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EDITOR'S CORNER: WHY WE DO IT

SEAN MCNEELEY, MD, FCUCM

Welcome to our second updated version of Urgent Caring

As we fight through this second wave of the coronavirus pandemic, we need something to focus on to help us stay on track and get up each morning. For me it’s not complicated. Every year we have had a flu season and I find I need to focus on why we see patients to help me survive the long days and fatigue brought on by increased volumes and patient anxiety. I do it because medicine is the one field where we make a difference in the most important aspect of our lives. Without our health we don’t have much left. We forget this often as we are busy with life but once illness strikes, we are painfully aware of it. What we do is important to our patients and their families. We must never forget that as every new patient is another opportunity and we cannot let a single one down.

Contact Dr. McNeeley at sean.mcneeley@uhhospitals.org

Are You Vaccinated Against COVID-19? A Tough Conversation

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

Talking to patients and our staff regarding the importance of vaccination and addressing their concerns and fears has never been more important than the current times. Yet, it is somehow one of the toughest conversations to have today. With the amount of misinformation and incorrect messaging that is currently being circulated, it is no wonder that only 54.1% of our population has been fully vaccinated as of August 13, 2021 (CDC data). Our clinicians are having a tough time having these conversations and often, our emotions are getting the best of us and making us say and do things that can derail our ultimate efforts of getting more people vaccinated.

BEST PRACTICES

The Tetanus Vaccination in Urgent Care

Subject: Tetanus Immunization in Urgent Care Practice
 
Patient Population: Adolescents and adults
 
Introduction: C. tetani spores are found in dirt worldwide. They
may enter the body through wounds where the
spores germinate. The bacteria produce toxins which
disseminate through the body entering the nervous
system. These toxins block neurotransmitters leading
to unopposed muscle contractions and spasms. Seizures may also occur. Those at risk are patients who have either never received a tetanus vaccine series or did not stay up to date with the recommended 10-year booster shots. Improper wound care also increases the risk. As morbidity and mortality from this disease is high, prevention with vaccination is highly recommended.

 


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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