Inappropriate Use of Thyroid Ultrasound Is Common in Clinical Practice

Abstract The aim of this study was to evaluate the clinical practice of CR mammography in Tanzania. The equipment performance and operational conditions were studied; and mean glandular dose (DG) estimated to 75 women undergoing diagnosis at three mammography facilities. All mammograms during this study were reported to be useful for the intended diagnosis. The median DG for craniocaudal and mediolateral oblique projections ranged from 1.27 ± 0.18 mGy to 1.9 ± 0.27 mGy and from 1.3 ± 0.18 mGy to 1.9 ± 0.27 mGy, respectively, and were below the national regulatory guidance of 2.5 mGy. Despite this positive result, unavoidable inappropriate use of beam quality and tube loading settings which could have been through appropriate staff training and performing routine quality control were not uncommon. This work provides an insight of current operational conditions of CR in Tanzania and what strategy should be employed to this service to improve patient care in the country.

Download Full-text

Big data registries in spine surgery research: the lurking dangers

BMJ evidence-based medicine ◽

10.1136/bmjebm-2019-111333 ◽

2020 ◽

pp. bmjebm-2019-111333

Author(s):

Chad F Claus ◽

Evan Lytle ◽

Daniel A Carr ◽

Doris Tong

Keyword(s):

Big Data ◽

Clinical Practice ◽

Spine Surgery ◽

Easy Access ◽

Inappropriate Use ◽

Number Of Patients ◽

Surgery Research ◽

National Databases ◽

Proper Interpretation ◽

Quality Evidence

Spine surgery research has improved considerably over the last few decades. Its’ most recent growth is in large part due to the mounting increase in studies conducted using national databases and registries. With easy access to a large number of patients, the benefit of these registries has become evident. However, as with any research, this type of data must be used responsibly with the appropriate strengths and limitations kept in mind. Inappropriate use of these registries continues to be a growing concern as potentially false or inaccurate conclusions can adversely impact clinical practice. It is, therefore, the author and the readers’ responsibility to acknowledge and understand the limitations of this type of data. Knowledge of methodological requirements in the use and analyses of registry data is essential to ensuring quality evidence with proper interpretation.

Download Full-text

Inappropriate use of thyroid ultrasound: a systematic review and meta-analysis

Endocrine ◽

10.1007/s12020-021-02820-z ◽

2021 ◽

Author(s):

Matthew K. Edwards ◽

Nicole M. Iñiguez-Ariza ◽

Naykky Singh Ospina ◽

Eddy Lincango-Naranjo ◽

Spyridoula Maraka ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Thyroid Ultrasound ◽

Inappropriate Use

Download Full-text

Clinical Practice Guideline: Hoarseness (Dysphonia)

Otolaryngology ◽

10.1016/j.otohns.2009.06.744 ◽

2009 ◽

Vol 141 (1_suppl) ◽

pp. 1-31 ◽

Cited By ~ 212

Author(s):

Seth R. Schwartz ◽

Seth M. Cohen ◽

Seth H. Dailey ◽

Richard M. Rosenfeld ◽

Ellen S. Deutsch ◽

...

Keyword(s):

Clinical Practice ◽

Head And Neck ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Voice Therapy ◽

Evidence Based ◽

Inappropriate Use ◽

Vocal Effort

Objective: This guideline provides evidence-based recommendations on managing hoarseness (dysphonia), defined as a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL). Hoarseness affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness. Purpose: The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech-language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology–head and neck surgery, pediatrics, and consumers. Results The panel made strong recommendations that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL. The panel made recommendations that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL; 2) the clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti-reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as options that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti-reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate/counsel patients with hoarseness about control/preventive measures. Disclaimer: This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.

Download Full-text

Non-steroidal anti-inflammatory drug effects on renal and cardiovascular function: from physiology to clinical practice

European Journal of Preventive Cardiology ◽

10.1177/2047487319848105 ◽

2019 ◽

Vol 27 (8) ◽

pp. 850-867 ◽

Cited By ~ 3

Author(s):

Aderville Cabassi ◽

Stefano Tedeschi ◽

Stefano Perlini ◽

Ignazio Verzicco ◽

Riccardo Volpi ◽

...

Keyword(s):

Clinical Practice ◽

Drug Effects ◽

Daily Practice ◽

The Elderly ◽

Drug Induced ◽

Inflammatory Drug ◽

Inappropriate Use ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

Cyclooxygenase 2 Inhibitors

Excessive or inappropriate use of non-steroidal anti-inflammatory drugs can affect cardiovascular and renal function. Non-steroidal anti-inflammatory drugs, both non-selective and selective cyclooxygenase 2 inhibitors, are among the most widely used drugs, especially in the elderly, with multiple comorbidities. Exposition to a polypharmacy burden represents a favourable substrate for the onset of non-steroidal anti-inflammatory drug-induced deleterious effects. Cardiovascular and renal issues concerning the occurrence of myocardial infarction, atrial fibrillation, heart failure and arterial hypertension, as well as acute or chronic kidney damage, become critical for clinicians in their daily practice. We discuss current available knowledge regarding prostanoid physiology in vascular, cardiac and renal systems, pointing out potential negative non-steroidal anti-inflammatory drug-related issues in clinical practice.

Download Full-text

Ultrasound grading of thyroid nodules using the BTA U-scoring guidelines – Is there evidence of intra-and interobserver variability?

Ultrasound ◽

10.1177/1742271x20971323 ◽

2020 ◽

pp. 1742271X2097132

Author(s):

Michael Couzins ◽

Stuart Forbes ◽

Ganesh Vigneswaran ◽

Indu Mitra ◽

Elizabeth E Rutherford

Keyword(s):

Clinical Practice ◽

Thyroid Nodules ◽

Interobserver Variability ◽

Imaging Modality ◽

Scoring Systems ◽

Intraobserver Variability ◽

Thyroid Ultrasound ◽

Scoring Method ◽

Doppler Flow ◽

Ultrasound Classification

Introduction U-score ultrasound classification (graded U1-U5) is widely used to grade thyroid nodules based on benign and malignant sonographic features. It is well established that ultrasound is an operator-dependent imaging modality and thus more susceptible to subjective variances between operators when using imaging-based scoring systems. We aimed to assess whether there is any intra- or interobserver variability when U-scoring thyroid nodules and whether previous thyroid ultrasound experience has an effect on this variability. Methods A total of 14 ultrasound operators were identified (five experienced thyroid operators, five with intermediate experience and four with no experience) and were asked to U-score images from 20 thyroid cases shown as a single projection, with and without Doppler flow. The cases were subsequently rescored by the 14 operators after six weeks. The first and second round U-scores for the three operator groups were then analysed using Fleiss’ kappa to assess interobserver variability and Cochran’s Q test to determine any intraobserver variability. Results We found no significant interobserver variability on combined assessment of all operators with fair agreement in round 1 (Fleiss’ kappa = 0.30, p <0.0001) and slight agreement in round 2 (Fleiss’ kappa = 0.19, p < 0.0001). Cochran’s Q test revealed no significant intraobserver variability in all 14 operators between round 1 and round 2 (all p>0.05). Conclusions We found no statistically significant inter- or intraobserver variability in the U-scoring of thyroid nodules between all participants reinforcing the validity of this scoring method in clinical practice, allaying concerns regarding potential subjective biases in reporting.

Download Full-text

Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary

Otolaryngology ◽

10.1177/0194599816689660 ◽

2017 ◽

Vol 156 (3) ◽

pp. 403-416 ◽

Cited By ~ 28

Author(s):

Neil Bhattacharyya ◽

Samuel P. Gubbels ◽

Seth R. Schwartz ◽

Jonathan A. Edlow ◽

Hussam El-Kashlan ◽

...

Keyword(s):

Clinical Practice ◽

Head And Neck ◽

Clinical Practice Guideline ◽

Practice Guideline ◽

Benign Paroxysmal Positional Vertigo ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Inappropriate Use ◽

Positional Vertigo ◽

Paroxysmal Positional Vertigo

The American Academy of Otolaryngology—Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology–Head and Neck Surgery featuring the “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).” To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.

Download Full-text

339. Assessing Utilization of the Venereal Disease Research Laboratory Test in Cerebrospinal Fluid for the Diagnosis of Neurosyphilis: A Cohort Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.534 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S239-S240

Author(s):

Terin Sytsma ◽

Elitza Theel ◽

Zelalem Temesgan ◽

Michel Toledano

Keyword(s):

Cerebrospinal Fluid ◽

Cohort Study ◽

Clinical Practice ◽

False Positive ◽

Research Laboratory ◽

Venereal Disease ◽

Venereal Disease Research Laboratory ◽

Inappropriate Use ◽

Disease Research ◽

False Positivity

Abstract Background The Venereal Disease Research Laboratory (VDRL) test performed in cerebrospinal fluid (CSF) is considered highly specific for the diagnosis of neurosyphilis, but algorithms to diagnose neurosyphilis require positive syphilis serologic testing prior to obtaining CSF-VDRL. Inappropriate use of diagnostic tests depletes healthcare resources, and contributes to rising healthcare expenditures. CSF-VDRL has historically been improperly utilized; however there is no recent evaluation of its use in clinical practice. We aimed to quantify rates of appropriate CSF-VDRL testing, determine the CSF-VDRL false-positivity rate and describe causes of false-positive CSF-VDRL reactivity. Methods In this retrospective cohort study of three Mayo Clinic sites (Rochester, MN, Jacksonville, FL, and Scottsdale, AZ), we measured the rate of appropriate CSF-VDRL test utilization in patients with negative testing from January 1, 2011 to December 31, 2017. We then identified all patients with positive CSF-VDRL testing from January 1, 1994 to February 28, 2018, characterized true- and false-positive rates and described causes of CSF-VDRL false-positivity. Results Among 8,553 persons with negative CSF-VDRL results, testing was unnecessarily ordered in 8,399 (98.2%). The word “syphilis” or “neurosyphilis” appeared in the notes of only 1,184 (13.8%) individuals with a negative CSF-VDRL result. From January 1994 through February 2018, 33,933 CSF-VDRL tests were performed on 32,626 individual patients. Among 60 positive CSF-VDRL results, 41 (68.3%) were true-positives, 2 (3.3%) were indeterminate, and 17 (28.3%) were false-positives. Every patient with true-positive CSF-VDRL had positive serologic syphilis testing prior to CSF testing. All patients with false-positive CSF-VDRL results were inappropriately tested. Neoplastic meningitis was a common cause of false-positive CSF-VDRL results. Conclusion This is the first study in decades to review CSF-VDRL utilization for the diagnosis of neurosyphilis. Inappropriate use of CSF-VDRL testing for diagnosis of neurosyphilis remains problematic in clinical practice. Following recommended testing algorithms would prevent unnecessary testing, preserve resources, and minimize false-positive results. Disclosures All Authors: No reported disclosures

Download Full-text

Serum Tumor Markers in Paraneoplastic Neurologic Syndromes: A Systematic Review of Guidelines

Frontiers in Neurology ◽

10.3389/fneur.2020.607553 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chiara Trevisiol ◽

Ilaria Cani ◽

Aline S. C. Fabricio ◽

Massimo Gion ◽

Bruno Giometto ◽

...

Keyword(s):

Clinical Practice ◽

Tumor Markers ◽

Dissemination And Implementation ◽

Circulating Biomarkers ◽

Neurologic Disorder ◽

Onconeural Antibodies ◽

Inappropriate Use ◽

Literature Searches ◽

Common Framework ◽

Paraneoplastic Neurologic Syndromes

Purpose: Algorithms for the detection of a malignancy in patients with unclear neurologic symptoms of suspicious paraneoplastic origins are not universally applied. Frequently, circulating tumor markers (TMs) are considered a valuable tool for cancer diagnosis in patients with paraneoplastic neurologic syndromes (PNS). Our aim was to extract the recommendations on the use of TMs and onconeural antibodies (Abs) for the diagnosis of malignancies in PNS from clinical practice guidelines and put them forward as evidence in a common framework to facilitate diffusion, dissemination, and implementation.Methods: Systematic literature searches were performed for guidelines on both oncology and PNS published since 2007. Guidelines containing information and recommendations for clinical practice pertaining to the screening and diagnosis of PNS were selected. Information on circulating TMs and onconeural Abs was extracted and synthesized in consecutive steps of increasing simplification.Results: We retrieved 799 eligible guidelines on oncology for the potential presence of information on PNS but only six covered treated diagnosis or the screening of cancer in PNS, which were then selected. Seventy-nine potentially relevant guidelines on PNS were identified as eligible and 15 were selected. Synoptic tables were prepared showing that classical TMs are not recommended for the screening or the diagnosis of a malignancy in patients with a suspected PNS. Neither should onconeural Abs be considered to screen for the presence of a malignancy, although they could be helpful to define the probability of the paraneoplastic origin of a neurologic disorder.Conclusion: The present work of synthesis may be a useful tool in the diffusion, dissemination, and implementation of guideline recommendations, potentially facilitating the decrease of the inappropriate use of circulating biomarkers for cancer screening in the presence of PNS.

Download Full-text

Appropriateness in Echocardiography

European Cardiology Review ◽

10.15420/ecr.2012.8.1.23 ◽

2012 ◽

Vol 8 (1) ◽

pp. 23

Author(s):

Rosa Sicari ◽

Lauro Cortigiani ◽

◽

Keyword(s):

Clinical Practice ◽

Clinical Outcomes ◽

Present Article ◽

Healthcare System ◽

Routine Clinical Practice ◽

Appropriateness Criteria ◽

Inappropriate Use ◽

Non Invasive ◽

Contemporary Medicine ◽

The Impact

Appropriateness is the new imperative of contemporary medicine. In the words of the American College of Cardiology Foundation (ACCF), ‘Appropriate echocardiograms are those that are likely to contribute to improving patients’ clinical outcomes, and importantly, inappropriate use of echocardiography may be potentially harmful to patients and generate unwarranted costs to the healthcare system’. The appropriateness criteria issued by the ACCF stem from a real practical need to reduce costs and avoid the abuse and misuse of non-invasive imaging technologies. Even though very often cited and referred to, these criteria have not yet had a real impact on routine clinical practice. The present article assesses the impact of the ACCF criteria on the basis of the available evidence.

Download Full-text