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6 passages

recommendationchoosing-wisely· primary care / musculoskeletal· item cwus-aafp-001

Don't do imaging for low back pain within the first six weeks unless red flags are present. Setting: acute low back pain of less than 6 weeks with no red flags (major trauma, neurological deficit, history of cancer, unexplained weight loss, fever/infection, IV drug use) Why: Imaging of the low back before six weeks does not improve outcomes but exposes patients to unnecessary cost, radiation, and incidental findings that prompt further low-value testing. Consider instead: conservative management with reassessment; image only if red flags emerge or symptoms persist beyond 6 weeks Source: American Academy of Family Physicians (Choosing Wisely, US, 2012).

recommendationchoosing-wisely· primary care / infectious disease· item cwus-aafp-002

Don't routinely prescribe antibiotics for uncomplicated upper respiratory infections or mild acute rhinosinusitis. Setting: uncomplicated viral upper respiratory infection, or acute rhinosinusitis with mild-to-moderate symptoms of less than 7 days Why: Most acute URIs and sinusitis are viral and self-limited; antibiotics do not speed recovery and drive resistance and adverse effects. Consider instead: symptomatic treatment; reserve antibiotics for persistent (>10 days), severe, or worsening ('double-sickening') presentations Source: American Academy of Family Physicians (Choosing Wisely, US, 2012).

recommendationchoosing-wisely· primary care / urology· item cwus-aafp-003

Don't screen for prostate cancer using a PSA test without a discussion of the risks and benefits. Setting: asymptomatic average-risk man, particularly under 55 or over 69 years, without shared decision-making Why: PSA screening without informed discussion leads to over-diagnosis and over-treatment of indolent disease with significant harms. Consider instead: shared decision-making before any PSA testing Source: American Academy of Family Physicians (Choosing Wisely, US, 2012).

recommendationchoosing-wisely· primary care / bone health· item cwus-aafp-004

Don't perform DEXA (bone density) screening for osteoporosis in women younger than 65 or men younger than 70 with no risk factors. Setting: woman under 65 or man under 70 with no osteoporosis risk factors Why: Bone-density screening in younger low-risk adults has low yield and can lead to unnecessary treatment. Consider instead: screen at the guideline age, or earlier only if risk factors are present Source: American Academy of Family Physicians (Choosing Wisely, US, 2012).

recommendationchoosing-wisely· primary care / respiratory· item cwus-aafp-005

Don't prescribe antibiotics for acute bronchitis in otherwise healthy adults without evidence of pneumonia. Setting: acute bronchitis or acute cough illness in an otherwise healthy adult with no clinical or radiographic evidence of pneumonia (no consolidation) Why: Acute bronchitis is overwhelmingly viral; antibiotics (including respiratory fluoroquinolones) do not shorten the illness and add adverse effects and resistance. Consider instead: symptomatic treatment and safety-netting; reassess for pneumonia if focal chest findings, hypoxia, or deterioration Source: American Academy of Family Physicians (Choosing Wisely, US, 2012).

recommendationchoosing-wisely· primary care / respiratory· item cwus-aafp-005

Don't prescribe antibiotics for acute bronchitis in otherwise healthy adults without evidence of pneumonia. Setting: acute bronchitis or acute cough illness in an otherwise healthy adult with no clinical or radiographic evidence of pneumonia (no consolidation) Why: Acute bronchitis is overwhelmingly viral; antibiotics (including respiratory fluoroquinolones) do not shorten the illness and add adverse effects and resistance. Consider instead: symptomatic treatment and safety-netting; reassess for pneumonia if focal chest findings, hypoxia, or deterioration Source: American Academy of Family Physicians (Choosing Wisely, US, 2016).