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Evolution of Experience and Practise in Two Nations
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
The wide experience of two nations has certainly made me wiser. Multiple treatment options for EOS are available to us, and each has its advantages and disadvantages. ‘Choosing wisely’ enables us to provide the best care [61]. Therefore, I choose techniques that are tailored to the individual patient’s needs to achieve the best long-term functional outcome. Amongst all these differences, practising in India is much more satisfying because most patients are still inordinately grateful. It is a little more gratifying to apply the skill and knowledge gained from training in the NHS in treating such complex spinal problems.
Reengineering Data Analytics
Published in Paul Cerrato, John Halamka, Reinventing Clinical Decision Support, 2020
Although data analytics and ML will play an important role in clinical medicine over the next several years, there is also evidence to show it is already having an impact on the financial side of medicine. Among the most significant initiatives that are having an effect on healthcare expenditure is the Choosing Wisely program that was launched by several national organizations in 2012 to limit the number of unnecessary tests and procedures performed on patients.12 The list of questionable tests and procedures is quite long, including routine cholecystectomy for patients with asymptomatic cholelithiasis; routine use of ultrasound in evaluating clinically apparent inguinal hernia; and screening for genital herpes simplex virus infection in asymptomatic adults, including pregnant women.
Learning health systems
Published in Graham C. M. Watt, The Exceptional Potential of General Practice, 2018
‘Choosing Wisely’, the title of an American programme reducing low-value care, is a key issue (7). It is easy to get sidetracked into trying to ‘boil the ocean’ and sort out the political mantra of the moment rather than evidence-based policies. In 2014, the local CCGs were mandated to support ‘integrated care’ based on an American idea that because 80% of the health care resources were used by 20% of high-risk patients, targeting these high-risk patients would reduce hospital admission (8).
Embedding planetary health concepts in a pre-medical physiology subject
Published in Medical Teacher, 2023
Christian Moro, Michelle McLean, Charlotte Phelps
Bearing in mind these barriers, this study set out to explore the feasibility of embedding planetary health concepts, which incorporated a ‘did you know’ fact relevant to the content, along with a written solution and reference for further reading, into an existing first-year Physiology subject. It drew on the recommendation of the recent Association for Medical Education in Europe Consensus Statement on Planetary Health and Education for Sustainable Healthcare, co-authored by 35 educators and students in several health professions, to integrate planetary health in the curriculum (Shaw et al. 2021). As an example of how this was undertaken in the Physiology subject, in a session in which medical imaging was indicated, a single ‘fact’ mentioned that the contrast agent commonly used for some magnetic resonance imaging (MRI) scans contains gadolinium, which, after excretion by the patient a few days later, cannot be removed by the municipal sewerage treatment facilities, and becomes toxic to fish life around the plant’s wastewater efflux (Inoue et al. 2020). While this information should not impact a clinician’s decision when an MRI is necessary, it should influence the clinician’s decision to select, when appropriate, a less environmentally harmful imaging modality or to not request any imaging if there are no red flags such as for lower back pain (Choosing Wisely Australia 2022).
Frequency and estimated costs of ten low-value practices in the Spanish primary care: a retrospective study
Published in Expert Opinion on Drug Safety, 2022
Kamila Cheikh-Moussa, Johanna Caro Mendivelso, Irene Carrillo, María Pilar Astier-Peña, Guadalupe Olivera, Carmen Silvestre, Marian Nuín, José Joaquín Mira
The Choosing Wisely initiative successfully increased the attention of worldwide public healthcare systems to address the right use of resources and its consequences as it has been done in the past for the inappropriate underuse or misuse [26]. LVPs are present in all healthcare system levels [15,26]. In countries where primary care is highly frequented by patients, as the gateway to the healthcare system, it is necessary to adopt effective measures to reduce LVPs and thus also the associated risk for the patient and the extra cost to the system [23]. That is the case in Spain, where the annual rate of visits to primary care is more than seven times per person. Based on the ABIM Foundation’s general parameters, each country adopted an unrecommended LVPs list [7]. The consensus reached in Spanish societies identifies 10 LVPs in primary care, and the SOBRINA research team protocol was designed to detect its frequency considering the differences in treatment and disease classification coding (ICD9 or ICD10, or/and the international classification of primary care ICPC-2) and the extent of this analysis demonstrate the considerable differences that persist in the daily practice [23].
Overutilization in laboratory medicine: tackling the problem with quality improvement science
Published in Critical Reviews in Clinical Laboratory Sciences, 2021
Daniel R. Beriault, Julie A. Gilmour, Lisa K. Hicks
The Choosing Wisely campaign enlisted numerous medical professional societies to identify specific instances of inappropriate or unnecessary care. The societies were asked to provide a list of tests, treatments and procedures commonly used in their field that were not supported by evidence or where potential harms were anticipated to outweigh benefits in most cases [10]. The Choosing Wisely effort began in the United States where it was spearheaded by the American Board of Internal Medicine (ABIM) Foundation. At the time of writing, the partnership of more than 80 organizations with the ABIM has resulted in more than 550 recommendations [22]. The Choosing Wisely campaign has also spread to more than 20 countries. In Canada, the campaign has produced more than 60 lists of recommendations, many of which have a laboratory focus [23].