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 MoreTurning Rejection Into Opportunity
A quarter of a century ago, a former colleague of mine who specialized in stress management told me that everyone experiences stress; what matters is how one manages it. Analogous advice would seem to apply to sales: “Every sales professional experiences rejection. What matters is how they manage that rejection.” This month’s column features a plan for learning how to live with rejection, and turning it to your advantage.
Read MoreClinical Challenge: June, 2010
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 4 1/2 -year-old girl who presents with local pain and swelling in the fifth digit of her left hand. The parents report that …
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The Case of a 21-year-old Woman with Sinus Pain
I would rather have a patient with a stab wound to the chest than a patient with a serious underlying problem who just wants antibiotics and a quick evaluation. Is there a way to tease out benign- appearing patients who are “pre-crump?” This month’s case is that very patient—a raindrop in a torrent of mucus and purulent drainage.
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Asthma in the Pediatric Population: An Urgent Care Approach
Urgent message: though sometimes viewed as an easily controlled disease, asthma can become a medical emergency quickly. It is important for the urgent care clinician to be able to recognize the signs of a potentially life-threatening asthma exacerbation – and know how to treat it accordingly. Muhammad Waseem, MD, Nicholas Caputo, MD, Geeta Krishna, MD, Joel Gernsheimer, MD Introduction Asthma is an episodic and reversible airflow obstruction. It is the most common chronic disease in …
Read MoreMinding Your E’s & M’s
Nothing hurts a business more than leaving money on the table. It is hard enough to attract business; the last thing you want to do is not get paid once services are rendered. There are a number of steps in the coding and billing process, and errors at any level can lead to bad debt, missed charges, and poor reimbursement. Let’s look at a few I would call the “low-hanging fruit.” Collection at the Time …
Read MoreClinical Challenge 2: April 2010
The patient is a 26-year-old who presents to urgent care after “twisting” the right foot, complaining of local pain but able to bear weight. View the image taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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16-year-old male falls from motorcycle, takes blow to right ankle
The patient is a 16-year-old male who fell from his motorcycle and received a blow to his right ankle. The motorcycle was moving at a “good pace.” On exam, he is able to weight bear, but with significant pain. You note swelling and tenderness over the medical malleolus. View the x-ray taken and consider what your diagnosis and next steps would be.
Read MoreEvaluating Febrile Patients with Rash
Urgent message: The broad differential diagnoses in patients presenting with rash and fever range from minor conditions to life threatening illnesses, requiring the urgent care provider to make prompt but valid assessment with minimal diagnostic tools. Kosta G. Skandamis, MD The combination of fever and rash is so common that it may sometimes seem to be a daily occurrence in the urgent care setting. Nonetheless, the extensive differential diagnosis requires the provider to be vigilant …
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Beyond Vital Signs: Managing by Metrics for Optimal Health of Your Practice
Urgent message: Establishing a system of metrics and ‘dashboards’ allows the urgent care operator to quantify key success factors and company values that may otherwise be impossible to measure. Laurel Stoimenoff Metric – Function: noun \’me-trik\ Def: A standard of measurement – Merriam Webster Online Dictionary. “What gets measured gets managed.” This pearl applies not only to the behemoths like General Electric, but also to a single-site urgent care center. A 2008 survey by the …
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