Clinical Decision Tool Identifies Boys at Low Risk of Testicular Torsion Key point: No child with a normal testicular lie, age <11 years, and absence of nausea or vomiting had torsion. Citation: Shah MI, Chantal CA, Mendez DR. Prospective pi- lot derivation of a decision tool for children at low risk for testicular torsion. Acad Emerg Med. 2013;20(3): 271-278. To develop a clinical decision tool for identifying children at low risk for testicular torsion, investigators …
Read MoreRegional Health System Integration: Charting Your Course
Lee A. Resnick, MD, FAAFP These are indeed stormy and transformational times. While no one can seem to agree on the political path to reform, change is nonetheless happening at a rapid pace in health care. Previous efforts to manage health care costs and quality on a national scale sunk at sea (the HMOs and Managed Care Organizations of the 80s and 90s). But the current path to reform appears unstoppable to me, regardless of …
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An Urgent Care Approach to Complications and Conditions of Pregnancy Part 2
Urgent message: From pregnancy confirmation to the evaluation of bleeding, urgent care centers are often the initial location for management of obstetric-related issues. Careful use of evidence-based guidelines is the key to successful outcomes. DAVID N. JACKSON, MD, FACOG and PETAR PLANINIC, MD, FACOG Case Presentation Urgent care providers are called upon to manage a variety of complaints in pregnancy. Some conditions can be managed at the urgent care center whereas others require stabilization and …
Read MoreClinical Challenge: September, 2013
The patient, a 76-year-old male, presented with a complaint of palpitations. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
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Paraphimosis
Urgent message: Most cases of paraphimosis can be managed in the urgent care setting and prompt treatment is necessary to avoid complications. MOHAMED A. FAYED, MD Overview An uncircumcised male’s penis consists of the penile shaft and glans penis covered by foreskin. At birth, the foreskin and glans penis are fused, which is called physiologic phimosis. Approximately half of uncircumcised males have fully retractable foreskins by age 10 years; by age 17, the foreskins of …
Read MoreWhat’s In a Test? The Psychology of Patient Expectations
Lee A. Resnick, MD, FAAFP The impact of patient expectations and pressures on high utilization rates in this country is a subject of significant discussion but surprisingly little study. A literature review produces scant evidence of scientific inquiry in this area. And yet, most clinicians would say that patient expectations are perhaps an even stronger motivation for utilization than fear of malpractice suits. In an ever-competitive, service- oriented industry like urgent care, this can only …
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An Urgent Care Approach to Complications and Conditions of Pregnancy
Urgent message: From pregnancy confirmation to the evaluation of bleeding, urgent care centers are often the initial location for management of obstetric issues. Careful use of evidence-based guidelines is the key to successful outcomes. DAVID N. JACKSON, MD, FACOG Introduction Although close to 160 million visits are made to urgent care providers each year in the United States, there are currently no prospective studies describing how pregnancy may initiate or complicate an urgent care consultation. …
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Dissecting Cellulitis of the Scalp
Urgent message: Prompt recognition of dissecting cellulitis is important to help patients receive appropriate treatment and avoid long-term conse – quences such as alopecia. MOHAMED A FAYED, MD Introduction Dissecting cellulitis of the scalp is a chronic skin condition for which patients often present to urgent care providers. Prompt recognition of such cases could have significant potential benefit to patients in ensuring successful treatment and preventing complications. Case Presentation A 39-year-old African-American male presented with …
Read MoreClinical Challenge: July/August, 2013
The patient, a 41-year-old male, was a construction worker who fell on his right knee. Because of the pain he opted to take a vacation from work for a week and not seek medical attention. Upon his return, he was still having pain and elected to be seek medical attention. View the image taken (Figure 1) and consider what your diagnosis would be. Resolution of the case is described on the next page.
Read MorePhysicians Criticizing Physicians: A Two-Headed Snake
Lee A. Resnick, MD, FAAFP In the Hippocratic Oath it is written and we are bound: “To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art if they …
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