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By T. Koraz. Youngstown State University.

The campaign reconvened and committed to pursuing a second list cheap 100 mg serophene otc. The 2014 Task aims to encourage conversations between patients and their health Force was composed of 13 individuals representing a broad care teams about tests discount serophene 50mg mastercard, treatments buy serophene 25mg cheap, and procedures that discount 50 mg serophene otc, in certain spectrum of hematologic expertise; malignant buy 100mg serophene, benign, adult, and scenarios, are unnecessary, can contribute to avoidable harm, and pediatric specialists were all well represented on the Task Force. In 2012, the Institute of Medicine estimated that 210 billion dollars are wasted annually on unnecessary medical care in The selection and prioritization of items for ASH’s second Choos- the United States,1 a daunting figure that highlights the importance ing Wisely campaign were guided by the same 5 principles used in of Choosing Wisely and other stewardship initiatives. This article was selected by the Blood and Hematology 2014 American Society of Hematology Education Program editors for concurrent submission to Blood and Hematology 2014. It is reprinted with permission from Blood 2014, Volume 124. Guiding principles for the ASH Choosing Wisely Table 2. ASH 2014 Choosing Wisely recommendations campaign Key 1. Harm avoidance Recommendations should aim to reduce potential Recommendation reference(s) harm to patients 1. Evidence Recommendations should be evidence based than 3 months in a patient with a first VTE 3. Cost Recommendations should aim to decrease the occurring in the setting of a major transient cost of health care risk factor. Do not routinely transfuse patients with 15,16 procedures, or treatments that are common SCD for chronic anemia or uncomplicated 5. Purview of the Recommendations should target tests, pain crisis without an appropriate clinical hematologist procedures, or treatments within the purview of indication. Impact Recommendations that are likely to have greater surveillance CT scans in patients with impact (lead to greater positive changes) asymptomatic, early-stage CLL. Do not test or treat for suspected HIT in 28 impact patients with a low pretest probability of HIT. Do not treat patients with ITP in the 34 evidence-based recommendations, (3) considering cost, (4) consid- absence of bleeding or a very low platelet ering frequency of tests and treatments, and (5) making recommen- count. As with the first ASH Choosing Wisely campaign, harm avoidance was established nonmalignant focus and 34 with a malignant focus. Among the 10 as the campaign’s preeminent guiding principle. For the second semifinalist items selected for systematic review, 7 had a nonmalig- ASH Choosing Wisely campaign, a sixth overarching principle nant focus and 3 had a malignant focus. One of the 10 semifinalist was adopted: impact (Table 1). Items that were felt to have a greater items was ultimately excluded because the systematic review probability of triggering positive changes in practice were priori- proved to be infeasible in the prescribed time frame due to a very tized over items felt to have lower potential impact. Items that high number of potentially eligible citations. This item involved overlapped substantially with published Choosing Wisely recom- thrombophilia testing for arterial disease. Table 2 summarizes the 5 mendations from other medical societies received lower priority. Suggestions for the second ASH Choosing Wisely list were solicited from members of the ASH Committee on Practice, the Discussion ASH Committee on Quality, the ASH Choosing Wisely Task The first recommendation of ASH’s second Choosing Wisely Force, ASH Consult-a-Colleague volunteers, and members of the campaign is not to anticoagulate patients with a first VTE provoked ASH Practice Partnership. Guided by the 6 principles outlined by a major, transient VTE risk factor such as surgery, trauma, or an above (Table 1), the ASH Choosing Wisely Task Force scored all 4-9 intravascular catheter for more than 3 months. Randomized suggestions for inclusion in ASH’s second Choosing Wisely list. These recommendations are driven largely by a low the 10 semifinalist items using the same methods described previ- 2 risk of VTE recurrence after 3 months in the setting of a provoked ously. The search strategies for each of the Anticoagulation for VTE continued beyond 3 months is associated 10 semifinalist items are outlined in the supplemental Appendix to with a major bleeding risk of 2. These estimates come from prospective hierarchical search strategies were used such that if recent (subse- clinical trials of warfarin; it is likely that bleeding risks are higher in quent to 2008) evidence-based guidelines were found, the literature clinical practice, where patients tend to be older and have more search was curtailed. Bleeding risks may be lower with new oral anticoagulants. However, in addition to potential harms from Guided by the 6 core principles outlined in Table 1 and by our anticoagulation, anticoagulation with new oral anticoagulants is systematic reviews of the evidence, the ASH Choosing Wisely expensive. Task Force selected 5 recommendations for inclusion in ASH’s second Choosing Wisely campaign.

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Because ® of this risk purchase serophene 50mg visa, use of FORADIL for the treatment of asthma without a concomitant long-term asthma control Foradil Formoterol medication discount serophene 100mg with amex, such as an inhaled corticosteroid cheap serophene 100mg visa, is contraindicated serophene 50mg visa. Use FORADIL only as additional therapy for patients with asthma who are currently taking but are inadequately controlled on a long-term asthma control medication generic 100mg serophene free shipping, such as an inhaled corticosteroid. Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (e. Do not use FORADIL for patients whose asthma is adequately controlled on low or medium dose inhaled corticosteroids. Controller medications for asthma 218 of 369 Final Update 1 Report Drug Effectiveness Review Project Trade name Active ingredient(s) Boxed warnings Long-acting beta2-adrenergic agonists (LABA), such as formoterol the active ingredient in CERTIHALER, increase the risk of asthma-related death. Data from a large placebo-controlled US study that compared the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of LABA, including formoterol. Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from LABA. Because of this risk, use of CERTIHALER for the treatment of asthma without a concomitant long-term asthma control ® Certihaler Formoterol medication, such as an inhaled corticosteroid, is contraindicated. Use CERTIHALER only as additional therapy for patients with asthma who are currently taking but are inadequately controlled on a long-term asthma control medication, such as an inhaled corticosteroid. Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (e. Do not use CERTIHALER for patients whose asthma is adequately controlled on low or medium dose inhaled corticosteroids. Long-acting beta2-adrenergic agonists (LABA), such as formoterol the active ingredient in FORADIL AEROLIZER, increase the risk of asthma-related death. Data from a large placebo-controlled US study that compared the safety of another LABA (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. This finding with salmeterol is considered a class effect of LABA, including formoterol. Currently available data are inadequate to determine whether concurrent use of inhaled corticosteroids or other long-term asthma control drugs mitigates the increased risk of asthma-related death from LABA. Because of this risk, use of FORADIL AEROLIZER for the treatment of asthma without a concomitant long-term asthma ® Foradil Aerolizer Formoterol control medication, such as an inhaled corticosteroid, is contraindicated. Use FORADIL AEROLIZER only as additional therapy for patients with asthma who are currently taking but are inadequately controlled on a long-term asthma control medication, such as an inhaled corticosteroid. Once asthma control is achieved and maintained, assess the patient at regular intervals and step down therapy (e. Do not use FORADIL AEROLIZER for patients whose asthma is adequately controlled on low or medium dose inhaled corticosteroids. Data from a large placebo-controlled US study that compared the safety of another long-acting beta2-adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients receiving ® salmeterol. This finding with salmeterol is considered a class effect of LABA, including formoterol, the active Perforomist Formoterol ingredient in PERFOROMIST Inhalation Solution. The safety and efficacy of PERFOROMIST in patients with asthma have not been established. All LABA, including PERFOROMIST, are contraindicated in patients with asthma without use of a long-term asthma control medication. Controller medications for asthma 219 of 369 Final Update 1 Report Drug Effectiveness Review Project Trade name Active ingredient(s) Boxed warnings Data from a large placebo-controlled US study (Salmeterol Multi-center Asthma Research Trial) comparing the safety of the long-acting beta2-adrenergic agonist salmeterol to that of a placebo added to the original asthma therapy showed an increase in asthma-related deaths in patients receiving salmeterol. Although the trial results were specific to salmeterol, one of the conclusions derived from this study is that long-acting beta2-adrenergic agonists may increase the risk of asthma exacerbation and possibly asthma-related death. Although available data Oxeze ® Formoterol for formoterol fumarate dihydrate do not suggest increased risk, it cannot be excluded that the findings with Turbuhaler salmeterol may apply to all longacting beta2-adrenergic agonists including formoterol fumarate dihydrate, the active ingredient in OXEZE TURBUHALER. When treating asthma patients, OXEZE TURBUHALER should be used only as additional therapy for patients whose conditions are not adequately controlled using low-to-medium dose inhaled corticosteroids or whose disease severity clearly warrants the initiation of treatment with two maintenance therapies, i. OXEZE TURBUHALER in addition to an inhaled corticosteroid. Data from a large placebo-controlled US study that compared the safety of another long-acting beta2 –adrenergic agonist (salmeterol) or placebo added to usual asthma therapy showed an increase in asthma-related deaths in patients ® Brovana Arformoterol receiving salmeterol. This finding with salmeterol is considered a class effect of LABA, including arformoterol, the active ingredient in BROVANA. The safety and efficacy of BROVANA in patients with asthma have not been established. All LABA, including BROVANA, are contraindicated in patients with asthma without the use of a long- term asthma control medications Long-acting beta2-agonists (LABAs), such as salmeterol, the active ingredient in SEREVENT, increase the risk of asthma-related death.

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