Monday 19 September 2016

Choosing Wisely campaign

ASCP Five new recommendations - Choosing Wisely campaign The American Society for Clinical Pathology (ASCP) has added five new evidence- and consensus-based recommendations to its list of Choosing Wisely campaign. • Do not test for amylase in cases of suspected acute pancreatitis. Instead, test for lipase. • Do not request serology for H. pylori. Use the stool antigen or breath tests instead. • Do not routinely perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because these tests do not improve survival • Do not routinely order expanded lipid panels (particle sizing, nuclear magnetic resonance) as screening tests for cardiovascular disease • Do not perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome (MDS)-related abnormalities on bone marrow samples obtained for cytopenias when an adequate conventional karyotype is obtained These new recommendations were unveiled on September 15, 2016 at Pathology and Lab Medicine 2016, the recently concluded Annual Meeting of the American Society for Clinical Pathology (ASCP) in Las Vegas, USA. These new five recommendations now make it a total of 15 recommendations “Fifteen Things Physicians and Patients Should Question”. 1. Don’t perform population based screening for 25-OH-Vitamin D deficiency. 2. Don’t perform low-risk HPV testing. 3. Avoid routine preoperative testing for low risk surgeries without a clinical indication 4. Only order Methylated Septin 9 (SEPT9) to screen for colon cancer on patients for whom conventional diagnostics are not possible. 5. Don’t use bleeding time test to guide patient care. 6. Don’t order an erythrocyte sedimentation rate (ESR) to look for inflammation in patients with undiagnosed conditions. Order a C-reactive protein (CRP) to detect acute phase inflammation. 7. Don’t test vitamin K levels unless the patient has an abnormal international normalized ratio (INR) and does not respond to vitamin K therapy. 8. Don’t prescribe testosterone therapy unless there is laboratory evidence of testosterone deficiency. 9. Don’t test for myoglobin or CK-MB in the diagnosis of acute myocardial infarction (AMI). Instead, use troponin I or T. 10. Don’t order multiple tests in the initial evaluation of a patient with suspected non-neoplastic thyroid disease. Order thyroid-stimulating hormone (TSH), and if abnormal, follow up with additional evaluation or treatment depending on the findings. 11. Do not routinely perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because these tests do not improve survival. 12. Do not routinely order expanded lipid panels (particle sizing, nuclear magnetic resonance) as screening tests for cardiovascular disease. 13. Do not test for amylase in cases of suspected acute pancreatitis. Instead, test for lipase. 14. Do not request serology for H. pylori. Use the stool antigen or breath tests instead. 15. Do not perform fluorescence in situ hybridization (FISH) for myelodyplastic syndrome (MDS)-related abnormalities on bone marrow samples obtained for cytopenias when an adequate conventional karyotype is obtained Of these 15 recommendations, 1 to 5 were released on February 21, 2013; 6 to 10 on February 3, 2015 and 11 to 15 were released this year at the ASCP Annual Meeting. (Source: Medscape, Choosing Wisely Campaign – ASCP Five More Things Physicians and Patients Should Question)

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