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 …
Read MoreAbstracts in Urgent Care: January, 2015
Fatigue and inappropriate antibiotic prescription Key point: As the day goes on, resistance to prescribe potentially inappropriate antibiotics seems to fade. Citation: Linder JA, Doctor JN, Friedberg MW, et al. Time of day and the decision to prescribe antibiotics. JAMA Intern Med. 2014 Oct 6; doi: 10.1001/jamainternmed.2014.5225. [Epub ahead of print] Previous research has shown that resistance to making the easier choice tends to fade as fatigue increases. Physicians make many difficult decisions during …
Read MoreAbstracts in Urgent Care: December, 2014
Pulse oximetry and decision-making on hospitalization Key point: Use of pulse oximetry to decide on necessity of hospitalization may need to be reconsidered. Citation: Schuh, S, Freedman S, Coates A. et al. Effect of oximetry on hospitalization in bronchiolitis, JAMA. 2014; 312(7):712-718. Pulse oximetry has been used to help decide when an infant with bronchiolitis should be hospitalized. The authors of this study postulated that providers may be relying too heavily on it, resulting in …
Read MoreAbstracts in Urgent Care: November, 2014
Generic medication appearance Key point: When providing generic prescriptions, warn patients about generic medication colors and shapes. Citation: Kesselheim AS, Bykov K, Avorn J, et al. Burden of changes in pill appearance for patients receiving generic cardiovascular medications after myocardial infarction: Cohort and nested case–control studies. Ann Intern Med. 2014; 161:96-103. Researchers in this study attempted to determine if changes in color or shape of a generic drug led to discontinuation of that drug. Patients …
Read MoreAbstracts in Urgent Care: October, 2014
Timing of concussion symptoms Key point: Symptoms of concussion such as sleep disturbance, forgetfulness, and fatigue are late in onset. Citation: Eisenberg MA, Meehan WP 3rd, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999-1006. Estimates of the duration of concussion symptoms in children vary from 1 week to months. This study looks at previous cohorts where the median time to recovery was 13 days and considers symptoms, their duration, and clinical course. The …
Read MoreAbstracts in Urgent Care – September 2014
Antibiotics and middle ear effusion Key point: Treatment with antibiotics seems to reduce the duration of middle ear effusion. Citation: Tapiainen T, Kujala T, Renko M, et al. Effect of antimicrobial treatment of acute otitis media on the daily disappearance of middle ear effusion: A placebo-controlled trial. JAMA Pediatr. 2014;168(7):635-641. Authors in this randomized, double blind, placebo-controlled trial compared 84 children aged 6 months to 15 years with acute otitis media who were either given …
Read More