It has frequently been suggested that immediate test ordering in unexplained complaints is superfluous.[6-8] Since the pretest probability of serious pathology in patients with unexplained complaints is usually low, the risk of false-positive test results is relatively high. This may result in a chain of unnecessary further testing, which in turn might lead to patient anxiety, high costs, somatisation and a risk of serious side effects or even unnecessary morbidity.[9, 10] Applying a watchful waiting policy is recommended because the majority of these complaints are expected to be self-limiting. Patients in whom the complaints are not self-limiting will have a higher prior probability of having serious pathology, and the diagnostic accuracy of tests in this selected group is expected to be higher, because of the lower risk of false-positive test results.. We have found only one guideline on blood test ordering for unexplained complaints in general practice. This guideline, issued by the Dutch ...
Objectives: To examine the feasibility of application of the recent ACCF/ASE Appropriateness Criteria for Echocardiography.. Methods: Indications for transthoracic (TTE) and transesophageal echocardiography(TEE) were retrospectively determined by physician chart review in consecutive patients at a tertiary care center, and were classified according to the guidelines as appropriate (A), inappropriate (I), or uncertain (U), or, for situations not addressed in the document, as not classifiable (NC). To assess interobserver agreement, 63 studies were independently reviewed by 2 physicians.. Results: We included 493 consecutive pts who underwent echo: 176 (35%) outpatient TTE, 131 (26%) inpatient TTE, 95 (19%) outpatient TEE, and 91 (18%) inpatient TEE. Of all studies, 420 (85%) were A, 25 (5%) I, 1 (0.2%) U, and 47 (10%) NC. I and NC studies were more commonly TTE (7%, 13%, respectively) compared to TEE (2%, 5%) (p, 0.001). I studies were more common in outpatients than inpatients (9% vs 2%, p, ...
October 12, 2017 -- The American College of Radiology (ACR) has added five new topics and revised seven others in the latest release of its Appropriateness Criteria.. The new topics are as follows:. ul.editorialList li {margin-bottom:6px;} ...
1) Robert D. Harris, MD, MPH; Marcia C. Javitt, MD; Phyllis Glanc, MD, et al. ACR Appropriateness Criteria® - Womens Imaging - Clinically Suspected Adnexal/Pelvic Mass/Uterus. Available at https://acsearch.acr.org/docs/69466/Narrative/ American College of Radiology. Accessed June 30, 2017.. 2) Lynn Simpson, MD; Sandeep Prakash Deshmukh, MD; Kika M. Dudiak, MD, et al. ACR Appropriateness Criteria® Womens Imaging - Assessment of Fetal Well-Being. Available at https://acsearch.acr.org/docs/3094108/Narrative/ American College of Radiology. Accessed June 30, 2017.. 3) CAR Guidelines, Obstetrical Imaging. http://www.car.ca/en/standards-guidelines/guidelines.aspx Accessed June 30, 2017.. 4) Ann E. Podrasky, MD; Marcia C. Javitt, MD; Phyllis Glanc, MD, et al. ACR Appropriateness Criteria® Womens Imaging - Second and Third Trimester Bleeding. Available at https://acsearch.acr.org/docs/69465/Narrative/ American College of Radiology. Accessed June 30, 2017.. ...
The American Association of Neurological Surgeons and Congress of Neurological Surgeons have released a list of specific tests or procedures that are commonly ordered, but not always necessary, in neurosurgery. As part of Choosing Wisely®, an initiative of the ABIM Foundation, the list encourages physician and patient conversations about treatment options by identifying five targeted, evidence-based recommendations.
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Parasite Test Truth! ~ PCOS Lady: This womans experience is exactly what i am going through! Unnecessary tests from the wrong lab(s), wrong type tests ordered, wasted gas, wasted money to pay for those unnecessary tests, etc... I now have a out of pocket bill for $900 for tests and should have only spent $485…
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition
When are cardiac bypass procedures and catheter procedures appropriate? A new document - "Appropriateness Criteria for Coronary Revascularization" - gives guidance for 180 clinical scenarios that patients present to their cardiologists and that physicians present to insurers.. In a process that took more than a year, a 17-member panel of general cardiologists, interventional cardiologists, cardiac surgeons, and others scored each scenario to judge whether coronary revascularization was appropriate, inappropriate, or uncertain.. For example, the panel ruled that revascularization would be inappropriate in a patient who had plaque build-up in one or two arteries, experienced symptoms only during heavy exercise, had a small amount of heart muscle at risk, and was not taking medication to help control symptoms. For a similar patient who had severe symptoms despite taking the appropriate medication, revascularization was deemed appropriate.. The appropriateness criteria - the first to focus on ...
Advocate Illinois Masonic Medical Center, Professional Office Building Suite 625, 3000 North Halsted Avenue, Chicago, IL 60614, USA. [email protected] ...
Since writing my last post there has been a change of plans. While I was sitting thinking about all of the tests Carter was going to have to endure the next few weeks our surgeon was on the phone with another Doctor. The other Doctor informed him that the test may not give us the results we wanted to know. G.I. tests are not always accurate. With that being said I said "no." I do not want him going for any unnecessary tests. He has been through enough. I have decided it is time to fix the fistula and see what happens. Carter did not have any feeding intolerance problems before his initial surgery to add length to his bowel. So why does he now? The only changes he has had are the fistula, thats not suppose to be there, and the added length to his colon. So I think we should fix the fistula and see what happens. It has to be fixed anyways. In my mind there must be something going on with the fistula or added length of colon that is causing him to have the feeding intolerance issues. We are not ...
Yesterday I mentioned that Doctors estimate our country spends $6.8 billion in unnecessary tests. Who can fix this? We all can, doctors, health systems, patients, and insurers. In 2011 The National Physicians Alliance (NPA) published work on the Good Stewardship Project, a pilot which was developed with funding from the American Board of Internal Medicine…
Imagine this scenario: You bring your car in for routine maintenance. The basic services are covered under your warranty, so you dont expect to lay out any cash unless theres a repair needed. The cars in good shape, so you figure youll be out of there without much hassle. But before youve even gotten your complimentary cup of coffee, the receptionist hands you some intimidating forms. Apparently, there are several optional tests the mechanic can do if youre willing to pay. One detects engine problems sooner. Another could make your steering more responsive. A third will get you out the door today faster-and might also reveal wear and tear better. But maybe these tests do nothing. Its confusing. And the decision is on your shoulders.. You study the forms quizzically, trying to parse the technical jargon, and worry about making the wrong call. It feels like a lose-lose situation: either you waste money on unnecessary tests or risk missing out on valuable information. Sound familiar? This is ...
Overtreatment" is a neologism coined some 15 years ago to denote medical and surgical interventions that are unnecessary. It is a topical term for an old concept. However, it has rapidly become a shibboleth for those inclined toward finger-pointing and blaming in matters of health policy. As such, it is a "foe" that heats up rather than modulates debate. But if one examines the notion in the context of the contemporary patient-physician dialogue, it is anything but a foe. Overtreatment and its fellow travelers, overutilization and overprescription, face off with contrary notions when a patient contends with the challenge of evaluating any clinical option ...
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TY - JOUR. T1 - ACCF/SCAI/STS/AATS/AHA/ASNC 2009 appropriateness criteria for coronary Revascularization. AU - Patel, Manesh R.. AU - Dehmer, Gregory J.. AU - Hirshfeld, John W.. AU - Smith, Peter K.. AU - Spertus, John A.. AU - Masoudi, Frederick A.. AU - Brindis, Ralph G.. AU - Dehraer, Gregory J.. AU - Beckman, Karen J.. AU - Chambers, Charles E.. AU - Ferguson, T. Bruce. AU - Garcia, Mario J.. AU - Grover, Frederick L.. AU - Holmes, David R.. AU - Klein, Lloyd W.. AU - Limacher, Marian. AU - Mack, Michael J.. AU - Malenka, David J.. AU - Park, Myung H.. AU - Ragosta, Michael. AU - Ritchie, James L.. AU - Rose, Geoffrey A.. AU - Rosenberg, Alan B.. AU - Shemin, Richard J.. AU - Weintraub, William S.. PY - 2009/3/10. Y1 - 2009/3/10. N2 - The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an ...
The integration of chemotherapy, radiation therapy (RT), and surgery in the management of patients with stage IIIA (N2) non-small-cell lung carcinoma is challenging. The American College of Radiology (ACR) Appropriateness Criteria Lung Cancer Panel was charged to update management recommendations for this clinical scenario. The Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. There is limited level I evidence to guide patient selection for induction, postoperative RT (PORT), or ...
This document outlines the usefulness of available diagnostic imaging for patients without known coronary artery disease and at low probability for having coronary artery disease who do not present with classic signs, symptoms, or electrocardiographi
The indications contained in this report were selected to cover a wide variety of clinical presentations. They are based on common patient presentations such as symptoms suggestive of ischemia, multiple cardiac risk factors in an asymptomatic individual, and specific scenarios with indices of high clinical suspicion that are further stratified based on factors such as clinical risk, prior test results, and the interval since prior testing. The purpose of this approach is to delineate the possible value of CCT or CMR for a physician faced with everyday patient scenarios. The indications do not correspond directly to International Classification of Diseases-9th Revision (ICD-9) codes, as they convey more information than usually found in the ICD-9 classification system. Some correlation with previous model local coverage determination (LCD) documents is purposeful, but the indications are designed to provide further guidance within the categories outlined in the model LCD for ordering physicians. ...
Zosia Chustecka. April 5, 2012 - Five common cancer procedures and tests have been identified that are not supported by evidence and should no longer be used, according to the American Society of Clinical Oncology (ASCO).. Oncologists should stop the unnecessary use of chemotherapy in patients with advanced cancers who are unlikely to benefit, and should limit their use of colony-stimulating factor (CSF) drugs in patients undergoing chemotherapy.. They should also curb their use of advanced costly imaging technologies for staging of early breast and prostate cancers, and for detecting breast cancer recurrences.. These recommendations, compiled after an extensive review of the literature and with input from more than 200 ASCO members, were published online April 3 in the Journal of Clinical Oncology.. The move is part of the Choose Wisely campaign, organized by the American Board of Internal Medicine, in which many different medical specialties identified tests and procedures that could be ...
• Kidney disease patients and their physicians should question and discuss certain medical tests and procedures, taking into consideration patients preferences, needs, and health goals. • Doing so can improve care and reduce costs. An estimated 30% of care in America goes to unnecessary tests and procedures.
Interviewer: Thirty percent of healthcare spending is being used on unnecessary medical testing and treatments. What can be done about it? Next on The Scope.. Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. Youre listening to The Scope.. Interviewer: Were talking with Dr. Bradford Jones, a current physician at the University of Utah. A lot of patients come into the doctor and obviously they are worried about their health and whats happening to them. And so they ask for a bunch of treatments and its almost like theyre asking for too much treatment.. Dr. Jones: And its understandable. Like you say, youre worried when something happens to your body, when youre having changes that you dont understand. Thirty percent of our healthcare spending is on unnecessary tests and treatments. Thats $500 billion a year. That averages out to $1,700 per person in this country, which means youre spending that for ...
2012-07-21 16:18:46 I have been living in Davis for 4 years now and have taken 4 different cats to the cat clinic. My husbands cat got sick and Dr. Kaneko never tried to push us into unnecessary tests. I found a kitten on a play ground of the school I worked at and took him here immediately (he is always willing to take people in the same day they call, usually within the hour). He gave him nutrients (free of charge) and barely charged me for an exam. Unfortunately, the poor little guy had flea bite anemia and began having seizures and had to be put to sleep. He and his office staff were so helpful for that. My cat Dinah began having facial ticks and we took her to VetMed. they charged us $200 just to see her, then tried to charge us $1500 for tests. They also couldnt get blood from her. We took her to Dr. Kaneko the next morning and he charged us under a quarter of their cost, was able to get blood, and, no questions asked, gave us anti-seizure medicine. She unfortunately progressed too much ...
False Claims Act Whistleblower Lawsuit, by Ex-21st Century Oncologys Mariela Barnes, Settled at $19.75M w/ $3.2M Reward to Mariela Barnes for Reporting Healthcare Kickbacks & Unnecessary Tests
In acute paediatrics, overtreatment and overdiagnosis is encountered in threshold and developed countries. The foundation of overtreatment may be similar in the two settings, namely the mere availability of invasive procedures, which may lead to their inappropriate use. Physiological healing processes should be integrated in treatment plans. Whenever possible, natural organ functions should be maintained (e.g. enteral instead of parenteral nutrition). Standards and guidelines may assist the paediatrician in weighing up the benefits and risks of available invasive diagnostic and therapeutic procedures. Safe and simple methods, successfully introduced in countries with limited resources, are equally useful in the industrialised world, as they have the potential to reduce the application of risky invasive therapies. ...
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Would you like to help prevent overdiagnosis and overtreatment? GP Julian Treadwell has put together a proposal for the RCGP to take on
TY - JOUR. T1 - ACR appropriateness criteria chronic chest pain - Low to intermediate probability of coronary artery disease. AU - Woodard, Pamela K.. AU - White, Richard D.. AU - Abbara, Suhny. AU - Araoz, Philip A.. AU - Cury, Ricardo C.. AU - Dorbala, Sharmila. AU - Earls, James P.. AU - Hoffmann, Udo. AU - Hsu, Joe Y.. AU - Jacobs, Jill E.. AU - Javidan-Nejad, Cylen. AU - Krishnamurthy, Rajesh. AU - Mammen, Leena. AU - Martin, Edward T.. AU - Ryan, Thomas. AU - Shah, Amar B.. AU - Steiner, Robert M.. AU - Vogel-Claussen, Jens. AU - White, Charles S.. PY - 2013. Y1 - 2013. N2 - Chronic chest pain can arise from a variety of etiologies. However, of those potential causes, the most life-threatening include cardiac disease. Chronic cardiac chest pain may be caused either by ischemia or atherosclerotic coronary artery disease or by other cardiac-related etiologies, such as pericardial disease. To consider in patients, especially those who are at low risk for coronary artery disease, are ...
Hanley M, Ahmd O, Chandra A., Ptak T, et al. ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation. J Am Coll Radiol 2016;13(7):796-800.. Rao S, Rao S, Rincon S, Caruso P, Ptak T, Raja AS, Prabhakar AM, Harvey HB. Assessment of Pediatric Neurotrauma Imaging Appropriateness at a Level I Pediatric Trauma Center. J Am Coll Radiol 2016;13(7):788-793.. Sonis JD, Miller ES, Borczuk P, Ptak T. Seizure and Fever. J Emerg Med. 2016 May;50(5):773-777. R Weiss, EM Azene, BS Maldalany, AF AbuRahma, Ptak T, et al. ACR Appropriateness Criteria Sudden Onset of Cold Painful Leg. J Am Coll Radiol 2017;14(15):S307-S313.. Expert Panels on Neurologic and Vascular Imaging: Schroeder J, Ptak T, Corey AS, et al. ACR Appropriateness Criteria Penetrating Neck Trauma. J Am Coll Radiol 2017 Nov;14(11S):S500-S505. ...
St. Joseph Medical Center in Maryland has agreed to pay $22 million to settle federal allegations that it paid kickbacks to a group of doctors over procedu
New guidelines issued this week by the American College of Physicians (ACP) recommend diagnostic imaging for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. For all other patients evidence indicates that routine imaging is not associated with clinically meaningful benefits and can lead to harm through radiation exposure and unnecessary tests and invasive procedures ...
August 7, 2008 - QuadraMed Corp. said its Smart Identity Exchange (Smart I/X) is now available. The Smart Identity Exchange (Smart I/X) is a next-generation identity management solution that helps hospitals and health information exchanges (HIEs) in their efforts to identify, reconcile and manage patient records to reduce the potential for medical errors and expenses such as unnecessary tests and procedures.. Adding another powerful tool to QuadraMeds Best in KLAS portfolio of identity management solutions, Smart I/X is both an enterprise master person index (EMPI) and a record locator/reconciliation solution designed specifically for organizations that require a means of more accurately identifying patients and establishing and maintaining a composite medical record across multiple data sources. The solution helps organizations comply with HIPAA and uses a probabilistic algorithm to analyze all records stored in an organizations MPI systems, cross-references and reconciles them, then assigns ...
Objective data from the clinical laboratory are critical to the majority of medical decisions, including initial diagnosis and monitoring of treatment outcome. Laboratory errors, including inaccurate RIs, can lead to inappropriate diagnosis, unnecessary test repetition, and inappropriate follow-up investigations (7). Excessively wide RIs may mask subclinical disorders, and the use of incorrect RIs may confuse the clinical picture. Therefore, relevant RIs are essential for correct test result interpretation and reducing the risk of false negatives and false positives. Failure to provide proper RIs in the pediatric population carries obvious consequences for immunochemical analytes such as TSH (8) and ferritin (9).. The current investigation established RIs in a large, multiethnic pediatric cohort. However, the study was not without its limitations. As it was a cross-sectional investigation, the long-term health of the participating children was not verified. Additionally, the RIs provided are ...
As expected, not everyone is excited about the rise of DIY DNA testing. Medical professionals are perhaps the most concerned. While DIY testing provides important genetic information and interpretation tools help decode this information, what matters most is what the individual does in the end.. Medical professionals are concerned that people experience undue anxiety about their health resulting in unnecessary tests. For example, a DNA tests that shows one has twice the risk of cervical cancer may cause panic but in reality, it is not that bad. The US cervical cancer rate is around 7.4 in a hundred thousand women per year. Twice that and it comes to around 1 in 6,750 women per year. Basically, the preventive measures taken by someone with normal risk are the same for someone with twice the risk. The needless anxiety can be damaging.. ...
A cardiologist with offices in New York City and New Jersey has admitted taking part in a scheme that subjected thousands of patients to unnecessary tests and treatment and resulted in $19 million in bogus bills, the largest case of healthcare fraud ever by a practitioner in either state, authorities said.
Some dancers are very toned; they perform the high jumps and leaps. Others work closer to the ground and provide the beautiful pauses in a routine. Both are needed for a show.. Babies are the same: Some have extremely tight, conditioned muscles, while others are, simply put, mushier. The toned ones tend to be smaller and leaner, while those with lower muscle tone are generally plumper. This is difference can generate unnecessary concern: Softer kids hold their heads upright a little later than others, they sit up a little later, they walk later, and so on. Because of these apparent delays, doctors subject them to unnecessary tests and interventions, such as physical therapy and special exercise. In most cases, this is unnecessary; babies with normal low muscle tone will develop at their own pace. This is different from "congenital hypotoniae," a serious condition that is marked by extremely low muscle tone and severely delayed milestones, and requires extensive physical therapy.. ...
Real-world clinical scenarios highlight the danger of limiting a judgment of quality to a single perspective. For example, a good outcome is important, though its value is much less compelling if it occurs despite an unnecessary procedure. Conversely, a poor outcome does not necessarily equate to poor quality if the treatment was properly rendered by a credentialed staff in the correct manner.. Structural measures reflect basic features of the provider makeup and resources of a health care facility. Examples include the total number of physicians and the percent who are board certified, the nurse/bed ratio, admissions and emergency department visits per year, and number of procedures performed. These measures are objective and easy to report, but are indirectly related to other measures of quality. Though some studies have shown survival advantages at facilities that provide a greater volume of some procedures,4 these studies are difficult to generalize to all procedures. Additionally, the ...
With the most savage type of skin cancer, melanoma, countless of dangerous looking moles are really harmless, but has dependably been difficult to know without an intrusive surgical biopsy. Today dermatologists have new help in making the correct call - a handheld tool affirmed by the FDA for multispectral analysis of tissue morphology. The MelaFind optical scanner is not for definitive diagnosis but rather to give extra information a doctor can use in figuring out if or not to arrange a biopsy. The objective is to lessen the quantity of patients left with superfluous biopsy scars, with the additional advantage of taking out the cost of unnecessary procedures. The MelaFind technology (MELA Sciences, Irvington, NY) utilizes missile navigation technologies initially paid for the Department of Defense to optically examine the surface of a suspicious lesion at 10 electromagnetic wavelengths. The collected signs are handled utilizing overwhelming algorithm and matched against a registry of 10,000 ...
The regulatory board responsible for licensing doctors in Maryland has filed charges against a Towson cardiologist accused of performing hundreds of unnecessary procedures
This paper proposes an insurance solution for the overtreatment problem. We show that a patient can be encouraged to seek a second opinion more often if the hea
Ashley EilandCMS 205.___ October 17, 2013 Title: The effects of Human Trafficking INTRODUCTION Attention-Getter -The unjustified trade and enslavement of...
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