Nine national medical groups are launching a campaign called Choosing Wisely to get U.S. doctors to back off on 45 diagnostic tests, procedures and treatments that often may do patients no good.

Many involve imaging tests such as CT scans, MRIs and X-rays. Stop doing them, the groups say, for most cases of back pain, or on patients who come into the emergency room with a headache or after a fainting spell, or just because somebody's about to undergo surgery.

A child with low belly pain and suspected appendicitis? Don't rush her to the CT scanner. Do an ultrasound first. That will give the answer 94 percent of the time, is cheaper and doesn't expose the child to radiation.

Don't put heartburn patients on high doses of acid-suppressing drugs when lower doses and shorter courses will do, they say. You might just be making their symptoms worse when they try to stop the medicine.

An apparently healthy middle-aged guy with few cardiac risk factors comes in for a yearly exam and wants to know how his ticker is. Don't give him a full cardiac workup, with a treadmill test and fancy imaging. This kind of patient accounts for almost half of unnecessary cardiac screening.

Postpone repeat colonoscopies for 10 years if the first one is negative, or if it found and removed one or two early-stage colon polyps, the guidelines state. And stop prescribing antibiotics for mild-to-moderate sinus infections.

And here's one that raises some tricky questions: Most patients who are debilitated with advanced cancer shouldn't get more chemotherapy.

"When somebody is literally bed-bound and unable to walk or take care of himself, it's almost futile to use cancer-directed treatment and will probably have negative consequences," says Dr. Lowell Schnipper, a Boston cancer specialist who helped develop the new guidelines.

Schnipper tells Shots many cancer patients are getting chemotherapy in the last weeks of their lives. He says that does no good, makes patients miserable and may shorten their life.

The Choosing Wisely project was launched last year by the foundation of the American Board of Internal Medicine. It recruited nine medical specialty societies representing more than 376,000 physicians to come up with five common tests or procedures "whose necessity ... should be questioned and discussed."

More.

Hospital operating rooms (ORs) are highly intense work environments that require the OR team to function as a well-honed unit under stressful conditions. Ongoing training opportunities are critical to improving the competency and cooperation of these OR teams. Training on patient simulators of various OR crisis scenarios improves OR team-based competencies such as communication, role clarity, and mutual support, concludes a new study.

For the study, patient simulators were set up in ORs at a 157-bed hospital. Seven crisis scenarios were duplicated, including cardiac arrhythmia, shock, and problems with anesthesia. OR personnel participated in two separate training sessions lasting up to 3 hours. Following each training session, participants were asked about their experience and how it affected team-related competency. A total of 45 team members participated, representing surgical residents, nurse anesthetists, circulating nurses, and surgical technicians.

Post-training scores improved significantly compared with pretraining scores. The scores increased from 4 out of 15 items related to teamwork competencies after the first training (Module 1) to 9 out of 15 items after the second training (Module 2). Competency areas that showed improvement after completion of the two trainings included role clarity, team orientation, open communication, and mutual support and backup behavior. Observers who were placed in the OR during the high-fidelity simulations witnessed distinct improvements in teamwork abilities from one module to the next.

The researchers conclude that such competency improvements can then be adopted in actual clinical practice in the OR. The study was supported in part by the Agency for Healthcare Research and Quality (HS16680).

See "Attitudinal changes resulting from repetitive training of operating room personnel using high-fidelity simulation at the point of care," by John T. Paige, M.D., Valeriy Kozmenko, M.D., Tong Yang, M.D., M.S., and others, in The American Surgeon 75(7), pp. 584-591, 2009.

Click here to access the article.