;"Choosing Wisely UK";"Royal Pharmaceutical Society";English;"It is recommended to adapt the pharmaceutical prescription with the patient's needs in patients aged over 18, including discontinuing or deprescribing some medicines if indicated, in order to improve adherence to medicines in patients aged 18 and over.";"This guide deals with medication adherence in people over 18 years of age. It recommends how to promote medication adherence by supporting and involving people in decisions about prescribed medications. Its goal is to ensure that a person's decision to use a drug is an informed choice.";2009;;;"High value";-;"Link to the recommendation on the website of the initiative " 1368;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Aspirin to prevent cardiovascular disease: men";"The USPSTF recommends the use of aspirin for men ages 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1369;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Aspirin to prevent cardiovascular disease: women";"The USPSTF recommends the use of aspirin for women ages 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1377;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Folic acid supplementation";"The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 �g) of folic acid. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1380;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Hepatitis B screening: pregnant women";"The USPSTF strongly recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1386;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Tobacco use counseling and interventions: nonpregnant adults";"The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1387;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Tobacco use counseling: pregnant women";"The USPSTF recommends that clinicians ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling to those who smoke. Recommendation Grade A";2009;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1389;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Syphilis screening: pregnant women";"The USPSTF recommends that clinicians screen all pregnant women for syphilis infection. Recommendation Grade A";2009;;;"High value";-;"Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 24;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use steroid enemas for treating men with radiation proctopathy.";"Steroid enemas should not be used for treating men with radiation proctopathy.";2008;;;"Low value";"enemas, steroids, cancer, neolplasm, prostate, proctopathy, postradiation, radiotherapy, radiation";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 25;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Biopsy of the prostatic bed should not be performed in men with prostate cancer who have had a radical prostatectomy.";"Biopsy of the prostatic bed should not be performed in men with prostate cancer who have had a radical prostatectomy.";2008;;;"Low value";"Biopsy, prostate, prostatic bed, cancer, neoplasia, prostatectomy";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 26;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not do magnetic mesonance (MRI) routinely in patients with prostate cancer and biochemical recurrence in whom salvage radical therapy is considered";"For men with evidence of biochemical relapse following radical treatment and who are considering radical salvage therapy, routine magnetic resonance imaging (MRI) scanning should not be performed prior to salvage radiotherapy in men with prostate cancer.";2008;;;"Low value";"Cancer, prostate, salvage, therapy, rescue, resonance, magnetic, neoplasia, radical treatment, radiotherapy";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 27;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bisphosphonates should not be used for the prevention of bone metastases in men with prostate cancer.";"Bisphosphonates should not be used for the prevention of bone metastases in men with prostate cancer.";2008;;;"Low value";"bisphosphonates, metastasis, bone cancer, neoplasia, prostate, prevention";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 28;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Bisphosphonates are not recommended routinely for preventing osteoporosis in patients with prostate cancer receiving androgen withdrawal therapy.";"Bisphosphonates should not be used routinely to prevent osteoporosis in men with prostate cancer receiving androgen withdrawal therapy.";2008;;;"Low value";"Bisphosphonates, cancer, neoplasms, prostate, osteoporosis, prevention, androgen";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 29;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Computerised tomography (CT) of the pelvis is not recommended for men with low- or intermediate-risk localised prostate cancer.";"Computerised tomography (CT) of the pelvis is not recommended for men with low- or intermediate-risk localised prostate cancer.";2008;;;"Low value";"CT, tomograhy, pevils, cancer, neoplasms, prostate";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 30;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Magnetic resonance spectroscopy is not recommended for men with prostate cancer except in the context of a clinical trial.";"Magnetic resonance spectroscopy is not recommended for men with prostate cancer except in the context of a clinical trial.";2008;;;"Low value";"magnetic resonance imaging, MRI, spectroscopy, spectroscopy, cancer, neoplasms, prostate";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 31;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Positron emission tomography imaging for prostate cancer is not recommended in routine clinical practice.";"Positron emission tomography imaging for prostate cancer is not recommended in routine clinical practice.";2008;;;"Low value";"CT, PET, cancer, neoplasms, prostate, Positron emission tomography";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 32;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Brachytherapy is not recommended for men with high-risk localised prostate cancer.";"Brachytherapy is not recommended for men with high-risk localised prostate cancer.";2008;;;"Low value";"Brachytherapy, cancer, neoplasms, prostate";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 33;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use high-intensity focused ultrasound and cryotherapy in patients with localised prostate cancer other than in the context of controlled clinical trials";"High-intensity focused ultrasound and cryotherapy are not recommended for men with localised prostate cancer other than in the context of controlled clinical trials comparing their use with established interventions .";2008;;;"Low value";"high-intensity focused ultrasound, cryotherapy, prostate, cancer, neoplasms, localised";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa " 34;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Routine digital rectal examination (DRE) is not recommended in men with localised prostate cancer while the prostate-specific antigen (PSA) remains at baseline levels.";"Routine digital rectal examination (DRE) is not recommended in men with localised prostate cancer while the prostate-specific antigen (PSA) remains at baseline levels.";2008;;;"Low value";neoplasms;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 35;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"The injection of bulking agents into the distal urinary sphincter is not recommended to treat stress incontinence. (patients with prostate cancer)";"The injection of bulking agents into the distal urinary sphincter is not recommended to treat stress incontinence. (patients with prostate cancer)";2008;;;"Low value";"cancer, neoplasms, prostate";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 36;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Adjuvant hormonal therapy in addition to radical prostatectomy is not recommended other than in the context of a clinical trial*";"*Even in men with margin-positive disease.

Evidence

""Evidence about neoadjuvant and adjuvant hormonal therapy comes from a systematic review (Kumar et al. 2006) of 21 randomised controlled trials.

-Adjuvant therapy with radical prostatectomy

Randomised trials report significant toxicity with adjuvant therapy in addition to radical prostatectomy (Kumar et al. 2006). With the exception of one small trial in node-positive men (Messing et al. 1999), these trials have not demonstrated significant benefit in overall survival. It is possible that modest survival benefits will emerge with longer follow-up.""";2008;;;"Low value";"cancer, neoplasms, prostate";"

Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa

" 1370;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Bacteriuria screening: pregnant women";"The USPSTF recommends screening for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later. Recommendation Grade A";2008;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1374;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Cholesterol abnormalities screening: men 35 and older";"The USPSTF strongly recommends screening men age 35 years and older for lipid disorders. Recommendation Grade A";2008;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1375;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Cholesterol abnormalities screening: women 45 and older";"The USPSTF strongly recommends screening women age 45 years and older for lipid disorders if they are at increased risk for coronary heart disease. Recommendation Grade A";2008;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1376;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Colorectal cancer screening";"The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. Recommendation Grade A";2008;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1383;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Hypothyrodism screening: newborns";"The USPSTF recommends screening for congenital hypothyroidism in newborns. Recommendation Grade A";2008;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 5807;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Active local educational interventions involving secondary care specialists and structured referral sheets are recommended to improve referral rates for outpatients";"In this systematic review, the authors searched for comparative effectiveness studies of interventions to change or improve outpatient referrals aimed at primary care physicians. They did their most recent search in October 2007. They included 17 studies evaluating professional educational (9 studies), organisational (4) and financial interventions (4), mostly conducted in the UK. They also identified an additional three articles, which are awaiting assessment. Passive dissemination of local referral guidelines, feedback on referral rates, and discussion with an independent medical advisor did not lead to improvements in referral behaviors. The effects of financial interventions on quality of referral are uncertain.";2008;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 3;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Do not use Clopidogrel as first-line monotherapy after an myocardial infarction";"Clopidogrel should not be offered as first-line monotherapy after an myocardial infarction (MI).";2007;;;"Low value";"Clopidogrel, myocardial infarction";"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa
" 1371;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Blood pressure screening in adults";"The USPSTF recommends screening for high blood pressure in adults age 18 years and older. Recommendation Grade A";2007;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1379;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Hemoglobinopathies screening: newborns";"The USPSTF recommends screening for sickle cell disease in newborns. Recommendation Grade A";2007;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 5791;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Ventilation measures in built environment are recommended to control the transmission and spread of airborne infectious agents, but the ventilation requirements is uncertain";"Physical interventions intended to prevent and control the transmission of airborne infectious agents should interrupt or reduce the spread of COVID-19. Research on the role of ventilation in the built environment may provide evidence to help with the choice of these interventions. In this systematic review, the authors searched for articles reporting on the contribution to the spread of airborne infectious diseases of indoor ventilation rates and the airflow patterns and on the minimum ventilation requirements to minimize transmission of airborne infectious diseases. They restricted their searches to articles published in English and did the search in March 2005. They included 40 articles and convened a multidisciplinary consensus panel to evaluate the content of these studies. There is strong and sufficient evidence of an association between ventilation measures and the control of transmission and spread of airborne infectious agents such as SARS and influenza; but the ventilation requirements to minimize airborne transmission of infectious agents in settings such as hospitals, schools, offices and other buildings is uncertain.";2007;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2645;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Paroxetine and venlafaxine should not be used for the treatment of depression in children and young people.";-;2005;;;"Low value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2646;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Tricyclic antidepressants should not be used for the treatment of depression in children and young people.";-;2005;;;"Low value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2647;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antidepressant medication should not be used for the initial treatment of children and young people with mild depression.";-;2005;;;"Low value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2648;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Antidepressant medication should not be offered to a child or young person with moderate to severe depression except in combination with a concurrent psychological therapy.";-;2005;;;"Low value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 2649;1;"NICE ";"National Institute for Health and Clinical Excellence (NICE)";English;"Electroconvulsive Therapy (ECT) is not recommended in the treatment of depression in children (5-11 years).";-;2005;;;"Low value";Depression;"Link to the recommendation on the website of the initiative / Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5480;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA";Spanish;"Wash your hands with soap and water when they are visibly dirty or contaminated with proteinaceous material, or visibly stained with blood or other bodily fluids, or when there are reasonable suspicions or tests of exposure to organisms with the ability to sporulate, as well like after going to the bathroom.";"Wash your hands with soap and water when they are visibly dirty or contaminated with proteinaceous material, or visibly stained with blood or other bodily fluids, or when there are reasonable suspicions or tests of exposure to organisms with the ability to sporulate (IB), as well like after going to the bathroom (II).";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5481;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"In all other clinical situations described in sections C (a) to C (f) below, even if the hands are not visibly dirty, preferably use friction with an alcoholic preparation for systematic antisepsis of the hands ( IA), or wash your hands with soap and water (IB).";"Even if the hands are not visibly dirty, preferably use friction with an alcoholic preparation for systematic antisepsis of the hands ( IA), or wash your hands with soap and water (IB).";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5482;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"Proceed to hand hygiene: before and after direct contact with patients; after removing gloves; before handling an invasive device; after contact with body fluids or excretions, mucosa, non-intact skin or wound dressings; attending the patient, when moving from an area of the body contaminated to another clean; after coming into contact with inanimate objects (including medical equipment).";"Proceed to hand hygiene: a) before and after direct contact with patients (IB); b) after removing gloves (IB); c) before handling an invasive device (whether gloves are worn or not) as part of patient care (IB); d) after contact with body fluids or excretions, mucosa, non-intact skin or wound dressings (IA); e) attending the patient, when moving from an area of the body contaminated to another clean (IB); f) after coming into contact with inanimate objects (including medical equipment) in the immediate vicinity of the patient (IB);";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5483;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"Wash your hands with water and a simple or antimicrobial soap, or rub them with an alcoholic preparation before handling medications or preparing food.";"Wash your hands with water and a simple or antimicrobial soap, or rub them with an alcoholic preparation before handling medications or preparing food (IB).";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5484;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"Do not use antimicrobial soaps when an alcoholic preparation for hand wash has already been used.";"Do not use antimicrobial soaps when an alcoholic preparation for hand friction has already been used (II).";2005;;;"Low value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5485;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"If the hands are visibly dirty, wash them with a common soap before proceeding to preoperative antisepsis; and, with a nail cleaner, under the open tap, remove the dirt that is under the nails.";"If the hands are visibly dirty, wash them with a common soap before proceeding to preoperative antisepsis (II). With a nail cleaner, under the open tap, remove the dirt that is under the nails (II).";2005;;;"High value";prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5486;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA ";Spanish;"It is recommended to remove rings, watches and bracelets before starting preoperative antisepsis on the hands. Artificial nails are prohibited.";"Remove rings, watches and bracelets before starting preoperative antisepsis on the hands (II). Artificial nails (IB) are prohibited.";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5487;34;"WHO recommendations";"DIRECTRICES DE LA OMS SOBRE HIGIENE DE LAS MANOS EN LA ATENCI�N SANITARIA";Spanish;"Proceed with the preoperative antisepsis of the hands by washing them with an antimicrobial soap or rubbing them with an alcoholic preparation, preferably insistently, before putting on the sterile gloves.";"Proceed with the preoperative antisepsis of the hands by washing them with an antimicrobial soap or rubbing them with an alcoholic preparation, preferably insistently, before putting on the sterile gloves (IB).";2005;;;"High value";Prevention;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 1385;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Rh incompatibility screening: first pregnancy visit";"The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. Recommendation Grade A";2004;;;"High value";-;"Link to the recommendations on the U.S. Preventive Services Task Force website / Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 1388;15;"U.S. Preventive Services Task Force A and B recommendations";"U.S. Preventive Services Task Force";English;"Syphilis screening: nonpregnant persons";"The USPSTF strongly recommends that clinicians screen persons at increased risk for syphilis infection. Recommendation Grade A";2004;;;"High value";-;"Enlace a las recomendaciones en la p�gina web de la U.S. Preventive Services Task Force" 5803;35;"Evidencias COVID-19";"Coronavirus (COVID-19): Evidence Collection. Evidence Aid";English;"Telephone consultation and triage are recommended to reduce the number of immediate visits to physicians, with equivalent levels of satisfaction compared to face-to-face appointments";"The COVID-19 pandemic is placing a strain on healthcare services and resources. Existing research on strategies that might ease this, such as telephone consultation and triage services, might provide useful information for policy makers. In this Cochrane review, the authors searched for comparative effectiveness studies of telephone consultation or triage in a general healthcare setting. They did not restrict their searches by date, type or language of publication and did the most recent searches in July 2007 (when no new studies were found to add to those in the existing review). They included five randomized trials, one controlled clinical trial and three interrupted time series studies. From the studies available at the time of the review, telephone consultation and triage appeared to decrease the number of immediate visits to physicians without, apparently, increasing visits to the hospital, and patients reported equivalent levels of satisfaction with medical procedures. telephone consultations than with face-to-face appointments. In the studies available at the time of the review, it was uncertain whether the introduction of telephone consultations simply delayed visits to a later time.";2004;;;"High value";Management;"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 5365;35;"Evidencias COVID-19";"Cochrane - Colecci�n Especial - medidas de prevenci�n y control de la infecci�n";Spanish;"There is uncertainty about the use of gowns for the prevention of mortality, infection or bacterial colonization in neonates admitted to a neonatal intensive care unit or a newborn unit";"Newborns, particularly those admitted to neonatal intensive care units, are at risk of contracting a variety of bacterial, viral, and fungal infections. High infection rates among newborns are due to low resistance to disease-causing agents, exposure to endemic pathogens in the newborn unit, prolonged use of central venous catheters, and exposure to intrauterine infections. Various barrier methods are used to control cross infection in hospitals. Gowns are an infection control barrier method often used to restrict the spread of infection. It is common for service staff and visitors to wear gowns in some newborn nurseries and neonatal intensive care wards. They are thought to help prevent the spread of nosocomial infections and to remind staff and visitors to wash their hands before contacting the newborn. The objective of this review was to evaluate the effects of the use of the gown by service personnel and visitors for the prevention of infection and death in neonates within newborn nurseries. The main results are: 1. Eight trials were included, reporting the results of 3811 infants. 2. The quality of the trials was highly variable, only two trials were of good quality. 3. The use of gowns was not associated with a reduction in the mortality rate 4. The use of gowns did not influence the incidence of systemic nosocomial infection 5. In general, the use of gowns does not produce significant effects on the incidence of colonization, the length of hospital stay or the frequency of hand washing. 6. No trials were found on the use of gowns by visitors This systematic review does not demonstrate that the use of gowns is effective in preventing mortality, infection, or bacterial colonization in neonates admitted to the nursery. The use of gowns in neonatal intensive care settings has not been tested using randomized, controlled study designs";2003;;;Uncertain;"Prevention COVID-19";"Link to the recommendation on the website of the initiative/ Enlace a la recomendaci�n en la p�gina web de la iniciativa" 6756;36;"Choosing Wisely UK";"Royal College of Obstetricians and Gynaecologists";English;"It is not recommended ultrasound be used to check if a baby is bigger than normal for its gestational age (macrosomia), unless the mother has diabetes.";"The diagnosis of fetal macrosomia is imprecise. For suspected fetal macrosomia, the accuracy of estimated fetal weight using ultrasound biometry is no better than that obtained with clinical palpation (Leopold's maneuvers).";2001;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 6743;36;"Choosing Wisely UK";"Faculty of Intensive Care Medicine";English;"It is not recommended order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions.";"Many diagnostic studies (including chest radiographs, arterial blood gases, blood chemistries and counts and electrocardiograms) are ordered at regular intervals (e.g., daily). Compared with a practice of ordering tests only to help answer clinical questions, or when doing so will affect management, the routine ordering of tests increases health care costs, does not benefit patients and may in fact harm them. Potential harms include anemia due to unnecessary phlebotomy, which may necessitate risky and costly transfusion, and the aggressive work-up of incidental and non-pathological results found on routine studies.";2000;;;"Low value";Diagnosis;"Link to the recommendation on the website of the initiative" 6745;36;"Choosing Wisely UK";"Faculty of Intensive Care Medicine";English;"It is not recommended transfuse red blood cells in hemodynamically stable, non-bleeding ICU patients with a hemoglobin concentration greater than 7 mg/dL.";"Most red blood cell transfusions in the ICU are for benign anemia rather than acute bleeding that causes hemodynamic compromise. For all patient populations in which it has been studied, transfusing red blood cells at a threshold of 7 mg/dL is associated with similar or improved survival, fewer complications and reduced costs compared to higher transfusion triggers. More aggressive transfusion may also limit the availability of a scarce resource. It is possible that different thresholds may be appropriate in patients with acute coronary syndromes, although most observational studies suggest harms of aggressive transfusion even among such patients.";2000;;;"Low value";Treatment.;"Link to the recommendation on the website of the initiative" 6748;36;"Choosing Wisely UK";"Faculty of Intensive Care Medicine";English;"It is not recommended deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation.";"Many mechanically ventilated ICU patients are deeply sedated as a routine practice despite evidence that using less sedation reduces the duration of mechanical ventilation and ICU and hospital length of stay. Several protocol-based approaches can safely limit deep sedation, including the explicit titration of sedation to the lightest effective level, the preferential administration of analgesic medications prior to initiating anxiolytics and the performance of daily interruptions of sedation in appropriately selected patients receiving continuous sedative infusions. Although combining these approaches may not improve outcomes compared to one approach alone, each has been shown to improve patient outcomes compared with approaches that provide deeper sedation for ventilated patients.";2000;;;"Low value";Treatment.;"Link to the recommendation on the website of the initiative"