Journal of Urgent Care Medicine

Abstracts – November 2009

Cost and Quality of Care at Retail Clinics Key point: Quality scores at retail clinics rivaled those at urgent care centers, physician offices, and EDs. Citation: Mehrotra A, Liu H, Adams JL, et al. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses. Ann Intern Med. 2009; 151(5): 321-328. Professional organizations have raised concerns about the quality of care that is delivered at store-based retail …

A Child with Constipation and Swollen Abdomen

Urgent message: Malignancies in children are often discovered only inadvertently, in conjunction with seemingly less dire presentations. Awareness of relevant signs and symptoms by the urgent care clinician can be invaluable in identifying tumors that might otherwise escape notice until they are at an advanced stage. Muhammad Waseem, MD Introduction The identification of a palpable abdominal mass in an urgent care center or emergency department is quite concerning, as it represents a serious underlying disorder. …

Treating Common Upper Respiratory Tract Infections in an Era of Increasing Antibiotic Resistance

Urgent message: Thorough evaluation and thoughtful prescribing can help ensure responsible, effective care and patient satisfaction. Joseph Toscano, MD Introduction Upper respiratory tract infections (URTIs) are among the most common reasons patients seek assistance in urgent care practice. The common cold, otitis media, acute sinusitis, and acute pharyngitis are well known to patient and provider alike. Acute bronchitis is a lower respiratory tract infection, with features similar to URTIs. These infections are most often self-limited …

The Hidden Costs of Medical Liability

The malpractice debate continues, like a rerun of Quincy, M.E. – you know the ending, but pretend to be surprised, if only to justify why you would watch the same show twice (or, in this case, many more). The issue of medical liability, while it has received little attention I the health reform debate, is perhaps the best example of why changing healthcare, no matter where you want it to go, is so difficult to …

Clinical Challenge: November, 2009

In each issue, JUCM will challenge your diagnostic acumen with a glimpse of x-rays, electrocardiograms, and photographs of dermatologic conditions that real urgent care patients have presented with. If you would like to submit a case for consideration, please e-mail the relevant materials and presenting information to [email protected] The patient is a 19-year-old male who complains of pain after receiving a blow to the shoulder. Range of motion is limited due to pain. The patient …

Abstracts in Urgent Care: October, 2009

Another Validation of Clinical Assessment and D-Dimer to Rule Out PE Key point: Among patients with low or intermediate risk, the sensitivity and negative predictive value of D-dimer testing were 100%. Citation: Gupta RT, Kakarla RK, Kirshenbaum KJ, et al. D-dimers and efficacy of clinical risk estimation algorithms: Sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009; 193: 425-430. Despite research showing that clinically important pulmonary embolism (PE) can be excluded when …

Preparing for Pandemic Influenza in the Urgent Care Setting

Urgent message: Between the current – and still growing – volume of H1N1 flu cases and fast-approaching influenza season, the urgent care physician will be challenged to distinguish among a variety of common cold and influenza-like conditions. Gary Klein, MD, MPH, MBA, CHS-V, FAADM Introduction The mainstream media have certainly accomplished the mission of alerting the public to the dangers of H1N1 flu – perhaps to the point that many are tempted to dismiss their …

What can YOU do for YOU?

I know this may sound like a funny way to start a column. It’s a bit confrontational perhaps, maybe even a little insulting. Why is this guy calling me out on the carpet here? What did I ever do to him? I have been involved in organized medicine for almost 10 years, at varying levels of responsibility. If I learned one thing alone the way, it is this: If you want id one, you better …

Clinical Challenge: October, 2009

A 57-Year-Old Woman with Acute Pain After a Fall The aptient is a 57-year-old woman who presented to urgent care complaining of severe pain in her right foot, leg, hip, and elbow. She reported that she fell three to four hours prior to presentation while outside walking her dog; she was “tripped up” in the pet’s leash. She presented ambulatory, but was unable to bear any weight on her right leg. Past medical history …

The Case of a 53-Year-Old Female with Headache and Eye Pain

Headaches are both common and challenging, accounting for 4% of ED visits and comprising the eighth most-common complaint seen by primary care physicians. This frequency can create a false sense of security, as there are numerous life-threatening etiologies hiding in the “haystack.” In this month’s case, our patient was a bounceback on her first visit, having previously seen her PCP and an urgent care doctor. In addition to a brief discussion of headaches and their …