Practice Management
The patient is a 15-year-old boy who experienced a blow to both ankles and the right knee two days ago. You observe that he can bear weight only minimally, with tenderness over the lateral and medial malleolus, as well as over the knee. You also observe there is marked swelling. View the x-ray taken and consider what your diagnosis and next steps would be.
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The patient is a 3-year-old girl who fell from a bicycle, receiving a blow to the elbow a short time before presentation. You note marked swelling and local tenderness over the elbow. The only other remarkable finding is a pulse of 132. View the x-rays taken and consider what your diagnosis or next steps would be.
Read MoreH1N1 Update: CDC Recommends Seasonal Flu Vaccination for Children Over 6 Months Key point: Get vaccinated! Citation: Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR. July 24, 2009; 58 (Early Release): 1-52. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr58e0724a1.htm. In contrast to last year, when seasonal flu shots for those between 6 months and 18 years of age were “encouraged,” …
Read MoreThe patient is a 45-year-old woman (herself a surgeon) who presented three weeks after first visiting her family physician with a cough, at which time the x-ray shown in Figure 1 was taken. She was started on erythromycin for 10 days. After finishing that course of antibiotics with no improvement, she was started on amoxicillin-clavulanic acid. Four days later, there was still no improvement in her status. Second Presentation: Urgent Care By the time the …
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The patient is a 51-year-old male with uncontrolled type 2 diabetes who presents with a painful, raised, pruritic rash that began after an afternoon of gardening eight days ago. In the interim, he self-treated with over-the-counter topical hydrocortisone 1 percent without relief. View the photo and consider what your diagnosis or next steps would be.
Read MoreUrgent message: Fractures of the distal radius are a common presentation in the urgent care setting. Nonetheless, a high index of suspicion is required for the diagnosis of a Galeazzi fracture–dislocation.By Heather L Hinshelwood, MD and David Caro, MD IntroductionThe anatomic structure of the forearm typically maintains the integrity of the distal radioulnar joint when the radius is fractured. However, in certain situations this joint may be compromised with certain rotational forces. CaseA 14-year-old African-American male …
Read MoreEarly Estimate of Pandemic Potential of Influenza A H1N1 “Swine Flu” Key point: The current virus is transmitted efficiently but probably is less lethal than past pandemic viruses. Citation: Fraser C, Donnelly CA, Cauchemez S, et al. Pandemic potential of a strain of influenza A (H1N1): Early findings. Science. 2009 May 14; e-pub ahead of print. A team of epidemiologists has analyzed the influenza A (H1N1) epidemic in Mexico. Data related to the outbreak were …
Read MoreThis month’s column provides some easy-to-execute sales and marketing tips that we have found helpful in moving a clinic’s occupational health initiative forward: Sales Skills and Techniques Use euphemisms to convert negative phrases into positives. “You have a problem” should be “You have an opportunity.” “You have a high injury rate” becomes “if we can help lower your injury rate, it would result in lower workers’ comp costs.” Orchestrate clinic visits to make …
Read MoreThroughout history, entrepreneurs have faced harsh critics. From Shakespeare’s The Merchant of Venice through Oliver Stone’s movie Wall Street (“greed is good, greed works.” etc.) entrepreneurial efforts are cast in a dim light. To paraphrase Lifebook founder Job Butcher, though, “no other social system can compete with the free market, entrepreneurial system in terms of productivity, raising living standards, and creating prosperity … Yet, despite its overwhelming contributions, some elements of society still associate profit-making …
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Urgent message: A robust – and effective – advertising campaign needs to take full advantage of all available media, with special consideration of online opportunities. Alan A. Ayers, MBA, MAcc In the past, advertising was a simple proposition; nearly everyone attached the same network television, read the same city newspapers, and searched for businesses in the Yellow Pages. But in recent years, such “mass marketing” has yielded to new marketing channels targeting the lifestyles and …
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