SEAN M. McNEELEY, MD Longer-Term Antibiotic Treatment and Persistent Lyme Disease Symptoms Key point: Longer therapy for Lyme disease is not helpful. Citation: Berende A, ter Hofstede HJ, Vos FJ, et al. Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. N Engl J Med. 2016;374:1209–1220. Lyme disease continues to be in the news because persistent symptoms after infection are of great concern. In a double- blind, placebo-controlled study, researchers gave antibiotics for …
Read MoreAbstracts in Urgent Care – May 2016
SEAN M. McNEELEY, MD Results Unavailable for 71% of Trials Key point: Many research findings are not easily available to clinicians. Citation: Chen Ruijun, Desai NR, Ross JS, et al. Publication and reporting of clinical trial results: cross sectional analyis across academic medical centers BMJ. 2016;352:i637. Researchers investigated the amount of clinical trial findings at academic medical centers that are not published and thus not easily available to clinicians. In a cross-sectional analysis of academic …
Read MoreAbstracts in Urgent Care: April, 2016
SEAN M. McNEELEY, MD Copeptin and Troponin Together Are Useful in Diagnosing Acute Coronary Syndromes Key point: There is a new tool for ruling out myocardial infarction. Citation: Ricci F, Di Scala R, Massacesi C, et al. Ultra-sensitive copeptin and cardiac troponin in diagnosing non-ST-segment elevation acute coronary syndromes—the COPACS Study. Am J Med. 2016;129:105–114. Concern about patients with non-ST-segment elevation myocardial infarction with chest pain and normal electrocardiogram (ECG) findings frequently causes a transfer …
Read MoreAbstracts in Urgent Care: March, 2016
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: November, 2015
Hypertonic Saline in Bronchiolitis Key point: Consider using hypertonic saline for bronchiolitis.Citation: Zhang L, Mendoza-Sassi RA, Klassen TP, Wainwright C. Nebulized hypertonic saline for acute bronchiolitis: a systematic review. Pediatrics. 2015;136:687–701. Bronchiolitis continues to be difficult to treat despite its high prevalence. With the exception of nasal bulb suction, few techniques have shown significant benefit, to the frustration of both patients’ parents and health-care providers. A Cochrane Review suggested that hypertonic saline (HS) may benefit …
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 …
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