Retail and Urgent Care Articles
Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribe greater quantities of opioids were more likely to transition to continued use.
Adverse drug events related to antibiotics led to nearly 70,000 ED visits a year in children ≤19 years. One out of every 330 children ≤2 years given amoxicillin will end up in the ED with an ADE.
Use of pregabalin in addition to opioids vs opioids alone was associated with an increased risk of death by opioid overdose.
The incidence of suicide nearly doubled in patients who had traumatic brain injury (TBI) compared to baseline. Risk increased with severity of injury, number of visits, and was highest in the first 6 months post-injury.
Suturing of facial lacerations by novice physicians resulted in less cosmetically favorable repair in follow up than experienced physicians.
Self-referral for elevated blood pressure after using a home or pharmacy cuff had a very low admission rate at 3%.
Patients with a penicillin allergy were 69% more likely to develop MRSA infection and 26% more likely to contract C. difficile.
Most doctors and clinicians think someone else is the problem when it comes to antibiotic resistance and stewardship. We are the problem. And we are the solution.
Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses. They were followed by the ED, medical offices, and finally by retail health clinics.
In this single center, 27% of urgent care to pediatric emergency department transfers were likely unnecessary and resulted in discharge with no ED resource utilization.
Acetaminophen use during late pregnancy was associated with premature ductus arteriosus closure in these two cases.
Patients with cardiovascular disease and concomitant COPD can be safely treated with a combination long-acting beta-agonist and a long-acting muscarinic antagonist when on a baseline beta-blocker.
In women with confirmed first trimester pregnancy loss, the combination of mifepristone 200mg orally and misoprostol 800μg vaginally at 24 hours vs misoprostol 800μg alone resulted in improved complete expulsion at day 8 (NNT = 6) and decreased need for surgery: 9% vs 24%.
This large RCT found tamsulosin was of no benefit for kidney stone passage at 28 days, regardless of size or location.
Oral fluconazole is safe to use in pregnancy.
Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.
Nitrofurantoin was clearly superior to fosfomycin for uncomplicated UTI in adult women.
Nuisance bleeding in patients with atrial fibrillation on oral anticoagulants did not portend subsequent major bleeding or increased risk for stroke/systemic embolism.
Influenza killed 675 children from the 2010-11 flu season to the 2015-16 season. Infants under 6 months had the highest incidence of mortality. Encourage everyone to get vaccinated. Antiviral treatment is encouraged in all children under 2, all patients with severe illness, and all hospitalized patients regardless of whether or not the duration of illness exceeds 48 hours.
Sniffing an isopropyl alcohol pad was more effective at reducing nausea than oral ondansetron at 30 minutes.
Opioids were no better than non-opioid medicines for chronic back, hip, or knee pain. However, undesirable medication-related symptoms occurred more commonly among those taking opioids.
Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor. Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.
The Boss-Holzach-Matter (aka Davos, self-reduction) technique was less painful than the physician-driven Spaso technique and just as successful and efficient.
Fluoroquinolone use was associated with increased risk of developing newly diagnosed aortic aneurysm or dissection.
Acetaminophen (APAP) was not inferior to diclofenac or APAP+diclofenac for acute extremity pain at 90 minutes.
This meta-analysis of 4 RCTs found anti-MRSA antibiotics in addition to I&D led to a far better cure rate than I&D alone.
Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.
Trimethoprim (TMP) was associated with increased risk of hyperkalemia and acute kidney injury (AKI) in adults over age 65.
Children with a non-fatal drowning event who present to the ED with normal vital signs and normal SpO2 very rarely deteriorated. The 3% (2/62) who had delayed complications did so within one hour of arrival.