SEAN M. McNEELEY, MD Inhaled Steroids Do Not Reduce Growth in Children with Asthma Key point: Inhaled steroids did not reduce growth velocity in a 1-year study. Citation: Wardenier NR, Klok T, de Groot EP, Brand PL. Height growth in children with asthma treated with guidelinerecommended dosages of fluticasone and electronically assessed adherence. Arch Dis Child. 2015 December 7. doi: 10.1136/archdischild-2015-309654. Adherence to therapy is important for children with asthma. Many factors, including fear of …
Read MoreAbstracts in Urgent Care: February, 2016
SEAN M. McNEELEY, MD Azithromycin Versus Doxycycline for Chlamydia Key point: Azithromycin is a little less effective than doxycycline for chlamydia. Citation: Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxycycline for urogenital Chlamydia trachomatis infection. N Engl J Med. 2015;373:2512–2521. This study of a population in a youth correctional facility compared the effectiveness of azithromycin with doxycycline in the treatment of chlamydia. A total of 567 participants were randomized to regimens of …
Read MoreAbstracts in Urgent Care: January, 2016
SEAN M. McNEELEY, MD When Accuracy Is a Must, Go for Central Thermometers Key point: Peripheral thermometers are not nearly as accurate as central thermometers. Citation: Niven DJ, Gaudet JE, Laupland KB, et al. Accuracy of peripheral thermometers for estimating temperature: a systematic review and meta-analysis. Ann Intern Med. 2015; 163:768–777. Temperature measurement is performed at most visits to urgent care centers. Although the data are not always important in clinical decision-making, sometimes they are …
Read MoreAbstracts in Urgent Care: December, 2015
SEAN M. McNEELEY, MD Family Members Are Most Frequent Cause of Pertussis in Children Younger Than 1 Year Key point: Be sure to suggest adding a pertussis vaccine to tetanus whenever possible. Citation: Skoff TH, Kenyon C, Cocoros N, et al. Sources of infant pertussis infection in the United States. Pediatrics. 2015;136:636–641. Despite recent efforts to increase the number of U.S. adults whose immunizations are current, pertussis still is a frequent problem for children younger …
Read MoreAbstracts in Urgent Care: October, 2015
SEAN M. McNEELEY, MD Differentiate Bacterial from Viral to Decrease Unneeded Antibiotic Prescriptions Key point: The overprescribing of antibiotics is still an issue. Citation: Jones BE, Sauer B, Jones MM, et al. Variation in outpatient antibiotic prescribing for acute respiratory infections in the veteran population: a cross-sectional study. Ann Intern Med. 2015;163:73–80. Concerns over the amount of antibiotic prescriptions continues. (See also “Delayed Prescribing of Antibiotics for Respiratory Tract Infections” in our September 2015 issue: http://www.jucm. …
Read MoreAbstracts in Urgent Care: September, 2015
SEAN M. McNEELEY, MD Adverse Events Unlikely in Patients with Negative Findings on Cardiac Evaluation Key point: Adverse events in patients admitted with negative findings on cardiac evaluation are very infrequent. Citation: Weinstock MB, Weingart S, Orth F, et al. Risk for clinically relevant adverse cardiac events in patients with chest pain at hospital admission. JAMA Intern Med 2015;175:1207–1212. In this 5-year retrospective study of patients seen in an emergency department for symptoms potentially representing …
Read MoreAbstracts in Urgent Care: July/August, 2015
SEAN M. McNEELEY, MD Sumatriptan Less Effective in Migraine with Aura Key point: Migraine with aura might require additional treatment measures. Citation: Hansen JM, Goadsby PJ, Charles A. Reduced efficacy of sumatriptan in migraine with aura vs without aura. Neurology. 2015;84:1880–1885. This study used pooled data to compare the response of patients with migraines with aura and the response of those with migraines without aura. A total of 3714 patients were compared; 1199 had an …
Read MoreAbstracts in Urgent Care: June, 2015
SEAN M. McNEELEY, MD Sudden Death When Older Patients Taking Spironolactone Are Given Trimethoprim-Sulfamethoxazole Key point: Another drug interaction with potential deadly consequences. Citation: Antoniou T, Hollands S, Macdonald EM, et al; Canadian Drug Safety and Effectiveness Research Network. Trimethoprim-sulfamethoxazole and risk of sudden death among patients taking spironolactone. CMAJ. 2015;187:E138–143. It is known that the combination of trimethoprim-sulfamethoxazole (TMP-SMX) and spironolactone may increase potassium levels in patients. This study is very similar to one …
Read MoreAbstracts in Urgent Care: April, 2015
SEAN M. McNEELEY, MD The Return of Measles Key point: Measles is back, so watch for it among your patients. Citation: Centers for Disease Control and Prevention. Measles (rubeola). Atlanta, GA: Centers for Disease Control and Prevention [updated February 12, 2015; cited February 18, 2015]. Available from: http://www.cdc.gov/measles/hcp/index.html Unfortunately measles is making a comeback. Most likely because of decisions to delay or avoid immunizations, a measles outbreak began in California in December 2014 and has …
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Oral and Facial Injuries in Urgent Care
Urgent message: For patients, cosmesis is often the top priority. But for clinicians, ruling out serious or life-threatening injury is paramount. Sean McNeeley, MD Introduction Patients with oral and related facial injuries often present to urgent care providers. Consider JT. He is 25-year-old male who was taken to an urgent care clinic by his friends after falling while mountain biking near his Ohio home. His friends were concerned because the hill was steep, and although …
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