Occult Bacteremia is Rate in Young Children with Unexplained Fever Key point: Since introduction of the pneumococcal vaccine, urinary tract infection has become the most common bacterial infection in children who have fever without localizing signs. Citation: Waddle E, Jhaveri R. Outcomes of febrile children without localizing signs after pneumococcal conjugate vaccine. Arch Dis Child. 2009; 94: 144-147. Occult bacteremia and invasive disease are important concerns in children with unexplained high fever. Investigators retrospectively compared …
Pharyngitis: Diagnosis and Treatment in the Urgent Care Setting
Urgent message: Sore throat is a complaint commonly encountered in urgent care. Proper evaluation and understanding and use of appropriate antibiotics will foster better patient care and understanding while limiting antibiotic resistance. William Gluckman, DO, MBA, FACEP and Jessica Kay, PharmD Pharyngitis refers to the inflammation or irritation of the pharynx, including the tonsils, and can have many etiologies, including a variety of infections, cancer, allergic reactions, gastroesophageal reflux, or toxic inhalations and ingestions. This …
Rekindling the Doctor-Patient Relationship
Lee A Resnick, MD, FAAFP The joy of practice is two-fold: Intellectual and Relational. The intellectual side of us thrives on the challenge of complex medical decision making and computational fact-finding. Understanding and applying pathophysiology is what we trained for, and what most of us consider to be a joyful brain exercise. However, since we do not practice medicine in a vacuum, the relational side of patient care is equally important to job satisfaction. It …
Readers’ Coding Inquiries
DAVID STERN, MD (Practice Velocity) Q.How would you define the difference between an expanded problem-focused exam and the detailed exam in the 1995 evaluation and management coding guidelines? – Question submitted by Eddie Stahl, Medical Staff Director, Tennessee Urgent Care Associates A.For both the expanded problem-focused exam (EPF) and the detailed exam, the provider must document between two and seven body systems. The difference is that the EPF exam requires a “limited” exam of a …
CA-MRSA Abscess Care and Treatment Guidelines in Urgent Care Practice
Urgent message: In the absence of controlled outpatient trials, the author proposes urgent-care specific guidelines for treatment of community-acquired MRSA, informed by clinical experience and local and regional case reports. Michael Dickey, MD The goal of any treatment is to maximize the chance of a positive outcome for a patient. The purpose of a treatment guideline is to maximize the chance of positive outcomes in groups of patients that present with a similar disease states. …
The Case of a 46-Year-Old Man with Neck and Upper Back Pain
This article is the second in a series that will sequentially answer the following questions: What is the incidence of bouncebacks? What is the incidence of bounceback admissions? What is the incidence of deaths in patients recently discharged from the ED? What percent of bouncebacks occur because of medical errors? How can we use this information to improve patient safety? In the September issue of JUCM, we discussed several studies which found the incidence of …
Abstracts In Urgent Care: September, 2007
Evaluating Fever of Unidentifiable Source in Young Children Key point: An excellent review of the approach to the febrile child. Citation: Sur DK, Bukont EL. Am Fam Physician. 2007;75:1805- 1811. Even with a thorough history and a complete physical examination, one in five acutely ill, nontoxic-appearing children had an unidentifiable source of fever. Physicians should be cautious in their approach because of the potential for unrecognized and untreated serious bacterial infections (SBI). The review notes …
Acute Pain Management in Urgent Care Medicine
Urgent message: Urgent care practitioners are called upon daily to alleviate pain. A thorough understanding of the various pain syndromes and the pharmacology and analgesic potencies of various medications will aid in their safe and appropriate use. Marc R. Salzberg, MD, FACEP and Paolo T. Coppola, MD, FACEP Pain, either chronic or acute, is the main reason patients seek medical care. In this article, we will discuss acute pain management in an urgent care setting, …
The Emergence of Retail Clinics
Urgent message: Retail-based healthcare clinics are a growing phenomenon. A report from the California HealthCare Foundation, excerpted here, says public perception is split, and their economic viability remains to be seen. How do their services stack up against those offered by urgent care? The first in-store clinics appeared in 2000 in the Minneapolis-St. Paul (MN) metropolitan area and were operated by QuickMedx, which later became Minute- Clinic. The company’s founder, Rick Krieger, says the business …