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Introduction and Aim: The prevalence and incidence of chronic liver disease is increasing resulting, in substantial direct and indirect medical costs. Overuse of investigations, treatments and procedures contribute to rising health care costs and can expose patients to unnecessary harm and delay in receiving care. The Choosing Wisely Canada (CWC) campaign has encouraged professional societies to develop statements that are directly actionable by their members in an effort to promote higher-value health care that will lead to downstream effect on how other practitioners make decisions., Material and Methods: The Canadian Association for the Study of the Liver (CASL) established its Choosing Wisely top five list of recommendations using the framework put forward by CWC. CASL convened a task force that developed a list of draft recommendations and shared this with CASL membership electronically with eventual ranking of the top five recommendations by consensus at Canadian Digestives Disease Week (CDDW) 2017. Following revisions, the CASL Executive Committee endorsed the final list, which was disseminated online by CWC (July 2017)., Results: The top five recommendations physicians and patients should question include: 1) Don't order serum ammonia to diagnose or manage hepatic encephalopathy (HE). 2) Don't routinely transfuse fresh frozen plasma, vitamin K, or platelets to reverse abnormal tests of coagulation in patients with cirrhosis prior to abdominal paracentesis, endoscopic variceal band ligation, or any other minor invasive procedures. 3) Don't order HFE genotyping based on serum ferritin values alone to diagnose hereditary hemochromatosis. 4) Don't perform computed tomography (CT) or magnetic resonance imaging (MRI) routinely to monitor benign focal liver lesions. 5) Don't repeat hepatitis C viral load testing in an individual who has established chronic infection, outside of anti-viral treatment., Conclusion: The Choosing Wisely recommendations will foster patient-physician discussions, reduce unnecessary treatment and testing, avert adverse effects from testing and treatment along with reducing medical expenditure in hepatology., (Copyright © 2019 Fundación Clínica Médica Sur, A.C. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Men and women are thought to regulate their smoking differently and to differ in their susceptibility to nicotine addiction., Methods and Materials: Various measures of smoke exposure were compared between 400 current regular tobacco-dependent (DSM-IV) male and female light (1-15 cigarettes per day) and heavy (>15 cigarettes per day) smokers. Between 2 and 8 PM, blood was collected for nicotine and cotinine analysis, and breath carbon monoxide (CO) was measured. Individuals with genetic variants of the CYP2A6 gene were removed from analysis (n = 25)., Results: No significant difference was found in the number of cigarettes per day or CO levels between the sexes. However, females had significantly lower nicotine levels than males (16.9 +/- 0.6 vs. 21.1 +/- 0.07, p < 0.01). This is only partly explained by the fact that females smoked lower nicotine-containing cigarettes. Female heavy smokers demonstrated higher -log nicotine/CO values (a representation of cost of smoking) compared with male heavy smokers (0.1 +/- 0.02 vs. 0.02 +/- 0.01 mg/L ppm, p < 0.05)., Conclusions: Thus, gender differences appear to exist in smoking behaviors, nicotine sensitivity, and nicotine requirements. These differences are expected to contribute to gender differences in health risks and cancers associated with smoking.