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Unnecessary Medical Tests


Doctors Call Out 90 More Unnecessary Medical Tests, Procedures


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医師、しばしば不要なテストと手順その害品質を発注するための批判や医療ケアのための国家のタブに追加、、テスト、医療処置の問題の得点に呼んでいる "潜在的に不要な強調 - 時々有害 - 米国で提供されるケア、" 25医療社会とワーキンググループは述べています。

Doctors, often criticized for ordering up unneeded tests and procedures that harm quality and add to the nation’s tab for medical care, are calling into question scores of tests and medical procedures, “highlighting potentially unnecessary – sometimes harmful – care provided in the U.S.,” a group working with 25 medical societies said.


Another 90 tests and procedures from 17 medical specialty societies have been released as part of the ABIM Foundation's Choosing Wisely campaign, an effort put together by Consumer Reports and the American Board of Internal Medicine Foundation.


Since the campaign was launched last year, more than 130 tests and procedures have been called into question by 25 medical specialty societies with more than 725,000 member doctors.




Don't schedule non-medically indicated inductions of labor or cesarean deliveries before 39 weeks, 0 days of pregnancy. Delivery prior to 39 weeks is associated with increased risk of learning disabilities, respiratory problems and other potential risks.


While sometimes induction prior to 39 weeks is medically necessary, the recommendation is clear that simply having a mature fetal lung test, in the absence of appropriate clinical criteria, is not an indication for delivery.(American College of Obstetricians and Gynecologists; American Academy of Family Physicians)



8 Unnecessary Medical Tests and Treatments


Don't use feeding tubes in patients with advanced dementia. Studies show that percutaneous feeding tubes do not result in better outcomes for these patients.


The recommendation states that assistance with oral feeding is a better, evidence-based approach.(American Academy of Hospice and Palliative Medicine; American Geriatrics Society)



Too Frequent Cervical-Cancer Screenings May Cause More Harm Than Good


女性30内のルーチン年間パパニコロウ試験は行わないでください- 。年齢の65歳を平均的リスクの女性では、ルーチン年次パップテスト(子宮頸部細胞診の上映)3年間の間隔で行われる上映以上ない利点を提供しません。。(産婦人科のアメリカの大学)

Don't perform routine annual Pap tests in women 30 – 65 years of age. In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage over screenings performed at three-year intervals.(American College of Obstetricians and Gynecologists)



Don't automatically use CT scans to evaluate children's minor head injuries. Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan.


CT scanning is associated with radiation exposure that may escalate future cancer risk.The recommendation calls for clinical observation prior to making a decision about needing a CT.(American Academy of Pediatrics)



Avoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease. The recommendation states that there is very little information on the benefit of using stress echocardiography in asymptomatic individuals for the purposes of cardiovascular risk assessment, as a stand-alone test or in addition to conventional risk factors.(American Society of Echocardiography)


2型糖尿病のほとんどの人65歳以上のための薬を処方する場合には、厳格な血糖コントロールを達成しようとすることは避けてください。推薦はしっかり高齢糖 ​​尿病患者の血糖値をコントロールする薬を使用することが有益であるという証拠はないと述べている。

When prescribing medication for most people age 65 and older with type 2 diabetes, avoid attempting to achieve tight glycemic control. The recommendation states that there is no evidence that using medicine to tightly control blood sugar in older diabetics is beneficial.


In fact, using medications to strictly achieve low blood sugar levels is associated with harms, including higher mortality rates.(American Geriatrics Society)



Don't perform EEGs (electroencephalography) on patients with recurrent headaches. Recurrent headache is the most common pain problem, affecting up to 20 percent of people.The recommendation states that EEG has no advantage over clinical evaluation in diagnosing headache, does not improve outcomes, and increases costs.(American Academy of Neurology)



Don't routinely treat acid reflux in infants with acid suppression therapy. Anti-reflux therapy, which is commonly prescribed in adults, has no demonstrated effect in reducing the symptoms of gastroesophageal reflux disease (GERD) in infants, and there is emerging evidence that it may in fact be harmful in certain situations.(Society of Hospital Medicine)



The new list includes advice on a range of tests and procedures such as how to treat pregnant women and when to give pap smears to avoiding expensive “echocardiographic images” to assess heart attack risks in otherwise low risk patients.

博士クリスティンカッセル、 ABIM財団の社長は言った、 "アメリカ人の何百万は、ますますそれが医療に来るとき、より多くのは必ずしも良くありませんが、ことを認識している" 。 "一連のテストと手順これらのリストを通じ、我々は、彼らが本当に必要なもののケアに関する医師と患者の間の会話を奨励するために願っています。 "

“Millions of Americans are increasingly realizing that when it comes to health care, more is not necessarily better,” said Dr. Christine Cassel, president of the ABIM Foundation. “Through these lists of tests and procedures, we hope to encourage conversations between physicians and patients about what care they truly need.”


The new lists include recommendations that advise medical-care providers:

· "高度な認知症患者に栄養チューブを使用しないでください。 "

“Don’t use feeding tubes in patients with advanced dementia.”

· "女性30内のルーチン年間のPapテストを実行しないでください - 65歳。 "

“Don’t perform routine annual Pap tests in women 30 – 65 years of age.”

· "自動的に子供のマイナーな頭部外傷を評価するためにCTスキャンを使用しないでください。 "

“Don’t automatically use CT scans to evaluate children’s minor head injuries.”

· "症状と冠動脈疾患を持っていることのリスクが低いを持たない人々に心血管リスクを評価するために、心エコー画像を用いたストレステストを行うことは避けてください。 "

“Avoid doing stress tests using echocardiographic images to assess cardiovascular risk in persons who have no symptoms and a low risk of having coronary disease.”

· "日常酸抑制療法による乳児の酸逆流の治療しないでください。


“Don’t routinely treat acid reflux in infants with acid suppression therapy.”

ホスピスと緩和医学のアメリカアカデミー; 、米国小児科学会、産婦人科のアメリカの大学、米国泌尿器科学会、リストはそのような家庭医のアメリカアカデミーなどのグループによってコンパイルされ、胸部外科学会。

The list was compiled by groups such as the American Academy of Family Physicians; the American Academy of Hospice and Palliative Medicine; the American Academy of Pediatrics; the American College of Obstetrics and Gynecology; the American Urological Association; and the Society of Thoracic Surgeons.

それは健康保険会社が医療保険ユナイテッドグループのように、健康保険( UNH ) 、エトナ( AET ) 、ヒューマナ( HUM ) 、シグナ(CI)とブルークロスの計画をされているコストを抑制したり、拒否するリストを使用するかどうかは不明だけどますます少なく不要な検査や手法につながる品質と成果ガイドラインに関する医療学会での作業。

Though it’s unclear whether health insurance companies will use the lists to rein in costs or even deny medical care coverage, health plans like UnitedHealth Group (UNH), Aetna (AET), Humana (HUM), Cigna (CI) and Blue Cross plans are increasingly working with medical societies on quality and outcomes guidelines that lead to fewer unnecessary tests and procedures.

"賢明に選択すると、患者は医師が自分の患者が推奨治療法についての質問をしたい良い医療の中心であることを医学界からの明確なメッセージを送信し、その優れた、エビデンスに基づくケアが結果される場合、すべての利害関係者がその目標に焦点を当てている、 "スーザン·ピサーノ、アメリカの健康保険プラン、健康保険業界のためのロビーの広報担当者は述べた。

“Choosing Wisely sends a clear message from the medical community that patients are at the center of good health care, that physicians want their patients to ask questions about recommended treatments, and that good, evidence-based care will be the result if all of the stakeholders are focused on that goal,” said Susan Pisano, spokeswoman for the America’s Health Insurance Plans, the lobby for the health insurance industry.

"健康計画は科学的根拠に基づいた、患者中心のケアの長年の支持者であった​​、そしてこれらの原則を促進するためにプロバイダと保健計画のメンバーと協力していきます。 "

“Health plans have been longstanding proponents of evidence-based, patient centered care, and will continue to work with providers and health plan members to further those principles.”

一方、 ABIMの努力は勢いとキープレーヤーからより多くの財政支援を得ている。ロバートウッドジョンソン財団は、それがために$ 2.5M(250万ドル)を受賞したと発表した"医療の潜在的な乱用の意識を高めるために、特定の地域社会で働くために医療専門社会や地域の健康増進のcollaborativesに資金を供給する。 "

Meanwhile, the ABIM effort is gaining momentum and more financial support from key players. The Robert Wood Johnson Foundation announced it has awarded $2.5 million to “fund medical specialty societies and regional health improvement collaboratives to work in specific communities to raise awareness of potential overuse of medical care.”

"医療資源の乱用を減らすことは、アメリカの医療の質の向上の重要な一部であり、 "博士りさLavizzo - Mourey 、ロバートウッドジョンソン財団の社長兼最高経営責任者(CEO)は述べています。 "我々は、この作品は特定の地域では対象としていたときに何が起こるか見てみたいし、賢く選ぶキャンペーンの具体的な影響力を高めることを嬉しく思います。 "

“Reducing the overuse of health care resources is a critical part of improving quality of health care in America,” said Dr. Risa Lavizzo-Mourey, the Robert Wood Johnson Foundation’s president and chief executive officer. “We want to see what can happen when this work is targeted in specific geographic regions and are pleased to help increase the tangible impact of the Choosing Wisely campaign.”


United States specialty societies representing more than 500,000 physicians developed lists of Five Things Physicians and Patients Should Question in recognition of the importance of physician and patient conversations to improve care and eliminate unnecessary tests and procedures.



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