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Background: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices., Aims: To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices., Methods: A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016)., Results: A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%); Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%); Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%); Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%)., Conclusions: This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned., (© 2017 Royal Australasian College of Physicians.)

Background: The international literature advocates for cancer screening in newly diagnosed patients with autoimmune myositis; however, there is no widely accepted consensus or guideline to outline the optimal cancer screening strategy and the evidence is currently insufficient to support any recommendation., Aim: Our study aimed to establish the current trends in practice in malignancy screening in autoimmune myositis among Australian rheumatologists., Methods: All rheumatologists who were full members of the Australian Rheumatology Association in 2016 (386) were invited to complete an online questionnaire. Respondent demographics and information on screening approach and concerns were collected using multiple choice and open-response questions. There were 60 respondents (16% response rate). All available quantitative data were analysed and reported using statistical software. Qualitative data were analysed and grouped according to themes., Results: Most respondents (93%) performed cancer screening. Significant variation was found in terms of approach to patient selection, choice of screening test, delegation of screening and repeat screening. A lack of clinical practice consensus and guideline (77%), test selection knowledge (37%), knowledge on repeated screening (53%) and the potential for harm (62%) were identified challenges in this area., Conclusion: Malignancy screening in autoimmune myositis was variable among this small cohort of Australian rheumatologists. The observed differences were driven by patient factors and clinician preferences. The group identified several challenges in the cancer screening process. Further research is warranted to address these challenges, close the evidence gap and develop workable guidelines., (© 2017 Royal Australasian College of Physicians.)