Antibiotics and middle ear effusion Key point: Treatment with antibiotics seems to reduce the duration of middle ear effusion. Citation: Tapiainen T, Kujala T, Renko M, et al. Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: A placebo-controlled trial. JAMA Pediatr. 2014;168(7):635-641. Authors in this randomized, double blind, placebo-controlled trial compared 84 children aged 6 months to 15 years with acute otitis media who were either given …
Read MoreSecurity Risk Assessment: Protecting Patients and Practice
Securing protected health information (PHI) is a goal we all share. Collectively, however, we are relatively clueless about how to achieve this, largely because of the massive amount of technology that almost all of us have adopted. A simple understanding begins with the most basic categorization of the technology that we use to store, transfer, and manage PHI: Software and hardware. Hardware includes all devices (desktops, laptops, routers, EKGs, and mobile devices) that store or …
Read MoreAbstracts in Urgent Care: September, 2014
Are we all ‘criminals’?
Show of hands…how many of you consider yourselves “compliant” with the array of regulations, laws and so-called “guidelines” you work under? Most of the time? Some of the time? Never? Now, let me pose the question a different way: How many of you think you can always, or even most of the time, remain in compliance and have a successful practice? Or, consider the question presented this way: How many of you think you can …
Read MoreClinical Challenge: July/August, 2014
THE CASE This patient presented with a sprained knee. View the image taken (Figure 1) and consider what your diagnosis would be.
Read MoreAbstracts in Urgent Care: July/August, 2014
Clinical prediction rule for ureteral stones Key point: A new clinical score may predict the presence of uncomplicated ureteral stones and reduce the need for CT scan. Citation: Moore CL, Bomann S, Daniels B, et al. Derivation and validation of a clinical prediction rule for uncomplicated ureteral stone—the STONE score: Retrospective and prospective observational cohort studies. BMJ. 2014; 348:g2191. In this two-phase trial, five factors were identified and then prospectively validated for prediction of ureteral …
Read MoreAcute Rheumatic Fever
Urgent message: Patients with seemingly unusual conditions do present to urgent care, underscoring the need to always take a thorough history for all “red flag” symptoms. LEE A. RESNICK, MD, FAAFP Introduction While the incidence of acute rheumatic fever has declined significantly in developed countries over the last several decades, sporadic cases do still occur. Diagnosis may be difficult due to the non-specific symptoms and the lack of experience with the condition amongst most urgent …
Read MoreEvaluation of Headaches in Urgent Care Part 2: Non-Emergent Headaches
Urgent message: Headaches are challenging chief complaints and being able to identify and differentiate among the non-emergent types of headaches will help with medical decision making and patient care. JACQUALINE DANCY, PA-C, MPAS In the conclusion of a two-part series, this article focuses on non-emergent headaches. For the purpose of this article, non-emergent headaches are classified as those that are not life-threatening and pose little to no risk of permanent functional disability. Most non-emergent headaches …
Read MoreAbstracts in Urgent Care: June, 2014
Modification of Wells criteria in cancer, previous DVT Key point: Wells criteria for deep venous thrombosis (DVT) may need modification for patients with cancer or previous DVT. Citation: Geersing GJ, Zuithoff NP, Kearon C, et al. Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data metaanalysis. BMJ. 2014;348:g1340. Possible DVT is an important diagnosis to make, however, many urgent cares do not have access to ultrasound. A combination …
Read MoreClinical Challenge – June 2014
THE CASE These x-rays were taken on a 49-year-old man with chronic bilateral knee pain that had increased over the past 6 months with ambulation. Examination was unremarkable. View the images taken (Figures 1, 2, and 3) and consider what your diagnosis would be.
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