Orvosi vizsgálatok és kezelések, amiktől óvakodni kell

Minden 4 páciensből 1 valamilyen orvosi tévedés áldozata az Egyesült Államok kórházaiban a New England Journal of Medicine riportja szerint.

Az orvosok mostanában elkezdtek visszalépni olyan orvosi tesztektől mint a mammográfia vagy a PSA mell vagy prosztatarák szűrés “érdekében”, mert egzre inkább kiderül, hogy több veszélyt rejt magában, mint amennyi hasznot hajt.  134 túlzásbavitt vagy kifejezetten veszélyes orvosi tesztet illetve kezelést sorol fel az American Board of Internal Medicine Foundation, ami a ChoosingWhisely.org weboldalán részletesen olvasható. http://www.choosingwisely.org/

Ez itt egy rövid válogatás nőknek és gyerekeknek

Ne ismételd évente rutinszrűen a Pap smer tesztet 30 és 65 év között.

Normális rizikófaktorok esetén az évi méhnyakrák szűrés nem mutat jobb eredményeket, mint a 3évenként ismétlődő papsmer.

However, a well-woman visit should occur annually for patients with their health care practitioner to discuss concerns and problems, and have appropriate screening with consideration of a pelvic examination.

Ne ajánlj követő vizsgálatgyanánt sugázás segítségével vizuális képet alkotó teszteket következetlen petefészek ciszták előfordulása után.

Simple cysts and hemorrhagic cysts in women of reproductive age are almost always physiologic. Small simple cysts in postmenopausal women are common, and clinically inconsequential. Ovarian cancer, while typically cystic, does not arise from these benign-appearing cysts. After a good quality ultrasound in women of reproductive age, don’t recommend follow-up for a classic corpus luteum or simple cyst <5 cm in greatest diameter. Use 1 cm

as a threshold for simple cysts in postmenopausal women.

Ne imsételd rutinosan a DXA szkent gyakrabban, mint 2 évente. (Csontritkulást ellenőrző vizsgálat)

Initial screening for osteoporosis should be performed according to National Osteoporosis Foundation recommendations. The optimal interval for repeating Dual-energy X-ray Absorptiometry (DXA) scans is uncertain, but because changes in bone density over short intervals are often smaller than

the measurement error of most DXA scanners, frequent testing (e.g., <2 years) is unnecessary in most patients. Even in high-risk patients receiving

drug therapy for osteoporosis, DXA changes do not always correlate with probability of fracture. Therefore, DXAs should only be repeated if the result

will influence clinical management or if rapid changes in bone d

ensity are expected. Recent evidence also suggests that healthy women age 67 and

older with normal bone mass may not need additional DXA testing for up to ten years provided osteoporosis risk factors do not significantly change.

Ne használj  PET (positron emission tomography)-t, CT (computed tomography)-t vagy radionukleáris csont szkent korai mellrák esetén, ha alacsony az áttétel esélye.  

• Imaging with PET, CT, or radionuclide bone scans can be useful in the staging of specific cancer types. However, these tests are often used in the staging evaluation of low-risk cancers, despite a lack of evidence suggesting they improve detection of metastatic disease or survival.

• In breast cancer, for example, there is a lack of evidence demonstrating a benefit for the use of PET, CT, or radionuclide bone scans in asymptomatic individuals with newly identified ductal carcinoma in situ (DCIS), or clinical stage I or II disease.

• Unnecessary imaging can lead to harm through unnecessary invasive procedures, over-treatment, unnecessary radiation exposure, and misdiagnosis.

Ne alkalmazz urinary katétert  inkontinencia esetén, és akkor sem, ha nem súlyosan beteg páciensek állapotát figyeld. (acceptable

indications: critical illness, obstruction, hospice, perioperatively for <2 days for urologic procedures; use weights instead to monitor diuresis).

Catheter Associated Urinary Tract Infections (CAUTIs) are the most frequently occurring health care acquired infection (HAI). Use of urinary catheters for incontinence or convenience without proper indication or specified optimal duration of use increases the likelihood of infection and is commonly associated with greater morbidity, mortality and health care costs. Published guidelines suggest that hospitals and long-term care facilities should develop, maintain and promulgate policies and procedures for recommended catheter insertion indications, insertion and maintenance techniques, discontinuation strategies and replacement indications.

Antibiotikumok alkalmazása kerülendő felismerhetően vírusos légzőszervi megbetegedések esetén. (sinusitis, pharyngitis, bronchitis).

Although overall antibiotic prescription rates for children have fallen, they still remain alarmingly high. Unnecessary medication use for viral respiratory illnesses can lead to antibiotic resistance and contributes to higher health care costs and the risks of adverse events.

Computed tomography (CT) szken nem szükségesalasó hasi fájdalom rutinvizsgálatához.

Utilization of CT imaging in the emergency department evaluation of children with abdominal pain is increasing. The increased lifetime risk for cancer due to excess radiation exposure is of special concern given the acute sensitivity of children’s organs. There also is the potential for radiation overdose with inappropriate CT protocols.

Ne használj PET/CT-t rákszűrés gyanánt egészséges embereken.

• The likelihood of finding cancer in healthy adults is extremely low (around 1%), based on studies using PET/CT for screening.

• Imaging without clear clinical indication is likely to identify harmless findings that lead to more tests, biopsy or unnecessary surgery.

Ne használj nukleáaris gyógyszert pjzsmirigy működés tesztjeként, ha a pajzsmirigy normálisan működik.

• Nuclear medicine thyroid scanning does not conclusively determine whether thyroid nodules are benign or malignant.

• Cold nodules on thyroid scans will still require biopsy.

• Nuclear medicine thyroid scans are useful to evaluate the functional status of thyroid nodules in patients who are hyperthyroid