Ivan Koay MBChB, MRCS, FRNZCUC, MD Are Urine Dipsticks Accurate in Diagnosing UTIs in Infants? Take-home point: Point-of-care (POC) urinalysis (ie, urine dipstick) is moderately sensitive and highly specific for diagnosing urinary tract infection in febrile infants. The optimum cut-point for excluding UTI is leucocytes (1+), and the optimum cut-point for confirming UTI is nitrites (trace). Citation: Waterfield T, Foster S, Platt R, et al. Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract …
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Key Signs and Symptoms of Severe Illness in Urgent Care: Cervical Necrotizing Fasciitis and Necrotizing Mediastinitis
Urgent message: Cervical necrotizing fasciitis and necrotizing mediastinitis may ultimately occur in patients presenting with symptoms of odontogenic infection. While severe illnesses rarely present in urgent care, it is important to establish a prompt diagnosis and implement rapid medical management for these patients, in order to improve survival. Vitoria Regina Nunes Maia, MS and Lindsey E. Fish, MD ABSTRACT Cervical necrotizing fasciitis (CNF) is a rapidly progressive infection that can be fatal. This condition can …
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Conquering the Fear of Penicillin Allergy: The Boogeyman of Urgent Care
I had time to see one more patient as my shift was winding down. “Wound check. That should be a quick one,” I said to myself. Famous last words. I soon learned that the young woman with the dog bite on her hand was returning for her fourth visit in as many days for the same issue. She sat fidgeting on the exam table and was visibly irritated when I walked in the room. “It’s …
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Tips for Payer Reviews
Monte Sandler Insurance plans are scrutinizing claims more than ever before. Common questions from our clients are: What does this mean? What should I do? Should I be worried? Generally, there are three types of payer reviews: prepayment, postpayment, and probe. The first step is to figure out what type of review it is. What you do and how you handle the review is dependent on that information. Should you be concerned? Always. Payer reviews …
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Retrospective Study on the Impact of Increased Value-Add Time on Patient Experience in Pediatric Urgent Care Centers
Urgent message: Increase in the proportion of value-add time during an encounter was associated with an increased rate of positive perceptions of timeliness and overall patient experience in pediatric urgent care centers. Aimy Patel, MD; Brian R. Lee, MPH, PhD; Amanda Montalbano, MD, MPH; and Amanda Nedved, MD Citation: Patel A, Lee BR, Montalbano A, Nedved A. Retrospective study on the impact of increased value-add time on patient experience in pediatric urgent care centers. J …
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A Cause of Dizziness Not to Be Missed
Urgent message: Most cases of vertigo are benign. This includes etiologies such as benign paroxysmal position vertigo, labyrinthitis, and psychogenic causes. However, there are serious, “can’t miss” etiologies which should be considered during the urgent care evaluation of a dizzy patient. Cody McCoy, DO and Michael Weinstock, MD Citation: McCoy C, Weinstock M. A cause of dizziness not to be missed. J Urgent Care Med. 2023;17(5):13-16. Key words: dizziness, vertigo, disequilibrium, BPPV INTRODUCTION Dizziness presents …
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The ‘Triage’ Misnomer in Urgent Care
Urgent message: While the term “triage” refers to one distinct step in emergency department throughput, in urgent care the concept encompasses a series of activities that span queuing, registering, intake, and the physical exam. Given the clinical and legal implications of the term, including who legally can triage, the term should be avoided in most urgent care settings. Alan A. Ayers, MBA, MAcc According to modern dictionaries, triage refers to the “assignment of degrees of …
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It’s About Time: Repeat Vitals and Long Waits
Guy Melrose, MB, ChB It was with great interest that I read Dr. Joshua Russell’s opinions on the value of repeating vital signs in the urgent care setting in the November 2022 issue of JUCM.1 Having stated that this does not seem to be common practice amongst his peers, he went on to highlight a couple of very reasonable scenarios in which he recommended repeating vital recordings. Importantly, he alluded to the often-underappreciated phenomenon of …
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A Comparison of Chief Complaints, Specific Diagnoses, and Demographics of Pediatric Urgent Care Visits Before and During the COVID- 19 Pandemic: A Retrospective Study
Zaharoula A. Viennas, MD; Julie Martin, MAEd, MMS, PA-C; Benjamin Klick, MD; Tammy Speerhas, DNP, FNP-C, RN, CEN, CME; Turaj Vazifedan, DHSc; Danielle Millspaugh, DNP, FNP-C; Jennifer Ferris, MD; Margret Bedle, MD; Lauren Paluch, DMSc, PA-C; and Theresa Guins, MD Urgent message: Research has shown distinct differences in patterns of children presenting to emergency rooms during COVID-related lockdowns. However, data specific to urgent care have been lacking previously. Citation: Viennas ZA, Martin J, Klick B, …
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A 28-Year-Old with Tibial Pain After Prolonged Exercise
A 28-year-old male presents complaining of anterior shin pain. He shares that he is a runner training for a marathon, and that the pain began toward the end of an 18-mile run. There was no direct trauma. View the images taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.
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