Reconsidering antibiotics for COPD exacerbation Key point: Prescribing antibiotics to patients with mild-to-moderate COPD exacerbations who have no change in sputum probably is unnecessary. Citation: Miravitlles M, Moragas A, Hernandez S, et al. Is it possible to identify exacerbations of mild to moderate COPD that do not require antibiotic treatment? Chest. 2013;144(5): 1571-1577. The decision to prescribe antibiotics to patients with moderate to mild-to-moderate chronic obstructive pulmonary disease (COPD) exacerbations is usually based on increased …
Read MoreAbstracts in Urgent Care: February, 2014
Pyuria Poor Predictor of UTI in Nephrolithiasis Key point: Classic symptoms and urine culture are the best indicators of infection in patients with acute nephrolithiasis. Pyuria proved a poor predictor. Citation: Abrahamian FM, Krishnadasan A, Mower WR, Moran GJ, Talan DA. Association of pyuria and clinical characteristics with the presence of urinary tract infection among patients with acute nephrolithiasis. Ann Emerg Med 2013;62(5):526-533. Infection can complicate the diagnosis of acute nephrolithiasis. Patients with both a …
Read MoreAbstracts in Urgent Care: January, 2014
Metabolic Consequences of Insufficient Sleep Key point: A small, randomized, controlled crossover study demonstrates changes in a critical insulin-signaling pathway in peripheral tissue. Citations: Broussard JL, Ehrmann DA, Van Cauter E, Tasali E, Brady MJ. Impaired insulin signaling in human adipocytes after experimental sleep restriction: A randomized, crossover study. Ann Intern Med 2012;157(8):549-557. and Cappuccio FP, Miller MA. A new challenge to widely held views on the role of sleep. Ann Intern Med 2012;157(8):593-594. Small …
Read MoreAbstracts in Urgent Care: November, 2013
Long-term Survival Following Pneumococcal Pneumonia Key point: Pneumococcal pneumonia foretold considerably higher 10-year mortality than the expected rate. Citation: Sandvall B, Rueda AM, Musher DM. Long-term survival following pneumococcal pneumonia. Clin Infect Dis. 2013;56(8):1145-1146. Before antibiotics, pneumonia was called “the old man’s friend” for carrying the old and infirm to a swift and relatively painless death. Now that short-term survival after pneumonia is the rule, does the disease provide any long-term prognostic information? Veterans Administration …
Read MoreAbstracts in Urgent Care: October, 2013
Clinical Decision Tool Identifies Boys at Low Risk of Testicular Torsion Key point: No child with a normal testicular lie, age <11 years, and absence of nausea or vomiting had torsion. Citation: Shah MI, Chantal CA, Mendez DR. Prospective pi- lot derivation of a decision tool for children at low risk for testicular torsion. Acad Emerg Med. 2013;20(3): 271-278. To develop a clinical decision tool for identifying children at low risk for testicular torsion, investigators …
Read MoreAbstracts in Urgent Care: June, 2006
Azithromycin: FDA Issues Cardiac Warning Key point: The antibiotic azithromycin (Zithromax and Zmax) can cause QT interval prolongation and torsades de pointes. Citation: FDA Drug Safety Communication: Azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms. http://www.fda.gov/downloads/Drugs/DrugSafety/ UCM343347.pdf The agency says that healthcare providers should consider risk of fatal heart rhythms when treating patients already at high cardiovascular risk, including people with known prolon- gation of the QT interval, torsades de pointes, …
Read MoreAbstracts in Urgent Care: May, 2013
Ondansetron Safe During Pregnancy Key point: No significant association between the antiemetic on- dansetron and adverse pregnancy outcomes. Citation: Pasternak B, Svanstrom H, Hviid A. Ondansetron in pregnancy and risk of adverse fetal outcomes. N Engl J Med 2013;368:814-823. In this retrospective cohort study, ondansetron had been prescribed for nausea and vomiting in almost 2000 of some 600,000 pregnancies. Ondansetron users were no more likely than nonusers to experience spontaneous abortion or stillbirth, or to …
Read MoreAbstracts in Urgent Care: April, 2013
Soft cast versus rigid cast for treatment of distal radius buckle fractures in children Key point: Buckle fractures of the distal radius can be safely and effectively treated with a soft cast and only a single orthopedic outpatient clinic appointment. Citation: Witney-Lagen C, Smith C, Walsh G. Soft cast versus rigid cast for treatment of distal radius buckle fractures in children. Injury. 2012 Dec 21. pii: S0020-1383(12)00516-5. doi: 10.1016/j.injury.2012.11.018 Buckle fractures are extremely common and …
Read MoreAbstracts in Urgent Care: March, 2013
Statins for Prevention of UTIs? Key point: Statin use was significantly associated with reduced risk of urinary tract infections overall and for a second episode, but not for a first episode. Citation: Pouwels KB, Visser ST, Hak E. Effect of pravastatin and fosinopril on recurrent urinary tract infections. J Antimicrob Chemother. 2012 Oct 30; doi 10.1093/jac/dks419 [e-pub ahead of print]. Recurrent urinary tract infections (UTIs) are common, especially among women. Recent research has suggested that …
Read MoreAbstracts in Urgent Care: February, 2013
Flu Activity Picks Up Nationwide Key point: CDC recommends vaccination and antiviral treat- ment against influenza Citation: http://www.cdc.gov/flu/spotlights/flu-activity-picks- up.htm. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Influenza activity was continuing to increase in the United States and most of the country was experiencing high levels of in- fluenza-like-illness (ILI), according to CDC’s January 4 FluView report. “Reports of influenza-like-illness (ILI) are nearing what have been peak levels during …
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