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04-Sep-2019 09:48

Among nonolder adults, except for reductions in myocardial infarction and mortality with metformin, using medications to achieve glycated hemoglobin levels less than 7% is associated with harms, including higher mortality rates.Given the long time frame to achieve theorized microvascular benefits of tight control, glycemic goals should reflect patient goals, health status, and life expectancy.False-positive test results are likely to lead to harm through unnecessary invasive procedures, overtreatment, and misdiagnosis.Potential harms of routine annual screening exceed the potential benefit.Published guidelines provide clear indications for the use of telemetric monitoring in patients, which are contingent upon frequency, severity, duration, and conditions under which the symptoms occur.Inappropriate use of telemetric monitoring is likely to increase cost of care and produce false positives potentially resulting in errors in patient management.Skin or serum-specific Ig E testing for inhalants or foods is not indicated, unless there is a clear history implicating an allergen as a provoking or perpetuating factor for urticaria.There is little evidence that detection of coronary artery stenosis improves health outcomes in asymptomatic patients at low risk of coronary heart disease.

Limited laboratory testing may be warranted to exclude underlying causes.

While transesophageal echocardiography is safe, even the small degree of risk associated with a procedure is not justified if there is no expected clinical benefit.

Telemetric monitoring is of limited utility or measurable benefit in low-risk cardiac chest pain patients with normal electrocardiogram.

Don’t use coronary CT angiography in high-risk emergency department patients presenting with acute chest pain.

note: Risk defined by the Thrombolysis In Myocardial Infarction risk score for unstable angina/acute coronary syndromes.

If the results of the ultrasound exam are equivocal, it may be followed by CT.

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