Age-based cutoffs for D-dimer levels Key point: Age-based cutoffs for D-dimer levels can more accurately rule out deep venous thrombosis than the conventional cutoff level. Citation: Schouten HJ, Koek HL, Oudega R, et al. BMJ. 2012; 344: e2985. Researchers measured D-dimer values in some 650 patients suspected of having deep venous thrombosis but who had a low clinical probability according to their Wells score. Compression ultrasonography was used to confirm the diagnosis. Various cutoff levels …
Read MoreAbstracts in Urgent Care: July/August, 2012
Doctor Panels Recommend Fewer Tests for Patients Key point: The American Board of Internal Medicine, in partnership with nine medical specialty groups, is urging physicians to perform 45 common tests and procedures less frequently. Citation: http://www.nytimes.com/2012/04/04/health/doctor-panels-urge-fewer-routine-tests.html?_r=1 An article in the New York Times notes that unnecessary treatment accounts for an estimated one third of medical spending in the United States. The initiative, called Choosing Wisely, is aimed at both physicians and patients. Among the tests …
Read MoreAbstracts in Urgent Care: June, 2012
Is Oral Antibiotic Therapy Enough for Children with Acute Pyelonephritis? Key point: A randomized trial failed to prove the acceptability of oral antibiotic monotherapy relative to sequential intravenous and oral therapy, but evidence supporting and treatment alone as an option is accumulating. Citation: Bocquet N, Sergent AA, Jais JP, et al. Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics. 2012; 129(2): e269-275. Children with acute pyelonephritis typically receive intravenous …
Read MoreAbstracts in Urgent Care: May, 2012
ED Physicians Vary Widely in Use of Head CT Key point: ED physicians vary widely, by as much as 300% for patients who presented with atraumatic headache, in their ordering patterns for head CTs. Citation: Prevedello LM, Raja AS, Zane RD, et al. Variation in use of head computed tomography by emergency physicians. Am J Med. 2012; 125(4): 356-364. A research team led by Dr. Luciano Prevedello, a fellow at the Center for Evidence-Based Imaging …
Read MoreAbstracts in Urgent Care: April, 2012
Normalization of Vital Signs Does Not Reduce Risk for Acute Pulmonary Embolism Key point: Up to one-third of patients whose abnormal triage vital signs reverted to normal values had PE. Citation: Kline JA, Corredor DM, Hogg MM, et al. Normalization of vital signs does not reduce the probability of acute pulmonary embolism in symptomatic emergency department patients. Acad Emerg Med. 2010; 19(1): 11-17. In a prospective single-center study, researchers evaluated whether normalization of vital signs …
Read MoreAbstracts in Urgent Care: March, 2012
Symptoms May Say Sinusitis, But Scans Disagree Key point: Infection and even inflammation were not reliably present in the scans of patients with classic sinusitis symptoms. Citation: Ferguson BJ, Narita M, Yu VL, et al. Prospective observational study of chronic rhinosinusitis: Environment triggers and antibiotic implications. Clin Infect Dis. 2010; 54(1): 62-68. (http://dx.doi.org/10.1093/cid/cir747) Chronic sinusitis can be difficult to diagnose precisely and sometimes even more difficult to treat. Increasingly, experts are suggesting that antibiotics may …
Read MoreAbstracts in Urgent Care: February, 2012
Each month, Dr. Nahum Kovalski reviews a handful of abstracts from, or relevant to, urgent care practices and practitioners. For the full reports, go to the source cited under each title. Gloves Are No Substitute for Proper Hand Hygiene Key point: Healthcare workers frequently neglect hand hygiene when they use gloves. Citation: Fuller C, Savage J, Besser S, et al. “The dirty hand in the latex glove”: a study of hand hygiene compliance when gloves …
Read MoreAbstracts in Urgent Care: January, 2012
USPSTF to Advise Against Routine Prostate Cancer Screening Key point: The US Preventative Services Task Force has concluded that healthy men should not undergo routine prostate-specific antigen testing. Citation: Harris G. US panel says no to prostate screening for healthy men. New York Times website. Available at: www.ny-times.com/2011/10/07/health/07prostate.html. Accessed December 6, 2011. The recommendation was based on an analysis of five trials and applies to men of all ages. The Times quotes the task force’s …
Read MoreAbstracts in Urgent Care: December, 2011
NAHUM KOVALSKI, BSc, MDCM Effect of Adrenaline on Survival in Out-of-hospital Cardiac Arrest Key point: Adrenaline improves chance of return of spontaneous circulation but not survival to discharge. Citation: Jacobs IG, Finn JC, Jelinek GA, et al. Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomized double-blind placebo-controlled trial. Resuscitation. 2011;82(9):1138-1143. Adrenaline has been used to treat patients with cardiac arrest for more than half a century but has not been evaluated in …
Read MoreAbstracts in Urgent Care: November, 2011
Chinese Herbs Are as Efficient as Oseltamivir for Shortening Flu Symptoms Key point: Traditional Chinese herbal therapy resolves fever in influenza as quickly as oseltamivir. Citation: Wang C, Cao B, Liu Q-Q, et al. Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial. Ann Int Med. 2011;155(4):217-225. Researchers studied some 400 adults and adolescents in 11 Chinese hospitals who had uncomplicated 2009 H1N1 influenza A. Patients, who …
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