HERE ARE SOME CHANGES THAT OCCURRED IN CLINICAL MEDICINE THROUGH THE YEAR 2016
–Intranasal Flu vaccine (live attenuated virus) no longer recommended for prevention of influenza.
–For patients who are asymptomatic and present with hypertensive urgency, BPs of systolic >180, diastolic >110, there is no proven benefit of rapid reduction of BP. As usual, hypertensive emergency is evaluated on a different level in the ER setting. In a large study conducted by Janke, et.al., it was found the incidence of actual hypertensive emergency ( with evidence of end organ damage) was 2:1000 of adult ED visits overall. This is important information for Urgent Care Providers as we can start a patient comfortably on medication for hypertension after performing a thorough exam to rule out most end organ damage.
Janke, A. T., McNaughton, C. D., Brody, A. M., Welch, R. D., & Levy, P. D. (2016). Trends in the Incidence of Hypertensive Emergencies in US Emergency Departments From 2006 to 2013. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 5(12), e004511.
–Due to high rates of MRSA, it is now recommended that if a patient presents with a skin abscess of >2 cm or equal, antibiotics AND incision and drainage are recommended. The chosen antibiotic should have adequate coverage of MRSA.
–Intranasal glucocorticoids may be safe in pregnancy, with the exception of triamcinolone. We can now feel more comfortable using intranasal glucocorticoids for pregnant patient who are suffering from allergic rhinitis symptoms.
–Fluoroquinolones are no longer first line for urinary tract infections, acute sinusitis or acute bronchitis states the FDA. The risks of this drug outweighs the benefits and alternatives should be tried first.
-If a patient presents with more than one month of concussion symptoms, a team approach is suggested for best outcomes.
Ellis, M. J., Leddy, J., & Willer, B. (2016). Multi-Disciplinary Management of Athletes with Post-Concussion Syndrome: An Evolving Pathophysiological Approach. Frontiers in Neurology, 7, 136.
–Gonorrhea and Chlamydia reached an all-time peak in 2015 according to the CDC. Recommendation = condoms, condoms, condoms.
–The Epi-pen cost skyrocketed while patients and providers were furious. Luckily, CVS pharmacy came out with a competitor, Adrenaclick ® a fraction of the cost.
–Another study shows us that cranberry doesn’t make a significant difference for prevention in patients with urinary tract infections. The study reiterates what has been found previously in looking at UTIs and cranberry.