12 medical tests and procedures now being questioned worldwide as unnecessary
Doctors are often criticized for prescribing unneeded tests and procedures that harm more than they help and add to medical costs that could otherwise be avoided. 12 medical tests and procedures now being questioned worldwide as unnecessary and potentially cause — sometimes harmful results to patients. Since a campaign was launched last year, more than 130 tests and procedures have been called into question by 25 medical specialty societies with more than 500,000 member doctors. “Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better,” said Dr. Christine Cassel,Â president of the ABIM Foundation. “Through these lists of tests and procedures, we hope to encourage conversations between physicians and patients about what care they truly need.”
United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures. See the full list
12 MEDICAL TESTS TO AVOID
1. Avoid Inducing Labor or C-Section Before 39 Weeks
Delivery prior to 39 weeks is associated with increased risk of learning disabilities, respiratory problems and other potential risks. While sometimes induction prior to 39 weeks is medically necessary, the recommendation is clear that simply having a mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery. (American College of Obstetricians and Gynecologists; American Academy of Family Physicians)
2. Avoid Routine Annual Pap Tests
In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage. (American College of Obstetricians and Gynecologists)
3. Avoid CT Scans To Evaluate Minor Head Injuries
Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may escalate future cancer risk. CT technology exposes patients to approximately 100 times the radiation of a standard chest X-ray which itself increases the risk of cancer. The recommendation calls for clinical observation prior to making a decision about needing a CT. (American Academy of Pediatrics)
4. Avoid Stress Tests Using Echocardiographic Images
The recommendation states that there is very little information on the benefit of using stress echocardiography in asymptomatic individuals for the purposes of cardiovascular risk assessment, as a stand-alone test or in addition to conventional risk factors. (American Society of Echocardiography)
5. Avoid Prescribing Type 2 Diabetes Medication To Achieve Tight Glycemic Control
The recommendation states that there is no evidence that using medicine to tightly control blood sugar in older diabetics is beneficial. In fact, using medications to strictly achieve low blood sugar levels is associated with harms, including higher mortality rates. (American Geriatrics Society)
6. Avoid EEGs (electroencephalography) on Patients With Recurrent Headaches.
Recurrent headache is the most common pain problem, affecting up to 20 percent of people. The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs. (American Academy of Neurology)
7. Avoid Routinely Treating Acid Reflux
Anti-reflux therapy, which is commonly prescribed in adults, has no demonstrated effect in reducing the symptoms of gastroesophageal reflux disease (GERD) in infants, and there is emerging evidence that it may in fact be harmful in certain situations. (Society of Hospital Medicine)
ADDITIONAL MEDICAL TESTS TO BE AVOIDED
8. Avoid Lipid Profile Tests
Lipid Profile test checks various parameters of blood, such as cholesterol (good or high density lipoprotein as well as bad or low density lipoprotein) and triglyceride levels. Several scientific papers have proven that people with high so-called “bad” LDL cholesterol live the longest and there is noow a large number of findings that contradict the lipid hypothesis that cholesterol has to be lowered at all.
9. Avoid Mammograms
Mammograms and breast screening have had no impact on breast cancer deaths and have actually been found to increase breast cancer mortality. With toxic radiation, mammogram testing compresses sensitive breast tissue causing pain and possible tissue damage. To make matters worse, the false negative and false positive rates of mammography are a troubling 30% and 89% respectively. Another concern is that many breast cancers occur below the armpits; however, mammography completely misses this auxiliary region, viewing only the breast tissue compressed between two plates of glass. Considering these drawbacks, breast thermography should be given closer consideration. Thermography is a non-invasive and non-toxic technique which can detect abnormalities before the onset of a malignancy, and as early as ten years before being recognized by mammography. This makes it much safer and potentially life-saving health test for women who are unknowingly developing abnormalities, as it can take several years for a cancerous tumor to develop and be detected by a mammogram.
10. Avoid PSA Testing
A PSA blood test looks for prostate-specific antigen, a protein produced by the prostate gland. High levels are supposedly associated with prostate cancer. The problem is that the association isn’t always correct, and when it is, the prostate cancer isn’t necessarily deadly. Nearly 20 percent of men will be diagnosed with prostate cancer, which sounds scary, but only about 3 percent of all men die from it. The PSA test usually leads to overdiagnosis — biopsies and treatment in which the side effects are impotence and incontinence. Moreover, there is some evidence which suggests that biopsies and treatment actually aggravate prostate cancer. During a needle biopsy, a tumor may need to be punctured several times to retrieve an amount of tissue that’s adequate enough to be screened. It is believed that this repeated penetration may spread cancer cells into the track formed by the needle, or by spilling cancerous cells directly into the bloodstream or lympathic system.
11. Avoid Routine Colorectal Cancer Screening
Colorectal cancer screening often results in unnecessary removal of benign polyps which are of no threat to patients and the risks of their treatment or removal far exceed any benefit. The evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.
12. Avoid DEXA
Dual energy X-ray absorptiometry (DEXA or DXA) in a technique developed in the 1980s that measures, among many things, bone mineral density. The scans can determine bone strength and signs of osteopenia, a possible precursor to osteoporosis. Limitations abound, though. Measurements vary from scan to scan of the same person, as well as from machine to machine. DEXA doesn’t capture the collagen-to-mineral ratio, which is more predictive of bone strength than just mineral density. And higher bone mineral density doesn’t necessarily mean stronger bones, for someone with more bone mass will have more minerals but could have weaker bones.
Doctors view for LOVE
1) Psychiatric == Love is just like coin. .one side mania other side depression
2) Physician == Love is like heart beat only atrium(she) and ventrical(he) should trust …..
3) Surgery == Love is like laparotomy easy to open but difficult to close….
4) opthalmologist == Love is just like clear pupil smooth and delicate but small misunderstanding can make cataract
5) Radiologist == Love is like plain X ray simple and transparent
6) Gynaecologist == Love is like full term pregnancy having sweet sweet memories inside. …..
7) Orthopaedic == Love is like vertical bone always support the life but emotional trauma makes fracture. ….
8) Anaesthetist == Love is like short GA shows the person sweet dreams. …..
9) Microbiologist == Bacteria of Love is dangerous than virus, no antibiotic can have sensitivity
10) Paediatrician == Love is like new born baby, pure & delicate expecting only milk & care, but one careless lead to malnutrition
11) Forensic medicine expert == Love is like spiritual and natural power, nobody can do its postmortem. …..
12) Pharmacologist == Love is like a drug always cures the disease but too much dose shows the side effects.
13) Physiotherapist == Love is like SWD’s deep tissue heating,, too much heat can damage the tissue.
Doctor की शादी
कुछ इस तरह से होनी चाहिये की
लगे की doctor की शादी है…..
बारात ambulance में जाये
शादी hospital में हो
Photo की जगह x-ray लिया जाये
मेहमानों को cold drink की जगह glucose या ors
खाने मे vitamin c की गोली
वरमाला की जगह stethoscope
और मजा तो तब आये
जब doctor शादी के बाद बोले……
Posted from WordPress for Android – Google Nexus 5
Venous blood gases (VBG) are widely used in the emergency setting in preference to arterial blood gases (ABG) as a result of research published since 2001
The weight of data suggests that venous pH has sufficient agreement with arterial pH for it to be an acceptable alternative in clinical practice for most patients
Nevertheless acceptance of this strategy has been limited by some specialties and maybe inappropriate in some settings; for instance there is no data to confirm that this level of agreement is maintained in shock states or mixed acid-base disturbances
Clinically acceptable limits of agreement for blood gas parameters remains poorly defined
ARTERIAL BLOOD GAS PROS AND CONS
gold standard test for determining the arterial metabolic millieu (pH, PaCO2, HCO3)
can determine PaO2
pH, PCO2 (if normocapnic), HCO3 and base excess from a VBG are usually adequate for clinical decision making
SpO2 is usually sufficient for clinical decision making unless pulse oximetry is unreliable for other reasons (e.g. shock state, poor pick up)
painful (should be performed with local anaesthetic in conscious patients)
increased risk of bleeding and hematoma
risk of pseudo aneurysm and AV fistula
injury to staff
delays in care
serial exams may be needed
venous sampling may better represent the tissue milieu
CORRELATION BETWEEN VBG AND ABG
pooled mean difference: +0.035 pH units
good correlation in normocapnia
non-correlative in severe shock
100% sensitive in detecting arterial hypercarbia in COPD exacerbations using cutoff of PaCO2 45 mmHg and laboratory based testing (McCanny et al, 2012), i.e. if VBG PCO2 is normal then hypercapnia ruled out (PaCO2 will be normal), though this conflicts with the meta-analysis by Byrne et al 2014 (see below)
correlation dissociates in hypercapnia – values correlate poorly with PaCO2 >45mmHg
Mean difference pCO2 +5.7 mmHg (wide range in 95%CIs among different studies, on the order of +/-20 mmHg)
A more recent meta-analysis by Byrne et al, 2014 found that the 95% prediction interval of the bias for venous PCO2 was −10.7 mm Hg to +2.4 mm Hg. They note that in some cases the PvCO2 was lower than the PaCO2. The meta-analysis had considerable heterogeneity between studies which limits the reliability of its conclusions.
Mean difference −1.41 mmol/L (−5.8 to +5.3 mmol/L 95%CI)
Dissociation above 2 mmol/L
Mean difference 0.08 (-0.27 – 0.42 95%CI)
Mean difference 0.089 mmol/L (–0.974 to +0.552 95%CI)
PO2 values compare poorly
arterial PO2 is typically 36.9 mm Hg greater than the venous with significant variability (95% confidence interval from 27.2 to 46.6 mm Hg) (Byrne et al, 2014)
VBG can be used to guide management in preference to ABG (Ma et al, 2003)
VBG correlated with ABG well
Mean difference in pH -0.015 ± 0.006 units [95% CI]
ABG pH changed treatment or disposition in 2.5% cases compared to VBG pH
WHEN IS ABG NECESSARY?
ABG may be necessary:
to accurately determine PaCO2 in severe shock
to accurately determine PaCO2 if hypercapnic (i.e. PaCO2 >45 mmHg)
to accurately determine arterial lactate >2mM (rarely necessary)
In general, ABGs rarely need to be performed unless an arterial line is in place (for arterial blood pressure monitoring and ease of blood sampling)
References and Links
1. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014 Jan 3. doi: 10.1111/resp.12225. [Epub ahead of print] PubMed PMID: 24383789. [Free Full Text]
2. Kelly AM. Review article: Can venous blood gas analysis replace arterial in emergency medical care? Emerg Med Australas. 2010 Dec;22(6):493-8. doi: 10.1111/j.1742-6723.2010.01344.x. Review. PubMed PMID: 21143397. [Free Full Text]
3. Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001 Sep;18(5):340-2. PMID 11559602
4. Koul PA, Khan UH, Wani AA, Eachkoti R, Jan RA, Shah S, Masoodi Z, Qadri SM, Ahmad M, Ahmad A. Comparison and agreement between venous and arterial gas analysis in cardiopulmonary patients in Kashmir valley of the Indian subcontinent. Ann Thorac Med. 2011 Jan;6(1):33-7. PMID 21264169
5. Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med. 2003 Aug;10(8):836-41. PMID 12896883
6. McCanny P, Bennett K, Staunton P, McMahon G. Venous vs arterial blood gases in the assessment of patients presenting with an exacerbation of chronic obstructive pulmonary disease. Am J Emerg Med. 2012 Jul;30(6):896-900. PMID 21908141
7. Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Emerg Med J. 2006 Aug;23(8):622-4. PMID16858095
8. Tricia M McKeever et al : Using venous blood gas analysis in the assessment of COPD exacerbations: a prospective cohort study –
Thorax doi:10.1136 thoraxjnl-2015-207573
1. ALIEM — Paucis Verbis Card: VBG versus ABG (2012)
4. LITFL – VBG versus ABG
Posted from WordPress for Android – Google Nexus 5
Posted from WordPress for Android – Google Nexus 5