scholarly journals Choosing wisely in cardiology: Five proposals from the Italian Association for Cardiovascular Prevention and Rehabilitation

2019 ◽  
Vol 89 (2) ◽  
Author(s):  
Marika Werren ◽  
Roberto Copetti ◽  
Nicola Gaibazzi ◽  
Franco Giada ◽  
Andrea Faggiano ◽  
...  
Keyword(s):  
Calcium Score ◽  
Cardiovascular Prevention ◽  
Choosing Wisely ◽  
Native Valve ◽  
Italian Association ◽  
Less Is More ◽  
Electrocardiographic Monitoring ◽  
Slow Medicine ◽  
Bleeding Prophylaxis ◽  
Chest X Ray

We do not always accomplish what is best for our patients. Is “more procedures, more drugs” a real synonym of good and always useful medicine? Probably not. Indeed, it has been highlighted that many tests and treatments, widely used in medical practice, do not bring benefits to patients, but can be harmful. So, why do we keep performing them? Many reasons, surely one of the main is the constant fear of malpractice legal-medical consequences; this led to the development of a defensive medicine, no longer focused on the health of the patient. For this reason, the Italian Association of Cardiac Prevention and Rehabilitation (GICR-IACPR) joined an international project “Choosing Wisely”, supported by the Slow Medicine Initiative, a network which states that “Less is more”. The purpose of the “Choosing Wisely” project is to improve the quality and safety of health services through the reduction of practices that, according to available scientific knowledge, do not bring significant benefits to the patients, but can, on the opposite, expose them to risks. This GICR-IACPR paper proposes to avoid five widespread practices in cardiology, at risk for inappropriateness and lacking of clinical evidence of benefit: i) do not perform routine chest X-ray in patients entering rehabilitation programme after cardiac surgery; ii) do not perform Computed Tomography for coronary calcium score in patients at high cardiovascular risk; iii) do not perform Holter electrocardiographic monitoring in patients suffering from syncope, near syncope or dizziness, in whom a non-arrhythmic origin has been documented; iv) do not routinely prescribe proton pump inhibitors (PPI) for gastrointestinal bleeding prophylaxis in patient with single drug antiplatelet therapy in absence of additional risk factors; v) avoid routine use of infective endocarditis prophylaxis in mild to moderate native valve disease.

scholarly journals Sobrediagnóstico e tratamento excessivo: Médicos generalistas - é hora de uma revolução na medicina

2016 ◽  
Vol 11 (38) ◽  
pp. 1-5 ◽  
Author(s):  
Julian Treadwell ◽  
Margaret McCartney
Keyword(s):  
Choosing Wisely ◽  
Less Is More ◽  
Slow Medicine

Práticas médicas ineficientes e prejudiciais sempre estiveram conosco, mas a escala e institucionalização do sobrediagnóstico e do tratamento excessivo se expandiram exponencialmente nas últimas décadas.Este tema tem sido articulado em movimentos mundiais, tais como as conferências para Prevenção de Sobrediagnóstico, e campanhas como “Medicina em Demasia” (“Too Much Medicine”), do BMJ, “Menos é Mais” (“Less is More”) da JAMA, o movimento italiano “Desacelerem a Medicina” (“Slow Medicine”) e o projeto “Escolhendo com Inteligência” (“Choosing Wisely”), dos EUA (e agora internacional). (...)

scholarly journals Estimation of the Overuse of Preoperative Chest X-rays According to “Choosing Wisely”, “No Hacer”, and “Essencial” Initiatives: Are They Equally Applicable and Comparable?

2020 ◽  
Vol 17 (23) ◽  
pp. 8783
Author(s):  
Jorge Vicente-Guijarro ◽  
José Valencia-Martín ◽  
Paloma Moreno-Nunez ◽  
Pedro Ruiz-López ◽  
José Mira-Solves ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Choosing Wisely ◽  
X Rays ◽  
X Ray ◽  
Relative Value ◽  
Wide Variability ◽  
Chest X Ray ◽  
American Society ◽  
Practice Methods ◽  
Preoperative Chest

Background: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. Methods: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to “Choosing Wisely”, “No Hacer” and “Essencial” initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. Results: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the “No Hacer” recommendation and 73.3% according to “Choosing Wisely” and “Essencial” criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to “Choosing Wisely” and “Essencial”; 4.1% according to “No Hacer”). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to “No Hacer” and EUR 3895.29 (2276.1 Relative Value Units) according to “Choosing Wisely” or “Essencial” criteria. Conclusions: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

scholarly journals Slow Medicine and Choosing Wisely: a synergistic alliance

2022 ◽  
Vol 4 ◽  
pp. e4222
Author(s):  
Marco Bobbio ◽  
Sandra Vernero ◽  
Domenico Colimberti ◽  
Andrea Gardini
Keyword(s):  
Internal Medicine ◽  
Health Professionals ◽  
Choosing Wisely ◽  
New Paradigm ◽  
Professional Societies ◽  
Appropriate Care ◽  
Effective Care ◽  
Slow Medicine ◽  
Quality Principles ◽  
The World

Choosing Wisely® is an initiative of the American Board of Internal Medicine Foundation to help physicians and patients engage in conversations about the overuse of tests and procedures and support physician efforts to help patients make smart and effective care choices. Choosing Wisely campaigns are now active and present in 25 countries around the world, on five continents. Italy is the only country where a Choosing Wisely campaign was launched, and it is currently steered by a Nationwide association (Slow Medicine), creating a synergistic alliance. The Slow Medicine Association was founded in 2011 when a group of health professionals and citizens shared a new paradigm of values, methodology, and interventions and decided to establish an association with the mission of working for a health system driven by ethics and quality principles. Three keywords summarize the philosophy of Slow Medicine: measured because it acts with moderation, gradualness, and without waste; respectful because it is attentive to the dignity of individuals recognizing their values; and equitable because it is committed to ensuring appropriate care based on the best available evidence. Slow Medicine allowed the spread of Choosing Wisely in Italy involving several professional societies and participating at the National meetings of the Societies as well as numerous other meetings, in which the mission of the Association is combined with the principle of the ‘do not’ recommendations. Numerous other initiatives were carried out, and new projects were planned in synergy with Choosing Wisely.

scholarly journals The Italian Survey on Cardiac Rehabilitation - 2008 (ISYDE-2008). Part 3. National availability and organization of cardiac rehabilitation facilities. Official report of the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiolog

2016 ◽  
Vol 70 (4) ◽  
Author(s):  
Roberto Tramarin ◽  
Marco Ambrosetti ◽  
Stefania De Feo ◽  
Massimo Piepoli ◽  
Carmine Riccio ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Prevention ◽  
Phase Iii ◽  
Day Hospital ◽  
Physical Medicine ◽  
Italian Association ◽  
Physical Medicine And Rehabilitation

From January 28th to February 10th 2008, the Italian Association for Cardiovascular Prevention, Rehabilitation and Epidemiology (IACPR-GICR) conducted the ISYDE- 2008 study, the primary aim of which was to take a detailed snapshot of cardiac rehabilitation (CR) provision in Italy – in terms of number and distribution of facilities, staffing levels, organization and setting – and compare the actual CR provision with the recommendations of national guidelines for CR and secondary prevention. The secondary aim was to describe the patient population currently being referred to CR and the components of the programs offered. Out of 190 cardiac rehabilitation centers existing in Italy in 2008, 165 (87%) took part in the study. On a national basis, there is one CR unit every 299,977 inhabitants: in northern Italy there is one CR unit every 263,578 inhabitants, while in central and southern Italy there is one every 384,034 and 434,170 inhabitants, respectively. The majority of CR units are located in public hospitals (59%), the remainder in privately owned health care organizations (41%). Fifty-nine percent are located in hospitals providing both acute and rehabilitation care, 32% are in specifically dedicated rehabilitation structures, while 8% operate in the context of residential long term care for chronic conditions. Almost three-quarters of CR units currently operating are linked to dedicated cardiology divisions (74%), 5% are linked to physical medicine and rehabilitation divisions, 2% to internal medicine, and 19% to cardiac surgery and other divisions. Inhospital care is provided by 62.4% of the centers; outpatient care is provided on a day-hospital basis by 10.9% of facilities and on an ambulatory basis by 20%. The CR units are led in 86% of cases by a cardiologist and in only 14% of cases by specialists in internal medicine, geriatrics, physical medicine and rehabilitation, pneumology or other disciplines. In terms of staffing, each cardiac rehabilitation unit has 4.0±2.7 dedicated physicians (range 1-16, mode 2), 10.1±8.0 nurses, 3.3±2.5 physiotherapists (range 0 – 20; 16% of services have no physiotherapist in the rehabilitation team), 1.5±0.8 psychologists, and a dietitian (present in 62% of CR units). Phase II CR programs are available in 67.9% of cases in residential (inpatient) and in 30.9% of cases in outpatient (day-hospital and ambulatory) settings. Phase III programs are offered by 56.4% of the centers in ambulatory outpatient regime, and on an at home basis by 4.8% with telecare supervision, 7.3% without. Long term secondary prevention follow up programs are provided by 42.4% of CR services.

scholarly journals Choosing wisely in Allergology: a Slow Medicine approach to the discipline promoted by the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC)

2015 ◽  
Vol 13 (1) ◽  
Author(s):  
Enrico Heffler ◽  
Massimo Landi ◽  
Silvana Quadrino ◽  
Cristoforo Incorvaia ◽  
Stefano Pizzimenti ◽  
...  
Keyword(s):  
Clinical Immunology ◽  
Italian Society ◽  
Choosing Wisely ◽  
Slow Medicine

Smarter Intensive Care Medicine: Choosing Wisely®, less is more, appropriate is better … and so what?

2021 ◽  
Vol 78 (7) ◽  
pp. 389-394
Author(s):  
Thierry Fumeaux ◽  
Antje Heise ◽  
Martin Balmer ◽  
Luca Lavina
Keyword(s):  
Intensive Care ◽  
Intensive Care Medicine ◽  
Choosing Wisely ◽  
Less Is More

Zusammenfassung. Die Top-9-Liste der Schweizerischen Gesellschaft für Intensivmedizin (SGI) wurde 2017 veröffentlicht. Welchen Stand hat diese Initiative in Bezug auf ihre Umsetzung auf den Schweizer Intensivstationen? Welches sind ihre Auswirkungen auf die Patientenversorgung und auf die Kosten der Intensivmedizin? Welche evidenzbasierten, neueren Entwicklungen rechtfertigen eine Aktualisierung der Liste und welche Massnahmen sind erforderlich, um diese Initiative erfolgreich in den kommenden Jahren fortzusetzen? Der folgende Artikel gibt einen aktuellen Überblick über die «Choosing Wisely®»-Initiative der SGI.

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