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June 2007 Volume 1, Number 8 jucmcov_0607ideas:final 5/21/07 3:50 PM Page 1 ™ JUNE 2007 VOLUME 1, NUMBER 8 THE JOURNAL OF URGENT CARE MEDICINE® www.jucm.com | The Official Publication of the Urgent Care Association of America IN THIS ISSUE FEATURES 11 Management of Patients Presenting with Symptoms of Vulvovaginitis 19 Bouncebacks: The Case of an 18-Year-Old Male with Hand Pain 30 UCAOA Benchmarking Survey: Addressing the Data Drought DEPARTMENTS 23 Abstracts in Urgent Care 25 Insights in Images: Clinical Challenge 33 Coding Q & A 34 Health Law 35 Occupational Medicine 40 Developing Data PUBLICATION BRAVEHEART A ciprodex:Layout 1 5/17/07 12:30 PM Page 1 HOW CAN YOU MISS? Achieve Proven Otitis Externa Cures with the #1 Otic Drop Among ENTs and Pediatricians.1,2 Based on 2 clinical trials, CIPRODEX® Otic demonstrated clinical cures in 87% and 94% of per protocol evaluable acute otitis externa (AOE) patients. And, among culture positive patients, clinical cures were 86% and 92% per protocol for CIPRODEX® Otic.1 Licensed to Alcon, Inc. by Bayer HealthCare AG. CIPRODEX is a registered trademark of Bayer AG, licensed to Alcon, Inc. by Bayer AG. Please see adjacent page for prescribing information. ©2007 Alcon, Inc. 5/07 CDX07505JA CIPRODEX® Otic is indicated in patients 6 months and older for acute otitis externa due to Staphylococcus aureus and Pseudomonas aeruginosa. CIPRODEX® Otic is contraindicated in patients with a history of hypersensitivity to ciprofl oxacin, to other quinolones, or to any of the components in this medication. Use of this product is contraindicated in viral infections of the external canal including herpes simplex infections. CIPRODEX® Otic should be discontinued at the fi rst appearance of a skin rash or any other sign of hypersensitivity. Serious and occasionally fatal hypersensitivity (anaphylactic) reactions, some following the fi rst dose, have been reported in patients receiving systemic quinolones. Serious acute hypersensitivity reactions may require immediate emergency treatment. If the infection is not improved after one week of treatment, cultures should be obtained to guide further treatment. Most commonly reported adverse reactions in clinical trials in AOE patients: pruritus (1.5%), ear debris (0.6%), superimposed ear infection (0.6%), ear congestion (0.4%), ear pain (0.4%) and erythema (0.4%). ciprodex:Layout 1 5/17/07 12:35 PM Page 2 CareNow&HouseAd:Layout 2 5/21/07 3:31 PM Page 1 Every article that has appeared in JUCM, The Journal of Urgent Care Medicine is available on our website. Simply log on to www.jucm.com and click on the Past Issue Archive button to see every issue we’ve published. THE JOURNAL OF URGENT CARE MEDICINE resnick_0607:Layout 1 5/22/07 10:34 AM Page 3 LETTER FROM THE EDITOR-IN-CHIEF UCAOA: A Vision for the Future he UCAOA National Conference, held • Invest in research to study outcomes, best practices, last month in Daytona Beach, FL, was an customer service initiatives and risk management tools. important milestone in the organizational Ⅲ Member Recruitment Tevolution of UCAOA: The elections con- • Realize the power of numbers—the more people we ducted at the meeting marked the second represent, the louder our voice. rotation of board seats since our founding in Ⅲ Original Research 2004, and the first board election of a new president. • Encourage original research in the field. This is critical It is critical to the success of our organization to have a rotat- to identifying urgent care as legitimate in the house of ing leadership at the board and officer levels. Our bylaws guar- medicine. antee this to ensure that we adhere to the principles of a mem- Ⅲ JUCM ber voting organization with strictly democratic governance. • Drive submissions from within the urgent care commu- As the new president, I want to express sincere thanks to Bill nity. Please submit. We can help; contact me at Meadows, MD for his visionary leadership during our first three [email protected]. years. Additional gratitude should be extended to all of our Ⅲ Organizational Management founding board members. • Continue to build a reliable and accountable corporate There is, of course, no time to celebrate our past achievements, and management structure. as they simply represent a mandate for taking it to the next level. Ⅲ Association Leadership and Thought Leader Recruitment Success breeds expectations of even greater future success. • Groom the next association leaders. Looking ahead, I would like to outline what I see as the strate- • Augment our internal leadership through the counsel gic vision of UCAOA for the next three years: of thought leaders in specialty development, healthcare Ⅲ Training services research, etc. • Target resident recruitment/program expansion. • Continue to refine core competencies. Putting the You in UCAOA • Establish training program accreditation. Without the involvement of every one of our members, we will • Develop nurse practitioner and physician assistant not succeed. The critical initiatives presented here form the back- programs. bone that supports the success we have had and hope to Ⅲ Continuing Education achieve. If you’ve read this far, that means you! • Establish new programs for developing competencies If you would like to get involved with these efforts but are in key areas, both clinical and practice management. unsure where to begin, e-mail me ([email protected]) or our Ⅲ Convention executive director, Lou Ellen Horwitz ([email protected]); • Build on tremendous past success with new, value- we can help. added benefits for new and experienced practitioners, owners and operators. • Expand clinical content. Ⅲ Benchmarking • Augment and formalize benchmarking efforts to pres- ent the most authoritative and relevant data in our in- dustry; significant investment will be made to this end. Ⅲ Accreditation Lee A. Resnick, MD • Work toward creating a powerful and universally ac- Editor-in-Chief cepted tool for identifying industry standards. JUCM, The Journal of Urgent Care Medicine Ⅲ Quality Assurance President, UCAOA www.jucm.com JUCM The Journal of Urgent Care Medicine | June 2007 3 Ad_FullPage_Sized 3/21/07 3:35 PM Page 1 4(% 2)'(4 4//, &/2 4(% */" 34)8 IS THE ONLY %-2 FOR 5RGENT #ARE AND /CCUPATIONAL -EDICINE &ASTER%ASIER #OMPREHENSIVE 1Ã}ÊÌ iÊ ,É*À>VÌViÊ >>}iiÌÊÃvÌÜ>ÀiÊ`iÃ}i`Ê Ã«iVwV>ÞÊvÀÊÞÕÀÊÌÞ«iÊvÊ«À>VÌViÊ >iÃÊ>ÊÌ iÊ`vviÀiVi° / iÊ-/8Ê«>V>}iÊVÕ`iÃÊ>ÊÌ iÊ Ã«iV>ÊvÕVÌÃÊÞÕÊii`ÊvÀÊÞÕÊ >`ÊÞÕÀÊÃÌ>vvÊÌÊ«iÀ>ÌiÊ>ÌÊ«i>Ê «iÀvÀ>ViÊ>`Ê«ÀwÌ>LÌÞ°Ê-Ì«Ê ÌÀÞ}ÊÌÊwÌÊ>ÊÀÕ`Ê«i}ÊÊ>ÊõÕ>ÀiÊ iÊ>`Ê}iÌÊÌ iÊÃvÌÜ>ÀiÊLÕÌÊÌÊ }iÌÊÌ iÊLÊ`i° >Ênää{xnÓ{nÈÊÀÊi>Ê Ã>iÃJÌi}ÀÌ>ðVÊvÀ ÞÕÀÊvÀiiÊ«À`ÕVÌÊ`iÃÌÀ>Ì° ÜÜÜ°Ìi}ÀÌ>ðVÊ TOC_0607:Layout 1 5/21/07 3:21 PM Page 5 The Official Publication of the Urgent Care Association of America June 2007 VOLUME 1, NUMBER 8 CLINICAL 11 Management of Patients Presenting with Symptoms of Vulvovaginitis Approximately 10 million office visits are attributed to vulvovaginitis annually in the U.S. Are you prepared to evaluate and treat appropriately? By James Tiongson, MD, Samuel Keim, MD, and Peter Rosen, MD BOUNCEBACKS 9 From the Executive 19 The Case of an 18-Year-Old Male Director with Hand Pain DEPARTMENTS Not all diagnoses are obvious at first glance. What was missed in 23 Abstracts in Urgent Care the initial examination and treatment of this patient with an injury of suspicious origin? 25 Insights in Images: Clinical Challenges By Michael B. Weinstock, MD and Ryan Longstreth, MD, FACEP 33 Coding Q & A INDUSTRY NEWS 34 Health Law 35 Occupational Medicine Addressing the Data Drought 30 40 Developing Data The first UCAOA Benchmarking Survey confirmed that urgent care practitioners are hungry for data on how and what their colleagues are doing. The second report of the Benchmarking Committee moves one step closer to filling that void. By J. Dale Key www.jucm.com JUCM The Journal of Urgent Care Medicine | June 2007 5 TOC_0607:Layout 1 5/21/07 3:21 PM Page 6 JUCM EDITOR-IN-CHIEF Lee A. Resnick, MD Case Western Reserve University Department of Family Medicine EDITOR-IN-CHIEF University Hospitals Medical Practices Lee A. Resnick, MD [email protected] JUCM EDITORIAL BOARD EDITOR Tanise Edwards, MD, FAAEM Genevieve M. Messick, MD J. Harris Fleming, Jr. Author/editor (Urgent Care Medicine) Immediate Health Associates [email protected] Nahum Kovalski, BSc, MDCM Marc R. Salzberg, MD, FACEP CONTRIBUTING EDITORS Terem Immediate Medical Care Stat Health Immediate Medical Care, PC Nahum Kovalski, BSc, MDCM Peter Lamelas, MD, MBA, FAAEP John Shershow, MD Frank Leone, MBA, MPH MD Now Urgent Care Walk-In Urgent Care Association of America John Shufeldt, MD, JD, MBA, FACEP Medical Centers John Shufeldt, MD, JD, MBA, FACEP David Stern, MD, CPC Melvin Lee, MD NextCare, Inc. ART DIRECTOR Baptist Minor Medical Clinics; Mark D. Wright, MD Tom DePrenda Metro Memphis Physicians Group The University of Arizona [email protected] Elizabeth A. Lindberg, MD The University of Arizona JUCM ADVISORY BOARD Michelle H. Biros, MD, MS Peter Rosen, MD 2 Split Rock Road, Mahwah NJ 07430 University of Minnesota; Harvard Medical School Editor-in-Chief, Academic Emergency David Rosenberg, MD, MPH PUBLISHERS Medicine University Hospitals Medical Practices Peter Murphy Kenneth V. Iserson, MD, MBA, FACEP, Case Western Reserve University [email protected] FAAEM School of Medicine (201) 847-1934 The University of Arizona Martin A. Samuels, MD, DSc (hon), Daniel R. Konow, PA-C, MBA FAAN, MACP Stuart Williams RediMed Harvard Medical School [email protected] Steven Lelyveld, MD, FACEP, FAAP Kurt C. Stange, MD, PhD (201) 529-4004 University of Chicago Pritzker School Case Western Reserve University Mission Statement of Medicine Robin M. Weinick, PhD JUCM The Journal of Urgent Care Medicine supports Benson S. Munger, PhD Harvard Medical School The University of Arizona the evolution of urgent care medicine by creat- ing content that addresses both the clinical prac- tice of urgent care medicine and the practice UCAOA BOARD OF DIRECTORS management challenges of keeping pace with an Lee A.
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