Clinical

The words chest pain get the immediate attention of clinicians in any practice setting, including urgent care. The question of calculating risk for a major event is not quite as clear-cut, however. One assessment tool, the HEART Score for Major Adverse Cardiac Events (MACE), has been validated to predict 6-week risk of major adverse cardiac events in patients 21 years of age and older presenting with symptoms suggestive of acute coronary syndrome. Michael Weinstock, MD, led a live …

Especially now that flu season is upon us, nervous parents may be visiting urgent care centers with children who are suffering from a cold out of concern that it could be influenza. Relieved as they may be to learn that it’s “just” a cold, urge Mom and Dad to let their offspring ride out the symptoms instead of giving them decongestants. Children under 6 years of age should not take decongestants at all, and parents …

Financial barriers and difficulty in assessing immunization histories are among the toughest subjects for clinicians to tackle when talking to adult patients about vaccinations, according to a study just published in the The Journal of the American Board of Family Medicine. The report, which focused on pneumococcal vaccination, noted that over 95% of respondents reported they “routinely” check adult patients’ vaccination status, and 88% said they found the recommendations of the Centers for Disease Control …

An abstract presented at ID Week in Atlanta recently paints a grim picture of the evolution of hepatitis A transmissions. Between 2007 and 2017, the incidence of hepatitis A attributed to outbreaks (as opposed to common-source exposure) increased steadily—to the point that in 2017, 43% of hep A infections were associated with outbreaks, compared with only 5% between 2007 and 2011. In the past, large community outbreaks were most likely to be associated with asymptomatic …

Los Angeles County in California is beset by a major outbreak of typhus—so much so that area health officials have called it an epidemic, with no signs that it’s going to abate any time soon. Pasadena, CA has seen 20 cases, mostly in the past 2 months; in an average year, they might see five cases. Long Beach has confirmed 12 cases, double the typical annual number, with more than 2 months left in the …

Want to make patients happy? Prescribe an antibiotic and send them on their way. If you actually want to practice good antibiotic stewardship and help protect them against future resistance problems by prescribing an antibiotic only when it’s truly warranted, however…well, that’s another story. A study just published in JAMA Internal Medicine reveals that patients rate themselves happiest with a physician visit when they receive an antibiotic prescription they asked for to treat a respiratory …

The Centers for Disease Control and Prevention has released its official estimate of the toll of last year’s flu season: An estimated 80,000 Americans died of flu and related complications—the highest death toll in over 40 years. Public health experts usually consider it a “bad year” when flu-related mortality hits the 20,000 mark, according to an interview CDC Director Robert Redfield, MD gave to the Associated Press. The severity was due to a particularly harsh …

Hurricane Florence came and went, with most national media claiming that the Carolinas got off relatively easy compared with the disaster that could have ensued. While that’s small comfort to those who lost loved ones or property, to be sure, the fact is that urgent care centers still have work to do to help local patients in the region. Just days ago, the Centers for Disease Control and Prevention issued a Clinical Guidance urging clinicians …

A new study just published in the Annals of Internal Medicine reveals that almost 30% of opioids prescribed in clinics and physicians’ office in the U.S. are written without a documented reason.  Over 66% of the almost 809 million prescriptions written during outpatient visits over a 10-year period were for noncancer pain; just 5.1% were for cancer-related pain. There was no indication of pain or pain-related diagnoses for the other 28.5%. The lead author of …

In trying to fight the ongoing, nationwide opioid crisis, researchers are working to find new options that will ease patients’ pain without putting them at risk for addiction. The most recent effort was a study, published in the Annals of Emergency Medicine, of adult emergency room patients who were given either 1 mg intravenous hydromorphone or 1 g intravenous acetaminophen for acute pain. The primary outcome of this prospective, randomized, clinical trial was between-group difference …