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Urgent Care Focused Guideline Highlights
The following are highlights of guidelines from other groups reviewed by Urgent Care physicians. Our intent is to assure these highlights represent the actual intent of these articles and how they relates to the practice of urgent care medicine. These highlights are not intended to substitute for independent medical judgement nor are they intended to establish a standard of care. CUCM recommends at minimum reading those portions of these articles that relate to the scope of care you provide..
INCREASE RISK OF HEMATOLOGIC MALIGNANT NEOPLASMS ASSOCIATED TO ABDOMINAL CT USE IN PEDIATRIC PATIENTS
A new study published in JAMA Surgery on January 20 found that the use of abdominal CT scan for suspected acute appendicitis can increase risk of hematologic neoplasm in children under age 16. This finding emphasizes the need for clinicians to be judicious of radiation when ordering imaging within the pediatric population.
Full Article: JAMA
CHARACTERISTICS AND OUTCOMES OF US CHILDREN AND ADOLESCENTS WITH MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN (MIS-C) COMPARED WITH SEVERE ACUTE COVID-19
On February 24th 2021, JAMA published an article on MIS-C that analyzed case series of 1116 patient age younger than 21 years of age. The study findings showed that patients with MIS-C were more likely to be 6-112 years old, (40.8%) non-Hispanic black, (32.3%) and have severe cardiovascular or mucocutaneous involvement and more extreme inflammation. Patients with MIS-C had higher neutrophil to lymphocyte ratio (median, 6.4 vs 2.7, P < .001), higher C-reactive protein level (median, 152 mg/L; P < .001), and lower platelet count (<150 ×103 cells/μ, P < .001]).
Full Access: JAMA
SOME WITH LONG COVID SEE RELIEF AFTER VACCINATION
Patients who are living with a condition that’s been known as long COVID and that was recently termed postacute sequelae of SARS-CoV-2 infection (PASC) might have symptoms improvement after receiving COVID-19 vaccine. Some of these patients report that they’ve finally seen their symptoms resolve, giving hope that long COVID might not be a lifelong condition. Survivor Corps, which has a public Facebook group with 159,000 members, recently took a poll to see whether there was any substance to rumors that those with long COVID were feeling better after being vaccinated. Out of 400 people, 36% showed an improvement in symptoms, anywhere between a mild improvement to complete resolution of symptoms
One possibility is that the virus continues to stimulate the immune system, which continues to fight the virus for months. If that is the case, the vaccine may be giving the immune system the boost it needs to finally clear the virus away.
Full Access: MDedge
Week of 3/26
INAPPROPRIATE MAGNETIC RESONANCE IMAGING IS ASSOCIATED WITH NEGATIVE OUTCOMES
Clinicians often order MRI for acute uncomplicated nonspecific lower back pain. In a large retrospective cohort study of > 400,000 Electronic Medical Records were reviewed. Findings showed that MRI in early clinical course was associated with potential harm due to excess surgery and opioid use. This study was shared by NEJM Journal on January 12.
Full Article: Journal of General Internal Medicine
INTERIM GUIDANCE FOR COVID-19 VACCINATION IN CHILDREN AND ADOLESCENT
On February 2nd, 2021 The American Association of Pediatrics published Interim Guidance for SARS-Covid-2 vaccination. The AAP recommends that anyone 16 years of age and older who meets criteria in phased implementation groups, as recommended by the ACIP, receive the COVID-19 vaccine. The CDC, through the ACIP, has identified priority groups for phased vaccination. States and communities continue to develop and to modify vaccine distribution based on this guidance, reflecting unique community situations
Full Access: AAP
FIRST PILL FOR COVID-19 COULD BE READY BY YEAR'S END
New pills to treat patients with COVID-19 are currently in mid-stage clinical trials and, if successful, could be ready by the end of the year. Early trial results were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) 2021 Annual Meeting, as reported by Medscape Medical News. Interim phase 2 results for the oral experimental COVID-19 drug molnupiravir showed that after 5 days of treatment, no participants had detectable virus, whereas 24% who received placebo did. Two other oral agents are being developed by RedHill Biopharma: one for severe COVID-19 infection for hospitalized patients, and one for patients at home with mild infection
Full Access: Medscape
SHORT-COURSE ANTIMICROBIAL THERAPY FOR PEDIATRIC COMMUNITY-ACQUIRED PNEUMONIA. THE SAFER RANDOMIZED CLINICAL TRIAL
The SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) study was a 2-center, parallel-group, noninferiority randomized clinical trial. In this blinded randomized clinical trial, children treated with short-course antibiotic therapy had comparable rates of clinical cure at 14 to 21 days after enrollment compared with standard care (85.7% vs 84.1%). Clinical cure was observed in 101 of 114 children (88.6%) in the intervention group and in 99 of 109 (90.8%) in the control group in per-protocol analysis (risk difference, −0.016; 97.5% confidence limit, −0.087). This study suggests that short-course therapy for pediatric community-acquired pneumonia not requiring hospitalization offers more benefit than harm and should be considered for inclusion in treatment guidelines
Full Access: JAMA
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