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 …
Abstracts in Urgent Care: October, 2011
A New Approach to Managing Young Non-Toxic-Appearing Febrile Children Keypoint: Researchers suggest an emphasis on more limited evaluation, now that vaccines have greatly reduced the likelihood of serious bacterial infections. Citation: Jhaveri R, Byington CL, Klein JO, Shapiro ED. Management of the non-toxic-appearing acute lyfebrile child: a 21stcentury approach. J Pediatr. 2011;59(2):159:181. Since the 1970s, considerable attention has been paid to the management of febrile children aged £3 years without an obvious focus of infection. …
Acute Stridor in Children
Urgent message: Acute stridor in pediatric patients is alarming to children, parents, and healthcare providers alike. Differential diagnosis is the key to initial evaluation and management of this worrisome symptom. Here is how to think it through. JERRI A. ROSE, MD, FAAP Stridor is an externally audible sound caused by abnormal air passage during breathing.1 It results from turbulent airflow through large airways. When a normal respiratory volume of air passes through narrowed airways, the …
Medical Necessity in E/M Coding
DAVID STERN, MD (Practice Velocity) Q.Recently some of my charts were audited and the payor challenged the levels of the evaluation and management (E/M) codes I had used. The payor said that the charts were actually coded correctly, based on the information that was documented on the chart. The auditor, however, challenged what she called the “medical necessity” of the documentation. She claimed that, based on the patients’ chief complaints, many elements of the E/M …
Enhancing Profits with Immigration Physicals
Urgent message: Conducting immigration physicals can be surprisingly lucrative. These relatively high-priced, cash-only visits incur no insurance billing or accounts receivable carrying costs. And because they are scheduled, ebbs and flows in patient volume can be leveled. Here’s how it works. Alan A. Ayers, MBA, MAcc Practice Velocity The success of a new urgent care center in a community requires a change in consumer behavior, with a sufficient number of residents shifting their utilization from …
Giant Cell Arteritis: A Clinical Review for Urgent Care Providers
Urgent message: Giant cell arteritis is an under-recognized and easily missed vasculitis of older adults, a challenging but “can’t miss” diagnosis. The urgent care clinician must be able to recognize this entity sometimes referred to as the “great masquerader” and be comfortable initiating timely emergency treatment. Ryan C. Jacobsen MD, EMT-P Giant cell arteritis (GCA), more commonly known as temporal arteritis, is an under-recognized vasculitis of older adults that can have potentially devastating consequences, most …
Assessment and Management of Scrotal Disorders
Urgent message: Males with a scrotal disorder often present to urgent care with pain, swelling, or both. Especially in boys and young men, it is important to quickly assess the acute scrotum, which can be a surgical emergency. Jason Chao, MD, MS Introduction Males with a scrotal disorder often present with pain, swelling, — or both. Because of the location of the problem, patients often choose to seek urgent medical attention. Especially in boys and …
In the Beginning: Doc’s In ERgent Care Clermont, Florida
(In the Beginning recounts the real-life experiences of urgent care owners who have taken the initiative to hang out the proverbial shingle and open a new start-up center. It will be an occasionally recurring feature available exclusively in the digital edition of JUCM.) From marketing to urgent care medicine to triathlons, it seems as though Dr. Cheryl Durstein Decker was literally and figuratively born to run, slowing down only occasionally to help others in her …
ICD-9 Updates for 2011
DAVID STERN, MD (Practice Velocity) Updates to the ICD-9 code set went into effect October 1, 2010. There will be one more regularly scheduled ICD-9 update on October 1, 201, the vastly larger ICD-10 code set is scheduled to take effect. The following are changes that are of particular interest to us in the urgent care field: New code to specify post-traumatic seizures: When a patient experiences seizure(s) as a result of a head injury, …
Abstracts in Urgent Care: June, 2010
Upper Gastrointestinal Tract Hemorrhage, Warfarin, and Urinary Tract Antibiotics Key point: Ciprofloxacin increased GI hemorrhage while on coumadin by twice as much, and cotrimoxazole by four times. Citation: Fischer HD, Juurlink DN, Mamdani MM, et al. Hemorrhage during warfarin therapy associated with cotrimoxazole and other urinary tract anti-infective agents: A population-based study. Arch Intern Med. 2010; 170(7): 617-621. Hemorrhage is a well-known side effect of long-term warfarin use in older patients. Interactions between warfarin and …