Case The patient is a 10-year-old boy who experienced a direct blow to the elbow approximately six hours prior to presentation. He had incomplete range of motion with minimal local swelling and considerable pain. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreWhen Urgent Care is the Safest Place to Turn
JOHN SHUFELDT, MD, JD, MBA, FACEP In retrospect, it was bound to happen: An estranged husband received information from his insurance company about his wife’s outpatient treatment. He called the patient accounting office to confirm the residential address his wife gave to the registration clerk. He thanked the woman who supplied him with the information profusely, then got in his car and drove to the domestic violence shelter where his wife was recovering from the …
Read MoreEmphasizing the Positive Gets Results in Occ Med Sales
A successful occupational health sales professional should develop a mechanism to monitor his or her choice of words and commit to using the English language to the mutual advantage of both the provider and the sales prospects. However, sales professionals often make poor word choices at critical moments. Negative words abound in our daily vocabulary. Frequently used negative words include bad, poor, problem, complication, unacceptable, and difficult. When calling on an occupational medicine prospect, these …
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No Appointment Needed: The Resurgence of Urgent Care Centers in the United States
Urgent message: A new report from the California Health Care Foundation, excerpted here, examines how the growth of urgent care is influencing delivery of healthcare—and what the prospects for the future of the industry might be. Prepared for the California HealthCare Foundation by Robin M. Weinick, PhD and Renée M. Betancourt, BA The days of having a family doctor in town who cared for all of a patient’s health needs are long gone. In their …
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Ruptured Ectopic Pregnancy with a Negative Urine Pregnancy Test
Urgent message: Ectopic pregnancy must be considered in women of childbearing age who present with abdominal pain—even if ‘ruled out’ by a negative hCG test. Yi-An A. Lee, MD, MPH, Gino Farina, MD, and Helene Lhamon, MD The incidence of ectopic pregnancy is estimated to be 19.7 per 1,000 pregnancies and is responsible for 9% of pregnancy-related deaths.1 Ectopic pregnancy is always near the top of the differential diagnosis for abdominal pain in women of …
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The Case of a 46-Year-Old Man with Neck and Upper Back Pain
This article is the second in a series that will sequentially answer the following questions: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? In the September issue of JUCM, we discussed several studies which found the incidence of …
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Assessment and Management of Common Hand Infections
Urgent message: Common superficial hand infections may be managed easily by the urgent care physician. Left untreated or undertreated, however, simple hand infections may progress to disabling conditions requiring urgent sub-specialty management. Arthur R. Smolensky, MD, Samuel M. Keim, MD, MS, and Peter Rosen, MD The hand is an intricate and crucial feature of the human body. Yet, with the exception of superficial cellulitis, common hand infections require relatively simple surgical procedures—many of which can …
Read MoreDefining Urgent Care
Lee A. Resnick, MD, FAAFP In this issue of JUCM, The Journal of Urgent Care Medicine, we excerpt the landmark report, “No Appointment Needed: The Resurgence of Urgent Care Centers in the United States”. Funded by the California HealthCare Foundation, and authored by Robin M. Weinick, PhD and Renée M. Betancourt, BA, the report represents the first comprehensive look into urgent care practice and the urgent care industry. Everything from business models and staffing to …
Read MoreInsights In Images: October, 2007 -2
The patient is a 35-year-old Caucasian female who presented with dysphagia and progressively worsening neck pain. No history of injury was reported. Neurovascular exam was normal. View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
Read MoreAbstracts in Urgent Care: October, 2007
A Controlled Clinical Trial of Steroids forBronchiolitis Key point: One dose of oral dexamethasone was no different fromplacebo. Citation: A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357:331-339. Bronchiolitis is the leading cause of hospitalization of infants in the U.S. Use of steroids for infants with bronchiolitis remains controversial because of the lack of high-quality, sufficiently powered studies. In a multisite, double-blind clinical trial, researchers randomized 600 infants (age range, …
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