Position Statement on Sports Concussions Key point: Sports are second only to motor vehicle accidents as the leading cause of traumatic brain injury among 15- to 24- year-olds. Citation: AAN Sports Neurology Section, Practice Committee, and Board of Directors. Position statement on sports concus- sion. October 2010 (AAN Policy 2010-36). Concussion is a common consequence of trauma to the head in contact sports, estimated by the Centers for Disease Control and Prevention to occur 3 …
Read MoreAbstracts in Urgent Care: December, 2010
Nahum Kovalski, BSc, MDCM Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. New Guidelines for Prevention of Stroke in Patients with Stoke or TIA Key point: New, evidence-based recommendations aim at reducing risk of ischemic stroke in patients who have had a stroke or transient ischemic attack. Citation: Furie KL, Kasner SE, …
Read MoreAbstracts in Urgent Care: November, 2010
On ED Visits, Corticosteroids and COPD, Intranasal Steroid in Allergic Rhinitis, Intussusception in Children Under 5, Urinary Antigen Testing, and Emergency Contraception Nahum Kovalski, BSc, MDCM Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. Emergency Department Visits on the Rise Key point: ED use in the U.S. is up dramatically; these stats …
Read MoreAbstracts in Urgent Care: October, 2010
On Imaging Head Injuries, Routine Cellulitis, Alteplase and Ischemic Stroke, Head Lice, Steroids for Pharyngitis, and Brain Injury in Children Nahum Kovalski, BSc, MDCM Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. Diagnostic Imaging Rates for Head Injury in the ED and States’ Medical Malpractice Tort Reforms Key point: The authors found …
Read MoreAbstracts in Urgent Care: September, 2010
Non-intravenous Midazolam Effectively Terminates Pediatric Seizures Key point: A meta-analysis revelas that non-IV midazolam is as effective as or superior to IV or rectal diazepam for stopping seizures in children and young adults. Citation: McMullan J, Comilla S, Panciolo A, et al. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: A meta-analysis. Acad Emerg Med. 2010; 17(6): 575-582. Although intravenous (IV) lorazepam is considered first-line therapy for status epilepticus, …
Read MoreAbstracts in Urgent Care: July/August, 2010
Validation of the ABCD2 Score for Predicting Stroke Risk After Transient Ischemic Attack Key point: An ABCD2 score > 2 is associated with significantly increased risk for stroke within 90 days. Citation: Tsivgoulis G, Stamboulis E, Sharma VK, et al. Multicenter external validation of the ABCD2 score in triaging TIA patients. Neurology. 2010; 74(17): 1351-1357. The ABCD2 score has been endorse internationally as a simple method for identifying patients with transient ischemic attack (TIA) who …
Read MoreAbstracts in Urgent Care: June, 2010
Upper Gastrointestinal Tract Hemorrhage, Warfarin, and Urinary Tract Antibiotics Key point: Ciprofloxacin increased GI hemorrhage while on coumadin by twice as much, and cotrimoxazole by four times. Citation: Fischer HD, Juurlink DN, Mamdani MM, et al. Hemorrhage during warfarin therapy associated with cotrimoxazole and other urinary tract anti-infective agents: A population-based study. Arch Intern Med. 2010; 170(7): 617-621. Hemorrhage is a well-known side effect of long-term warfarin use in older patients. Interactions between warfarin and …
Read MoreAbstracts in Urgent Care: May, 2010
Emergency treatment of Anaphylactic Reactions Key point: Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction. Citation: Pumphrey R, Cant A, Clarke S, et al. Emergency treatment of anaphylactic reactions – Guidelines for healthcare providers. Resuscitation. 2008; 77(2): 157-169. Patients experiencing an anaphylactic reaction have life-threatening airway and/or breathing and/or circulation problems usually associated with skin or mucosal changes. Such patients should be treated using the ABCDE …
Read MoreAbstracts in Urgent Care: April, 2010
Diagnostic Medical Errors: What Goes Wrong and Why Key point: Errors often occur because clinicians don’t consider the diagnosis, test for it, or follow up on abnormal test results. Citation: Schiff GD, Hasan O, Kim S, et al. Diagnostic error in medicine: Analysis of 583 physician-reported errors. Arch Intern Med. 2009; 169: 1881-1887. Autopsy data from the past few decades reveal diagnostic error rates of 10% to 15%, but do not inform us about the …
Read MoreAbstracts in Urgent Care: March, 2010
Consequences of Increasing Copayments for Ambulatory Care Key point: Even small increases in cost-sharing were associated with fewer outpatient visits and more inpatient admissions among elders. Citation: Trivedi AN, Moloo H, Mor V. Increased ambulatory care copayments and hospitalizations among the elderly. N Engl J Med. 2010; 62: 320-328. Recently, many health plans have increased copayments for outpatient visits. Although the rationale, presumably, is to minimize unnecessary ambulatory care, the strategy could backfire if higher …
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