Vascular Surgery Archives - Choosing Wisely Italia

Do not request a Duplex scan as a first level test for lower limb arterial disease, in patients that are asymptomatic or with mild claudication. Measure instead the Ankle Brachial Index (ABI).

ACP

Avoid the habitual use of inhaled corticalsteroids in upper respiratory tract infections in children.

In absence of medical indications do not prescribe formula or liquids other than breast milk to newborns in the first weeks of life.

Do not prescribe antibiotics for viral acute respiratory tract diseases (ear infections, sinusitis, pharyngitis, bronchitis)

Do not prescrive chest x-ray for diagnosis and follow-up of uncomplicated pneumonia in children

ADI

Don’t follow “elimination” or fasting diets. These are specific nutritional approaches for some pathologies and only physicians can recommend them.

Do not encourage the extensive and indiscriminate use of vitamin and mineral supplements as preventive elements for cancer and cardiovascular disease.

Obese people of any age are not to be blamed. The stigma of obesity worsens the condition of those who are affected.

Do not follow Occidental style diets with high environmental impact. Only healthy diets such as the Mediterranean diet can guarantee the physical health of individuals and of the planet.

AICPR

Don’t perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery

Don’t perform Computed Tomography for coronary calcium score in patients at high cardioascular risk

Don’t perfom Holter electrocardiographic monitoring in patients suffering from syncope, near syncope o dizziness, in whom a non arrhytmic origin has been documented

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

Avoid routine use of Infective endocarditis profilaxis in mild to moderate native valve disease

AIFI

Do not use continuous passive mobilization (CPM) devices for postsurgical treatment of knee ligament reconstructions or uncomplicated hip or knee arthroplasties.

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.

Do not use specific exercises of selective strengthening of the vastus medialis obliquus (VMO) in patellofemoral pain syndrome.

Do not use ultrasound therapy for rotator cuff tendinopathy, ankle sprains and low back pain.

Do not teach or have patients with acute or chronic respiratory diseases practice diaphragmatic breathing.

AIGO

Prescribe fecal occult blood test (FOBT) only for screening of colorectal cancer.

Don’t repeat esofagogastroduodenoscopy (EGDS) for a patient that has been diagnosed with a gastroesophageal reflux disease, with or without hiatal hernia, in absence of new symptoms.

Once the diagnosis is established, don’t prescribe systematic abdominal ultrasound checkup in asymptomatic patients with epathic angiomas < 30 mm in diameter.

Don’t prescribe proton pump inhibitors (PPI) during steroid therapy or for long periods with patients that exhibit dyspeptic symptoms.

AIGO

Do not request surveillance investigations for patients with pancreatic cysts who are poor surgical candidates, irrespective of cysts nature and characteristics

Do not request esophagogastroduodenoscopy in patients with recent onset of upper gastrointestinal symptoms younger than 50 years, without alarm features

Do not request surveillance colonoscopy for asymptomatic colonic diverticular disease without changes in symptoms

Do not perform food intolerance tests except for those scientifically validated

Do not prescribe proton pump inhibitors to patients with liver cirrhosis, outside of established indications

AIGO

Do not prescribe endoscopic examination when low-waste, less invasive alternatives endorsed by evidence-based clinical guidelines are available.

Do not take mucosal biopsies when the histopathological results would not change the patient management.

Do not plan most elective endoscopic procedures on an inpatient basis if they can be performed safely without hospitalization, to avoid overnight hospital stays.

Do not use single use endoscopes regularly as they should be reserved for highly selected patients, on a case-by-case basis (immunocompromised patients or those with multidrug-resistant bacteria).

Do not abuse of periprocedural and intraprocedural medication and prefer their use only when strictly indicated (e.g. avoid inadequate antibiotic prophylaxis and saline fluid intravenous solution)

AIMN

Don’t use 18F-FDG (Fluorodeoxyglucose) PET-CT as a “screening” test for cancer in healthy subjects.

Don’t perform PET/CT with [18F]FDG (Fluorodeoxyglucose) in suspected peripheral osteomyelitis and in differential diagnosing between acute and chronic infection.

Don’t perform lymphoscintigraphy and radioguided biopsy of the sentinel node in patients affected by cutaneous melanoma thinner than 0.75 mm, with no ulceration and mitotic rate <1/mm2

AIRO

Do not recommend the use of “special” techniques or radiation therapy machines without having previously obtained the recommendation by a radiation oncologist.

Do not neglect to offer radiotherapy delivered with hypofractionated schedules when the scientific evidence is already available.

Do not use, to the extent possible, prolonged radiation therapy for palliative treatments in frail patients with a short life expectancy

Limit the use of diagnostic procedures in case of low-risk prostate and breast cancer. Avoid the use of serum biomarkers in early stage breast cancer.

AIURO

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.

Don’t carry out the assessment of pain without using standardized scales in the immediate post-operative period.

Unless there is any complication, don’t renew the dressing of the surgical site in the first 48 hours after surgery.

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.

AMD

Don’t use the ‘sliding scale insulin therapy’ for the treatment of hyperglycemia in hospitalized patients.

Don’t prescribe routine glucose self-monitoring to Type 2 diabetes patients who are being treated with drugs that do not cause hypoglycemia.

Don’t prescribe screenings for diabetes complications that are not in accordance with the national guidelines.

Don’t treat diabetes patients indiscriminately with antiplatelet drugs.

Don’t perform routine measurement of C-peptide in diabetes patients.

AME

Avoid excess bone density testing: intervals less than two years are rarely necessary.

Use of free testosterone testing is not recommended for hypogonadism or hyperandrogenism diagnosis.

Do not prescribe the dosage of FT3 (free triiodothyronine) for the initial evaluation of the functional state of the thyroid and in the periodic control of hypothyroidism in therapy.

Thyroid nodules patients should not be treated with L-thyroxine except in selected cases.

AMGE

Don’t prescribe a medication without conducting a drug regimen review (medication reconciliation)

Don’t use antimicrobials to treat asymptomatic bacteriuria in older adults

Don’t let older adults lie in bed all day during their hospital stay unless they’re terminally ill or they’ve got a specific medical advice

ANDRIA

Don’t clamp the umbilical cord before 1 minute in neonates that do not need immediate resuscitation manouvres.

Don’t use continous cardiotocography (CTG) during labour of women at low risk for hypoxia.

Don’t routinely require general blood tests, general coagulation tests or tests for trombophylia to prescribe hormonal contraceptive medications.

Don’t require a pelvic exam or other physical exam to prescribe oral contraceptive medications.

Don’t schedule elective, non medically indicated inductions of labour or Cesarean deliveries before 39 weeks 0 days gestational age.

ANIARTI

Don’t replace regularly the mechanical ventilator circuits to reduce the risk of VAP (Ventilator Associated Pneumonia)

Don’t routinely use personal protective equipment (gowns, masks, hats, gloves, ….) for the access of family members in ICU

Don’t perform endotracheal aspirations at regular intervals but according to early indicators of retention of bronchial secretions.

Don’t replace peripheral venous catheters at regular intervals but based on clinical evaluation.

Don’t maintain routine preoperative fasting since the midnight preceding the elective surgery.

ANIMO

Don’t make regular use of restraint as a falls risk management tool.

Don’t resort to bladder catheterization for managing incontinence or performing simple diagnostic tests.

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.

Don’t follow the mobilization protocols and those for the treatment of pressure sores as “standard” protocols in the dying patient.

ANIPIO

Do not use gloves as an alternative to hand hygiene with alcohol solution for performing non-biological care work, especially in the presence of a patient with multi-drug resistant organisms (MDRO).

Do not use antiseptic products routinely in addition to or in place of normal detergent in the pre-operative bath/shower.

Do not maintain precautionary isolation upon symptom resolution in patients with Clostridium difficile diarrhoea.

Do not replace surgical dressings before 48 hours have elapsed from the operation.

ANMCO

Don’t perform exercise stress test as part of routine follow-up in asymptomatic patients after surgical or percutaneous revascularization.

Don’t perform 24 hour Holter monitoring in patients with effort chest pain who can perform exercise stress test, unless arrhythmias should be investigated.

Don’t routinely perform stress cardiac imaging test during the initial evaluation of suspected ischemic heart disease.

Don’t perform exercise stress test as screening of ischemic heart disease in asymptomatic patients at low cardiovascular risk

ANMDO

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.

Never administer antibiotics for perioperative prophylaxis before 60 minutes prior to surgical incision*; the ideal time is upon induction of anesthesia.

Do not open the doors of the operating room during the surgical activity, except where necessary for the passage of patients, staff and equipment.

Do not forget to indicate in the patient health documentation (discharge letter or document for transfer to another healthcare facility) any positivity to alert microorganisms *

AOGOI

Don’t proceed to the early clamping (before 1 minute after birth) of the umbilical cord.

Don’t perform routine episiotomy apart from when there are clear clinical indications.

Don’t proceed to induction of labour before 39 weeks of gestation if appropriate maternal or fetal indications are lacking.

Don’t schedule routine repeated cesarean section (CS) in all the pregnant women with a previous cesarean section.

Don’t force to fasting and don’t forbid fluid intake during labour.

CIPOMO-Green Oncology

Don’t prescribe antibiotics to prevent infectious complications from neutropenia in cancer patients treated with standard dose chemotherapy.

Don’t routinely prescribe serum cancer markers during the diagnostic or staging procedures in cancer care.

Don’t routinely use cancer-directed therapy for solid tumor patients with low performance status (3 or 4) or progressive after 2-3 therapeutic lines, but prioritize palliative care.

Don’t prescribe neither chemotherapy nor radiotherapy in the treatment of ductal carcinoma in situ of the breast.

CNF

Don’t recommend enteral nutrition (PEG, percutaneous endoscopic gastrostomy or naso-gastric feeding tube) in patients with advanced dementia; instead offer oral assisted feeding.

Don’t use antipsychotics as the first choice to treat behavioral symptoms of dementia, avoiding prescription before careful evaluation and removal of precipitating factors.

Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia.

CNF

Do not perform an electroencephalogram (EEG) to patients who have experienced only transient loss of consciousness and have normal neurological examination and no history of epileptic symptoms.

COMLAS