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 …
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 …
Read MoreAbstracts in Urgent Care: March, 2015
Strict Rest Unnecessary After Concussion Key point: strict rest after a concussion offers no advantage over standard stepwise return to play. Citation: Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics 2015;135:213–223. Concussion treatment has been frequently debated. In this prospective study, patients with concussion were treated with either strict rest for 5 days or standard stepwise return to play. A total of 88 …
Read MoreAbstracts in Urgent Care: February, 2015
Duration of Troponin Testing for ACS Key point: No definitive evidence for the 2-hour troponin rule-out for ACS. Citation: Kelly A–M, Klim S. Prospective external validation of an accelerated (2-h) acute coronary syndrome rule-out process using a contemporary troponin assay. Int J Emerg Med. 2014 Oct 16. doi: 10.1136/emermed-2014-204442. [Epub ahed of print.] As with other serious diseases, ruling out acute coronary syndrome (ACS) is a balance between not missing it and over testing or …
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