Article Figures & Data
Figures
- Figure 1.
The Acquisition–Cognition–Application → Levels of Outcome (ACA-LO) theoretical model. The ACA-LO theoretical model explains the value of information, that is, how information is valuable from the information users' viewpoint. In this model, 4 “levels of outcomes” (LOs)—situational relevance, cognitive impact, use of information, and subsequent health benefits—are associated with the iterative “acquisition–cognition—application” process. The ACA-LO model is operationalized by the Information Assessment Method (IAM) questionnaire.
Tables
- Table 1. Title and Topic of the 29 Patient-Oriented Evidence That Matters Not Discussed in the Master List of the Choosing Wisely Campaign
Topic POEM Title Clinical Action to De-Adopt Diagnostics Annual screening chest radiograph does not reduce lung cancer mortality Annual screening chest radiograph Negative high-sensitivity troponin rules out AMI Repeat measurement of HS-troponin within 12 hours of presenting to the emergency department Repeat BMD testing: little, if any, value in elderly men and women Repeat testing of BMD Guideline: When to screen for and treat chronic kidney disease Screening eGFR test, urine for albumin Older adults feel a “moral obligation” to undergo screening Cessation of periodic screening tests in the elderly without taking the time to discuss the issue Colorectal neoplasia yield similar for FIT every 1, 2, or 3 years Annual FIT Most tests for rotator cuff disease are inaccurate Selected maneuvers to test for rotator cuff disease Medical interventions ASA: not for primary prevention ASA for primary prevention of cardiovascular disease Intermittent steroids effective for children with recurrent wheezing Daily inhaled steroids in children with recurrent wheezing ACP guideline: Universal VTE prophylaxis not recommended for hospitalized medical and stroke patients Anticoagulation for all medical inpatients Evidence for combination antipyretics is limited Combining antipyretics in management of fever in children 24 Months of clopidogrel after stent is no better than 6 months More than 6 months of clopidogrel after stent Mean duration of cough is 18 days; patients expect about 1 week Antibiotics for acute bronchitis Negative CT after mild blunt head trauma in children: send them home Hospitalization after negative CT in children with mild blunt head trauma Statins of modest benefit for low- to moderate-risk persons (NNT, ∼80) Statins for low- to moderate-risk persons Niacin not effective in CAD with low HDL-cholesterol (AIM-HIGH) Niacin for low HDL-cholesterol Nasal steroids ineffective for ET dysfunction Nasal steroids for eustachian tube dysfunction, including otitis media with effusion Treatment for mild hypertension is ineffective Antihypertensive treatment of mild hypertension Cutaneous warts in children: half disappear within a year Routine treatment without a discussion about prognosis of warts in children Fasting is not necessary before lipid panels Fasting before lipid panels Steroid injection for lateral epicondylitis worse than saline after 1 year Steroid injection for epicondylitis 5-Day steroid treatment effective for acute COPD exacerbation More than 5 days of oral steroids for acute COPD exacerbation Epidural steroids for sciatica are minimally effective in the short term Epidural steroids for sciatica Testosterone does not improve the effectiveness of sildenafil Testosterone for erectile dysfunction treated with sildenafil Limited evidence: manipulation ineffective for acute low-back pain Spinal manipulation for acute low-back pain Placebo almost as effective as hypnotics in adults Nightly hypnotic in adults Surgical interventions Asymptomatic gallstones rarely lead to cholecystectomy and may go away Cholecystectomy for asymptomatic gallstones Surgery + PT similar to PT alone for adults with meniscal tear and OA Repair of torn meniscus in adults with OA Knee injury: rehab = ACL reconstruction for many young adults ACL reconstruction for all young adults ACL, anterior cruciate ligament; ACP, American College of Physicians; AMI, acute myocardial infarction; ASA, aspirin; BMD, bone mineral density; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CT, computed tomography; eGFR, estimated glomerular filtration rate; ET, eustachian tube; FIT, fecal immunochemical test; HDL, high-density lipoprotein; HS, high sensitivity; NNT, number needed to treat; OA, osteoarthritis; PT, physical therapy; VTE, venous thromboembolism.
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