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British physicians draw up list of 40 procedures of little to no benefit

Choosing Wisely — an initiative led by the American Board of Internal Medicine to reduce waste in the healthcare system in the U.S. — was launched in the U.K. Monday.

Part of the Choosing Wisely U.K. launch, which is led by the Academy of Medical Royal Colleges, was the publication of a list of 40 unnecessary but common treatments, BBC reported. The list includes treatment recommendations that aim to reduce healthcare spending, such as that tap water is as good as saline solution for cleaning small cuts, or that bronchiolitis in children often resolves itself without treatment, according to the report.

The campaign also recommends patients ask their physician or nurse the following five questions to help inform care decisions.

  1. Do I really need this test, treatment or procedure?
  2. What are the risks or downsides?
  3. What are the possible side effects?
  4. Are there simpler, safer options?
  5. What will happen if I do nothing?

The full list of recommendations was created by experts in 11 specialties and incorporates feedback from patient groups. It includes nearly 50 recommendations, most of which advise clinicians against unnecessary action. Here are the 40 treatments experts recommended avoiding.

  1. Patients who have had the proper preoperative assessments and preparation do not need to be seen the day before surgery.
  2. Routine preoperative tests are usually not necessary before minor or intermediate surgery.
  3. Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.
  4. Plaster casts are usually not required for pediatric “buckle fractures,” or fractures on one side of the wrist. Splints are usually sufficient.
  5. Plaster casts are not required for small fractures of the base of the fifth metatarsal, a bone on the outside of the foot. A removable boot is sufficient.
  6. General anesthetic and an operating room is not required for injuries like hip and shoulder dislocations. They can be treated with sedation in the emergency department.
  7. Sterile saline is unnecessary for cleaning wounds. Tap water is just as effective.
  8. Frail patients who are near death do not need continue all medications, only those that control symptoms, unless otherwise advised by the patient or patient advocate.
  9. Screening groups of patients for dementia is unnecessary. Providers should be aware of the possibility of dementia when treating individual patients.
  10. Prescription drugs to treat blood pressure and prevent heart disease or stroke are not necessary unless blood pressure is consistently above 140-159/90-99 in people with additional risk factors.
  11. Imaging is not required for a women suspected of polycystic ovaries until a blood test has been taken to look for hormone patterns.
  12. Routine cholesterol monitoring is not necessary if a patient takes the recommended dose of statins, unless other risk factors exist.
  13. Women with unexplained, recurrent miscarriages should not use drugs such as aspirin, heparin or progesterone to maintain a pregnancy.
  14. Pregnant women should not use aspirin to reduce the development of blood clots.
  15. Ultrasound scans to see if a baby is bigger than normal are unnecessary unless the mother has diabetes.
  16. A small ovarian cyst in a pre-menopausal woman does not require follow up, nor blood testing for levels of the protein CA-125.
  17. Babies’ hearts do not require electronic monitoring during labor unless the mother is at a higher risk of complications than normal.
  18. Children with positional plagiocephaly should not be prescribed helmet therapy.Other treatment options should be discussed.
  19. Lactulose should not be used for children with chronic constipation. First, diet and lifestyle changes should be tried, and Polyethylene Glycol (Miralax) should be used if those changes do not help.
  20. Rectal and intravenous diazepam should not be used in treatment of pediatric and youth seizures. Instead, buccal midazolam or lorazepam should be used.
  21. Children with mild or moderate acute bronchiolitis do not need bronchodilators.
  22. Prostate-specific antigen-based screening does not extend life expectancy unless a patient has a family history or predisposition to prostate cancer.
  23. Calcium testing is not necessary multiple times within three months except in acute conditions of kidney stones, bone disease or nerve-related disorders are present, or during major surgery or for critically ill patients. In those cases, testing is not necessary multiple times within 48 hours.
  24. Transfusing platelets for patients with chemotherapy-induced thrombocytopenia is not necessary if the platelet count is greater than 10 x 109/L. Patients with clinical significant bleeding or who will be undergoing a procedure with a high risk of bleeding are exempt from this.
  25. No more than one unit at a time should be used for patients who need red cell transfusions, unless the patient is actively bleeding.
  26. O Rh D negative red cells should only be transfused to O Rh D negative patients, unless a female of childbearing potential has a medical emergency and her blood group is unknown.
  27. Valproate should not be prescribed to pregnant women or those planning a pregnancy for mental disorders. The drug should only be used in these cases if other treatments have been resisted or in high risk clinical situations.
  28. CT or MRI scans are not necessary when psychosis is diagnosed unless specific indications of signs or symptoms suggest neurological problems.
  29. Chemotherapy should be minimized in advanced cancer treatment if it is unlikely to be beneficial and may cause harm.
  30. Imaging is not necessary for minor head injuries.
  31. Uncomplicated back pain does not require imaging, unless associated with ‘red flags’ or radicolupathy.
  32. Routine scanning after cancer treatment is only necessary when beneficial to the patient.
  33. Patients at high risk of death or severely impaired functional recovery should not go on life support. Comfort should be prioritized.
  34. Routine tests and investigations are unnecessary and should only be use to answer specific questions.
  35. Blood transfusions are not necessary when hemoglobin is above 70 g/L, unless the patient is unstable or actively bleeding.
  36. Deep sedation is unnecessary for patients who are mechanically ventilated.
  37. Abnormal vaginal discharge caused by thrush or bacterial vaginosis, when occuring in a woman at low risk for a sexually transmitted infection, does not require a vaginal swab.
  38. A woman with recurrent thrush should not be given additional courses of treatment. Instead, a skin examination should be conducted to determine if she has allergies, lack of estrogen or another condition.
  39. Women over the age of 45 with typical symptoms of menopause do not require bloods tests to check hormone levels.
  40. Women who have a copper intrauterine device or hormonal intrauterine system do not need professional advice unless they cannot feel the threads hanging from the device.

Editor’s note: This article was updated Wednesday, Oct. 26 at 11:20 a.m. CT to include the full list of recommendations.