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EDITOR'S CORNER: AFTER A BRIEF HIATUS WE ARE BACK

SEAN MCNEELEY, MD, FCUCM

Well, we are back. After a short delay Urgent Caring is back and even better than before. We are now featuring a new format allowing us to reach more providers and an updated look and feel. Thanks to Laurel Stoimenoff and the rest of our CUCM team for the upgrade. While we have been busy fighting the delta variant the team took the time to prepare this upgrade. Tell us what you think. Let us know how we can upgrade and we will give it a try. Don’t forget to get your free CME.
All of us within the College are saddened by the cancellation of our 2021 Convention but we are appreciative to the boards for making the tough decision to wait until spring. We will definitely miss seeing all of you until then. Stay safe and we will be back next month.
Contact Dr. McNeeley at sean.mcneeley@uhhospitals.org


STAY STRONG

JASMEET BHOGAL, MD, MBA
PRESIDENT OF THE CUCM BOARD OF DIRECTORS

COVID cases are again on the rise. This time, it is the delta variant that is spreading across the country. Countries like India and United Kingdom (UK) have already gone through their surges and the experiences have been varied. India saw an unprecedented number of deaths and a near collapse of their health care system. The UK, on the other hand, saw a rise in cases after the initial restrictions were lifted in mid-July; however, the numbers have been declining since. Either way, this resurgence has stressed their healthcare systems. This is something that we in the United States need to be aware of and prepare for as the delta variant spreads at home.

THE COLLEGE AT WORK: CUCM FORMS A TASK FORCE TO FOCUS ON ADVANCING THE SPECIALTY OF URGENT CARE MEDICINE

JOE TOSCANO, MD, FCUCM
UC SPECIALTY TASK FORCE CHAIR

Long discussed has been the issue of whether Urgent Care will ever be a “true specialty” in the house of medicine. Training programs have evolved and changed, but none have been ACCME-approved. Board exams exist, one within ABPS but none within ABMS. In spite of this, UC is firmly entrenched in the healthcare landscape, delivering care for countless millions of patients for many years, and now crucial care during the ongoing pandemic.  There is, however, a rising concern among clinicians and operators in the urgent care community. That concern revolves around the gradual decrease in the scope of services offered in many urgent care centers.

 

PAROTITIS AS A PRESENTING SYMPTOM OF COVID-19 INFECTION

TRACEY QUAIL DAVIDOFF, MD, FCUCM

A 66-year-old female presented to urgent care with her spouse requesting testing for COVID-19 infection. The patient had been exposed to a co-worker 3-4 days earlier who had been diagnosed with the infection. Although previously vaccinated for COVID-19, the patient had awoken that morning with mild sore throat and nasal congestion and wanted to be sure she had not developed infection. She was informed at the front desk that due to the recent surge in infections there would be a three to four hours wait to be seen. She was put on the waiting list and was told to wait in her car until she was called in to be seen. While she was waiting, she and her spouse became hungry, and went to a nearby restaurant for food. While eating, she developed painful swelling of the right cheek, just in front of the ear and over the angle of the mandible.


PEARLS FROM A PRACTICING PEDIATRICIAN—“SPORTS PHYSICALS IN THE ERA OF COVID-19—WHAT YOU NEED TO KNOW”

THOMAS W. TRYON, MD, MBA, FAAP; FCUCM
UCA Pediatric Section Chair, Secretary of the Board of Directors

School is starting, fall sports are back in action, and on top of everything else in the business of urgent care with increased volumes of sick patients, COVID testing, COVID vaccinations and the potential for new COVID therapies on the horizon, this is also a time when many urgent care centers are deluged with sports physicals for school-aged athletes.  Parents, coaches and athletes will all have a lot of questions about COVID and the impact of this disease on their participation.


ACUTE FLACCID MYELITIS: TIPS FOR RECOGNIZING THE SIGNS AND SYMPTOMS IN THE URGENT CARE SETTING

Sarah Kid, MD
Sarah Kidd MD (1), Alexandra Hess PhD (1,2), Janell Routh MD (1)

Author affiliation: (1) Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; (2) Webber Shandwick

Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition that can cause limb weakness and paralysis. Multiple viruses, such as West Nile virus, adenovirus, and certain enteroviruses, are known to cause AFM in a small percentage of persons who are infected. Specific pathogens are rarely identified in the cerebrospinal fluid (CSF) of AFM patients, but recent research suggests that enterovirus D68 (EV-D68) is likely a primary driver of the recent increases in cases reported in the United States (US). Since first reported in 2014, US AFM cases have peaked during the late summer and early fall in a biennial pattern (in 2014, 2016, and 2018), with fewer cases reported during 2015, 2017, and 2019. Based on this pattern, another increase in AFM was expected in 2020. However, cases remained low in 2020, and it is uncertain when the next increase in AFM should be expected.


BEST PRACTICES

MANAGEMENT OF ASYMPTOMATIC ELEVATED BLOOD PRESSURE

Subject: Management of Asymptomatic High Blood pressure readings

Patient Population: Pregnant patients of any age and Adults (>18 years old)

Introduction: Blood pressure elevated above normal levels is commonly seen in urgent care, in patients with known HTN and those without the diagnosis. A reliable and accurate diagnosis of HTN requires elevated blood pressure readings on several occasions, in most cases over several days, and incorporating blood pressure readings when patients are outside of medical settings is now emphasized.

Expert guidelines outline an approach to patients with high blood pressure readings that is safe and improves the accuracy of diagnosis of the disease of HTN. Such an approach is suitable to urgent care medicine situations.


URGENT UPDATES

RANDOMISED TRIAL OF IV METOCLOPRAMIDE VS IV KETOROLAC IN TREATMENT OF ACUTE PRIMARY HEADACHES
A large variety of treatment options are available for acute primary headaches. This double-blind, randomized clinical trial study, we demonstrated that IV metoclopramide provided more headache relief but not statistically significant than IV ketorolac in adults patients presented to an ED with acute primary headache.
Full Access: Journal of Emergency Medicine

USE OF INVOLUNTARY EMERGENCY TREATMENT BY PHYSICIANS AND LAW ENFORCEMENT FOR PERSONS WITH HIGH-RISK DRUG USE OR ALCOHOL DEPENDENCE
In this cohort study, we compared the number of public court records of 213 that underwent temporary involuntary commitment secondary to substance use under Section 35 of the Massachusetts General Law. The high proportion of individuals with comorbid mental health diagnoses seen in this cohort suggests that optimal treatment should involve immersive, dual-diagnosis treatment. the findings suggest the need to further explore a multidisciplinary approach to caring for individuals with substance use disorders.
Full Access: JAMA

CONVALESCENT PLASMA DIDN'T HELP HIGH-RISK COVID PATIENTS: NIH
NIH new release that a clinical showed convalescent plasma did not stop the progression of COVID-19 in high-risk patients when given during the first few weeks of their symptoms. Of the 511 people in the study, the disease progressed in 77 (30%) in the COVID-19 plasma group compared with 81 patients (31.9%) in the placebo group. This finding suggests that more effective treatments against this devastating disease should be explored.
Full Access: Medscape

HOW TO PICK THE BEST FACE MASKS FOR KIDS, ACCORDING TO THE EXPERTS
The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics recommend masks for kids going back to school. This article provides guidance on selecting masks for kids including 1) N95s are not made to fit kids. They do not come in kid sizes 2) Any masks that gapes around the edges isn't going to work well, no matter how well it filters. Parents need to consider the attributes masks in this order of priority: Comfort: "If your kid won't wear it, it's not helping at all". Fit: "Leaks around the sides are like having a hole in your mask and aerosols carrying the virus can get right through". Filtration: How well the mask blocks small particles. KF94 or KN95 masks, which are being manufactured in China and Korea, are good choices. They offer nearly the same degree of filtration as an N95, and they fit closely to the face, to minimize leaks.
Full AccessMedscape

JOINT STATEMENT FROM HHS PUBLIC HEALTH AND MEDICAL EXPERTS ON COVID-19 BOOSTER SHOTS
Based on latest assessments, the current protection against severe disease, hospitalization, and death could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout. For that reason, experts suggest that a booster shot will be needed for American people to maximize vaccine-induced protection and prolong its durability.
Full Access: CDC

ANNOUNCEMENTS

FROM THE CDC: CAN WE GET A FOLLOW? CDC ADDS NEW TWITTER ANTIMICROBIAL RESISTANCE HANDLE

CDC’s Antibiotic Resistance Coordination and Strategy Unit (ARX) just launched a new Twitter handle, @CDC_AR, to engage partners, policymakers, and the public on antibiotic resistance in the United States and around the world.

Follow us today to stay up to date on what CDC’s doing to combat antibiotic resistance—including new resources, publications, and activities. Please share or like our content, tag @CDC_AR, and be sure to tell your friends. We look forward to seeing you there!

Quiz Questions—Test Your Knowledge

Quiz questions no longer need to be submitted to attain CME (instructions provided below on how to do so).

Answers will be provided in next month’s Urgent Caring.

1. Regarding COVID-19 and pre-participation physicals (sports physicals) for adolescent athletes, the American Academy of Pediatrics recommends each of the following EXCEPT:

a. Asking about either past or present COVID-19 infection
b. Asking about COVID-19 vaccination status
c. Encouraging COVID-19 vaccination IF the patient has not been vaccinated and qualifies for vaccination
d. Recommending that athletes no longer follow CDC transmission mitigation advice once fully vaccinated

2. The most common cause of parotitis is?

a. Stone formation
b. Mumps
c. Bacterial infection
d. Gum chewing

3. When evaluating young children for possible AFM, which of the following are important?

a. Proximal limb strength evaluation
b. Muscle tone and reflexes evaluation and documentation
c. Detailed history, including illness in the past 4 weeks, noting fever, respiratory, rash, or gastrointestinal symptoms
d. All of the above

 

CONTINUING MEDICAL EDUCATION (CME)

Target Audience
This CME activity is intended for medical professionals who practice medicine in the on-demand space including urgent care, retail medicine and other similar venues. These providers may include physicians, nurse practitioners, and physician assistants.
 
Designation Statement
The Urgent Care Association (UCA) designates this enduring material activity for a maximum of 1 AMA PRA Category 1 Credit(s) ™. Physicians should claim credits only commensurate with the extent of their participation in the activity. Credits may be claimed for one year from the date of release of this issue.
 
CME Objectives
1. Provide updates on the diagnosis and treatment of clinical conditions commonly managed by on-demand providers
2. Alert on-demand providers to potential unusual cases that may present to them
3. Utilize tips and tricks to improve patient care in the on-demand space
 
Accreditation Statement
This activity has been planned and implemented in accordance with the accreditation requirement and policies of the Accreditation Council for Continuing Medical Education (ACCME) though the joint providership of the Urgent Care Association and the College of Urgent Care Medicine. UCA is accredited by the ACCME to provide continuing medical education for physicians.
 
CME Credit Instructions 
Once you have read the article, please log into your UCA profile. Once you are logged in go to Learn-> CME->Request CME. Complete the survey with the requested information for Urgent Caring. Your certificate will then be emailed to you within 3-5 business days. Please email education@ucaoa.org with questions.
 
CUCM CME Planning Committee
Jasmeet Bhogal, MD, MBA
Reports no financial interest relevant to this newsletter
Tracey Davidoff, MD, FCUCM
Reports no financial interest relevant to this newsletter
Sean M. McNeeley, MD, FCUCM
Reports no financial interest relevant to this newsletter
Joseph Toscano, MD
Reports no financial interest relevant to this newsletter
 
Authors
Jasmeet Bhogal, MD
Reports no financial interest relevant to this newsletter
Tracey Davidoff, MD, FCUCM
Reports no financial interest relevant to this newsletter
Cesar Mora Jaramillo, MD
Reports no financial interest relevant to this newsletter
Sean M. McNeeley, MD, FCUCM
Reports no financial interest relevant to this newsletter
 
Disclaimer
Medical practice and knowledge is constantly evolving and changing. This information is peer-reviewed but should not be your only source. Providers of care should use discretion when applying knowledge to any individual patient.

 

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